NPIMap

Individual provider Active NPI

Matthew Layne Mallory, M.D.

  • Radiation Oncology Physician
  • Fayetteville, AR
National Provider Identifier
1194145532
Registry record updated Aug 10, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiation Oncology PhysicianTaxonomy code 2085R0001X
License
E-14474 Issued in AR
Practice address
60 E Monte Painter Dr
Fayetteville, AR 72703-4014
Phone
(479) 587-1700
Fax
(479) 587-1366
NPI assigned
Apr 24, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Radiation Oncology Physician 2085R0001X 0442072 KS
Student in an Organized Health Care Education/Training Program 390200000X
Radiation Oncology Physician 2085R0001X 2019024443 MO
Radiation Oncology Physician 2085R0001X E-14474 AR Primary

Addresses

Primary practice location

60 E Monte Painter Dr
Fayetteville, AR 72703-4014

Mailing address

222 E Dunbar LN Apt 326
Fayetteville, AR 72703-3276
Phone (434) 258-4408

Other practice location 1

808 S 52nd St
Rogers, AR 72758-8602
Phone (479) 587-1700

Other practice location 2

3901 Rainbow Blvd
Ms 4033
Kansas City, KS 66160-8500
Phone (913) 588-3600

Other practice location 3

2750 Clay Edwards Dr Lowr Level
North Kansas City, MO 64116-3237
Phone (816) 691-5216

Other practice location 4

902 N Riverside Rd Ste 201
Saint Joseph, MO 64507-2566
Phone (816) 271-7280

Other identifiers 2

IdentifierTypeStateIssuer
200993230AMedicaidOK
269386001MedicaidAR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191112002474 MO Practitioner - Radiation Oncology 1153546080 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Radiation Oncology
Education
University of Virginia School of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Meritas Health CorporationGroup PAC ID 6305748153, 492 clinicians

Practice addresses (Care Compare)

1600 N 2ND St
Clinton, MO 64735-1192
Phone (660) 885-5511

1602 N 2ND St
Clinton, MO 64735-1192

2750 Clay Edwards Dr
Lowr Level
North Kansas City, MO 64116-3237
Phone (816) 691-2280

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Golden Valley Memorial Hospital District Current Accepting new patients
Golden Valley Memorial Hospital District CurrentSince Dec 1, 2023 Accepting new patients
Golden Valley Memorial Hospital District CurrentSince Dec 1, 2023 Accepting new patients
Meritas Health Corporation Radiation Oncology CurrentSince Dec 6, 2024 Accepting new patients
Meritas Health Corporation Current Accepting new patients
Meritas Health Corporation CurrentSince Dec 6, 2024 Accepting new patients
Meritas Health Corporation Past Accepting new patients
Golden Valley Memorial Hospital District Past Accepting new patients
Meritas Health Corporation Past Accepting new patients

Locations

1600 N 2nd St
Clinton, MO 64735
Phone (660) 885-8171

9151 NE 81st Ter
Ste 220
Kansas City, MO 64158
Phone (816) 453-4000

2750 Clay Edwards Dr
Lowr
North Kansas City, MO 64116
Phone (816) 691-2880

Organizations & group practices 9

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 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1398297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1786320000000",
    "number": "1194145532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222 E DUNBAR LN APT 326",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727033276",
            "telephone_number": "434-258-4408",
            "fax_number": "479-587-1366"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 E MONTE PAINTER DR",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727034014",
            "telephone_number": "479-587-1700",
            "fax_number": "479-587-1366"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "808 S 52nd St",
            "address_purpose": "LOCATION",
            "city": "Rogers",
            "state": "AR",
            "postal_code": "727588602",
            "country_code": "US",
            "telephone_number": "479-587-1700",
            "fax_number": "479-587-1366",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3901 Rainbow Blvd",
            "address_2": "MS 4033",
            "address_purpose": "LOCATION",
            "city": "Kansas City",
            "state": "KS",
            "postal_code": "661608500",
            "country_code": "US",
            "telephone_number": "913-588-3600",
            "fax_number": "913-588-3663",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2750 Clay Edwards Dr Lowr Level",
            "address_purpose": "LOCATION",
            "city": "North Kansas City",
            "state": "MO",
            "postal_code": "641163237",
            "country_code": "US",
            "telephone_number": "816-691-5216",
            "fax_number": "816-346-7869",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "902 N Riverside Rd Ste 201",
            "address_purpose": "LOCATION",
            "city": "Saint Joseph",
            "state": "MO",
            "postal_code": "645072566",
            "country_code": "US",
            "telephone_number": "816-271-7280",
            "fax_number": "816-271-7044",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MALLORY",
        "first_name": "MATTHEW",
        "middle_name": "LAYNE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-04-24",
        "last_updated": "2026-08-10",
        "certification_date": "2026-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "KS",
            "license": "0442072",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "MO",
            "license": "2019024443",
            "primary": false
        },
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "AR",
            "license": "E-14474",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200993230A",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "269386001",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, AR

Sources for this page

Verify at the official NPI Registry.