Active NPI
Molly Zavala, M.D.
- Family Medicine Physician
- Rockford, IL
National Provider Identifier
1184060055
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 036.141151
- Practice address
- 1200 W State St
Rockford, IL 61102-2112 - Phone
- (815) 490-1600
- Fax
- (815) 490-1881
- NPI assigned
- May 17, 2013
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | 125-062930 | IL | |
| Family Medicine Physician | 207Q00000X | 036.141151 | IL | Primary |
Addresses
Primary practice location
1200 W State St
Rockford, IL 61102-2112
Mailing address
1200 W State St
Rockford, IL 61102-2112
Phone (815) 490-1600
Other practice location 1
632 Broadway Ph
New York, NY 10012-2614
Phone (800) 731-4254
Other names 1
- Molly Mennenga
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036.141151 | IL | MD | Family Medicine Physician |
| 125-062930 | IL | MD | Student in an Organized Health Care Education/Training Program |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Galileo Medical Group Ga, P.C. | Family Medicine | Current | Accepting new patients |
Locations
4300 Paces Ferry Rd SE
Ste 500
Atlanta, GA 30339
Phone (404) 496-8960
64 Bleecker St
New York, NY 10012
Phone (302) 313-1584
Networks
- Healthfirst Medicare Network H9678
- Healthfirst Medicare Network H3359
- Healthfirst Medicare Network H5989
- Healthfirst Medicare Network H1722
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1368748800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1741046400000",
"number": "1184060055",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1200 W STATE ST",
"city": "ROCKFORD",
"state": "IL",
"postal_code": "611022112",
"telephone_number": "815-490-1600",
"fax_number": "815-490-1881"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1200 W STATE ST",
"city": "ROCKFORD",
"state": "IL",
"postal_code": "611022112",
"telephone_number": "815-490-1600",
"fax_number": "815-490-1881"
}
],
"practiceLocations": [
{
"address_1": "632 Broadway Ph",
"address_purpose": "LOCATION",
"city": "New York",
"state": "NY",
"postal_code": "100122614",
"country_code": "US",
"telephone_number": "800-731-4254",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "ZAVALA",
"first_name": "MOLLY",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-05-17",
"last_updated": "2025-03-04",
"certification_date": "2025-03-04",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "IL",
"license": "125-062930",
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IL",
"license": "036.141151",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "MOLLY",
"last_name": "MENNENGA",
"credential": "M.D.",
"code": "1",
"type": "Former Name"
}
]
}
Other providers in Rockford, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2025; 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.