Individual provider Active NPI

Andrew Sean Mallon, DO

  • Otolaryngology Physician
  • Clearwater, FL
National Provider Identifier
1255569570
Registry record updated Jul 2, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
OS12619 Issued in FL
Practice address
1330 S Fort Harrison Ave
Clearwater, FL 33756-3313
Phone
(727) 216-0700
Fax
(727) 216-0704
NPI assigned
Jun 25, 2009
Last updated
Jul 2, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X OS12619 FL Primary

Addresses

Primary practice location

1330 S Fort Harrison Ave
Clearwater, FL 33756-3313

Mailing address

2515 Countryside Blvd Ste E
Clearwater, FL 33763-1603
Phone (727) 216-0700

Other identifiers 2

IdentifierTypeStateIssuer
OS12619OtherFLSTATE OF FLORIDA MEDICAL LICENSE
010925000MedicaidFL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140721002124 FL Practitioner - Otolaryngology 3779709100 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
West Coast Ear, Nose and Throat, IncGroup PAC ID 0941260103, 23 clinicians
Sports and Orthopedic Rehabilitation Services IncGroup PAC ID 0840104253, shared by 4 NPIs, 314 clinicians

Practice addresses (Care Compare)

1330 S Ft Harrison
Clearwater, FL 33756-3313
Phone (727) 441-3588

5347 Main St
Suite 202
New Port Richey, FL 34652-2520
Phone (727) 841-0515

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
OT013216PAMDOtolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
West Coast Ear, Nose & Throat Inc Otolaryngology CurrentSince Aug 1, 2014 Accepting new patients
Audiology Distribution, LLC PastSince Aug 1, 2014 Accepting new patients

Locations

1330 S Fort Harrison Ave
Clearwater, FL 33756
Phone (727) 216-0700

3190 N McMullen Booth Rd
Ste 100
Clearwater, FL 33761
Phone (727) 424-0971

646 Virginia St
Fl 3
Dunedin, FL 34698
Phone (727) 441-3588

11031 US Highway 19
Ste 104
Port Richey, FL 34668
Phone (727) 791-1368

8787 Bryan Dairy Rd
Ste 170
Seminole, FL 33777
Phone (727) 397-8551

6540 4th St N
Ste C
St Petersburg, FL 33702
Phone (727) 466-7916

11304 State Road 54
Trinity, FL 34655
Phone (727) 247-1234

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Interoperability endpoints

  • FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.441.1528

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.

NPI Registry JSON

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

{
    "created_epoch": "1245888000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782950400000",
    "number": "1255569570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2515 COUNTRYSIDE BLVD STE E",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337631603",
            "telephone_number": "727-216-0700",
            "fax_number": "727-216-0704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1330 S FORT HARRISON AVE",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337563313",
            "telephone_number": "727-216-0700",
            "fax_number": "727-216-0704"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALLON",
        "first_name": "ANDREW",
        "middle_name": "SEAN",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-25",
        "last_updated": "2026-07-02",
        "certification_date": "2026-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "FL",
            "license": "OS12619",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF FLORIDA MEDICAL LICENSE",
            "identifier": "OS12619",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010925000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clearwater, FL

Sources for this page

Verify at the official NPI Registry.