Mallory Fillmore, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA174128 Issued in OR

Practice address

3680 NW Samaritan Dr
Corvallis, OR 97330-3737

Phone

(541) 754-1150

NPI assigned

Nov 28, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

The Corvallis Clinic P CGroup PAC ID 1456244540, 128 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

93.65 of 100Reported as group

Quality

86.8

Promoting interoperability

100

Improvement activities

40

Cost

86.36

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mallory.fillmore.1@14349.direct.athenahealth.com
• FHIR API: https://api.platform.athenahealth.com/14349/brand/4/csg/42/fhir/r4

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.

• The Corvallis Clinic P C

  • Multi-Specialty Clinic/Center
  • Corvallis, OR
  • NPI 1649227265
  Medicare reassignment Care Compare group NPD
• Corvallis Gastroenterology PC

  • Specialist
  • Corvallis, OR
  • NPI 1124075627
  Medicare reassignment

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

{
    "created_epoch": "1354060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735516800000",
    "number": "1215272505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "444 NW ELKS DR",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973303745",
            "telephone_number": "541-754-1150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3680 NW SAMARITAN DR",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973303737",
            "telephone_number": "541-754-1150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FILLMORE",
        "first_name": "MALLORY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-11-28",
        "last_updated": "2024-12-30",
        "certification_date": "2024-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA174128",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500695157",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stephanie Nichole Fields
• Miki Fifita
• Robin Lee Fifita
• Elizabeth Figa, D.O.
• Krystal Ann Fillmore
• M. Elizabeth Finch
• Kelly Lynore Rosenthal Fink, PMHNP-BC, FNP-C
• Brian M Finley, LMT
• Kathryn C Finley
• David Finnigan, M.D.

• Physician Assistant in Corvallis, OR
• Providers in Corvallis, OR by specialty
• Physician Assistant in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2024; 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.

Verify at the official NPI Registry.