Active NPI
Mallory Sullivan, DO
- Family Medicine Physician
- Waterville, NY
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 274601
- Practice address
- 117 W Main St
Suite 1
Waterville, NY 13480-1165 - Phone
- (315) 841-4178
- Fax
- (315) 841-4338
- NPI assigned
- May 20, 2011
- Last updated
- Mar 20, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 274601 | NY | Primary |
Addresses
Primary practice location
117 W Main St
Suite 1
Waterville, NY 13480-1165
Mailing address
117 W Main St
Suite 1
Waterville, NY 13480-1165
Phone (315) 841-4178
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- New York College of Osteo Medicine of New York Institute of Technology, 2011
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
358 Madison St
Waterville, NY 13480-1116
Phone (315) 841-4973
Hospital & facility affiliations
- Vna Utica and Oneida Co Chha
- Acacia Certified Home Care Co
- Wynn Hospital
- Community Memorial Hospital, Inc
- Ascension Sacred Heart Bay
Merit-based Incentive Payment System (MIPS)
- Final score
- 85.28 of 100
- Quality
- 75.06
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 69.26
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of skin lesions | 1-10 |
| Removal of nail tissue | 1-10 |
| Removal or shaving of skin growth | 1-10 |
| Skin biopsy | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| MVHS Inc | Current | Accepting new patients | |
| MVHS Inc | Family Medicine | Current | Accepting new patients |
Locations
1656 Champlin Ave
New Hartford, NY 13413
Phone (315) 624-6222
120 Hobart St
Utica, NY 13501
Phone (315) 798-1149
1676 Sunset Ave
Utica, NY 13502
Phone (315) 624-5567
2209 Genesee St
Utica, NY 13501
Phone (315) 798-8100
117 W Main St
#1
Waterville, NY 13480
Phone (315) 841-4178
117 W Main St
#2
Waterville, NY 13480
Phone (315) 841-4184
358 Madison St
Waterville, NY 13480
Phone (315) 841-3222
Interoperability endpoints
- msullivan11990@mvhealthsystem.direct-ci.com
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
Hospital & facility affiliations 6
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Critical Access Hospital
- Hamilton, NY
- NPI 1992707608
-
dba Acacia Certified Home Care Company
- Home Health Agency
- Utica, NY
- NPI 1558327833
-
- Home Health Agency
- Utica, NY
- NPI 1134104573
-
dba Ascension Sacred Heart Bay
- General Acute Care Hospital
- Panama City, FL
- NPI 1720078041
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1305849600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1489968000000",
"number": "1124311360",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "117 W MAIN ST",
"address_2": "SUITE 1",
"city": "WATERVILLE",
"state": "NY",
"postal_code": "134801165",
"telephone_number": "315-841-4178",
"fax_number": "315-841-4338"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "117 W MAIN ST",
"address_2": "SUITE 1",
"city": "WATERVILLE",
"state": "NY",
"postal_code": "134801165",
"telephone_number": "315-841-4178",
"fax_number": "315-841-4338"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "MALLORY",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-05-20",
"last_updated": "2017-03-20",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "NY",
"license": "274601",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waterville, NY
- Adam Joseph Ryan, DPT
- Nicole R Schreck-Mathias, NP
- Natalie Anne Slobodian, PHARMD
- Dawn Marie Slye, LMSW
- Karen Alison Spencer, OTR/L
- The American People Services, Inc
- David Joseph Trombetta, NP
- View Point Clinical Therapy Services, LCSW,PLLC
- Waterville Area Volunteer Ambulance Corp Inc.
- Waterville Central School
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.