Active NPI
Robert Scott Malloy, N.P.
- Registered Nurse
- West Bloomfield, MI
National Provider Identifier
1134493935
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 4704169038
- Practice address
- 5790 Cherrywood
#1703
West Bloomfield, MI 48322-4518 - Phone
- (248) 977-0811
- NPI assigned
- Feb 27, 2012
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 4704169038 | MI | Primary |
Addresses
Primary practice location
5790 Cherrywood
#1703
West Bloomfield, MI 48322-4518
Mailing address
5790 Cherrywood
#1703
West Bloomfield, MI 48322-4518
Phone (248) 977-0811
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120824000615 | CA | Order and Referring Only - Nurse Practitioner | 7618124744 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4704169038 | MI | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1330300800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1330300800000",
"number": "1134493935",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5790 CHERRYWOOD",
"address_2": "#1703",
"city": "WEST BLOOMFIELD",
"state": "MI",
"postal_code": "483224518",
"telephone_number": "248-977-0811"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5790 CHERRYWOOD",
"address_2": "#1703",
"city": "WEST BLOOMFIELD",
"state": "MI",
"postal_code": "483224518",
"telephone_number": "248-977-0811"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MALLOY",
"first_name": "ROBERT",
"middle_name": "SCOTT",
"name_prefix": "Mr.",
"credential": "N.P.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-02-27",
"last_updated": "2012-02-27",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "MI",
"license": "4704169038",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Bloomfield, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2012; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.