Mallory K Bellissimo, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

10513 Issued in GA

Practice address

3617 Roswell Rd NE
Atlanta, GA 30305-1111

Phone

(404) 996-0196

Fax

(404) 467-2489

NPI assigned

Sep 28, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Mallory K Meehan Former name

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: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Virginia Mason Medical Center

  dba Virginia Mason Medical Center-Gim

  • Internal Medicine Physician
  • Seattle, WA
  • NPI 1194889071
  NPD
• Virginia Mason Medical Center

  dba St Joseph Medical Center

  • Interventional Cardiology Physician
  • Tacoma, WA
  • NPI 1821711953
  NPD

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

{
    "created_epoch": "1285632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699315200000",
    "number": "1255640074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "961 ADAIR AVE NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303063809",
            "telephone_number": "717-497-6851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3617 ROSWELL RD NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303051111",
            "telephone_number": "404-996-0196",
            "fax_number": "404-467-2489"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BELLISSIMO",
        "first_name": "MALLORY",
        "middle_name": "K",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-09-28",
        "last_updated": "2023-11-07",
        "certification_date": "2023-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "10513",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA60385985",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MALLORY",
            "last_name": "MEEHAN",
            "middle_name": "K",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Ernest Leon Bellefant Jr., NP
• Caelyn Thea Bellerose, M.D.
• Sonya Somika Belletti, LCSW
• Christina Bellin, PA-C
• James E Bellinger III, PA-C
• Stephanie Bellman, MD, PHD
• Hernan Bello Velez, M.D.
• Gisel Bello, MD
• Aditi Srikanth Bellur, OD
• Nikosazana Alaezi Belman, NP

• Physician Assistant in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2023; 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.

Verify at the official NPI Registry.