Individual provider Active NPI

Mallory Rose Holzer, PA

  • Physician Assistant
  • Chesterfield, MO
National Provider Identifier
1265399653
Registry record updated Mar 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2026005852 Issued in MO
Practice address
14532 S Outer 40 Rd
Dept Orthopaedic Surgery, Ste 200
Chesterfield, MO 63017-5705
Phone
(314) 514-3500
Fax
(314) 878-7678
NPI assigned
Jan 7, 2026
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 2026005852 MO Primary

Addresses

Primary practice location

14532 S Outer 40 Rd
Dept Orthopaedic Surgery, Ste 200
Chesterfield, MO 63017-5705

Mailing address

PO Box 7412011
Chicago, IL 60674-2011
Phone (314) 514-3500

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Washington University

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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

Enrollment IDStateProvider typePAC IDDetails
I20260306002603 MO Practitioner - Physician Assistant 9739661810 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Saint Louis University School of Medicine, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Washington UniversityGroup PAC ID 9830008770, 2,968 clinicians

Practice addresses (Care Compare)

14532 S Outer 40 Rd
Suite 200
Chesterfield, MO 63017-5784
Phone (314) 514-3500

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
2026005852MOMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Washington University CurrentSince Mar 2, 2026 Accepting new patients
Washington University CurrentSince Mar 2, 2026 Accepting new patients

Locations

14532 South Outer 40 Rd
Ste 200
Chesterfield, MO 63017

12634 Olive Blvd
Saint Louis, MO 63141
Phone (314) 434-0600

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1767744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773705600000",
    "number": "1265399653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7412011",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606742011",
            "telephone_number": "314-514-3500",
            "fax_number": "314-878-7678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14532 S OUTER 40 RD",
            "address_2": "DEPT ORTHOPAEDIC SURGERY, STE 200",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630175705",
            "telephone_number": "314-514-3500",
            "fax_number": "314-878-7678"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLZER",
        "first_name": "MALLORY",
        "middle_name": "ROSE",
        "name_prefix": "Ms.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2026-01-07",
        "last_updated": "2026-03-17",
        "certification_date": "2026-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MO",
            "license": "2026005852",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "Y",
            "affiliationName": "Washington University",
            "address_1": "14532 S Outer 40 Rd",
            "address_2": "Dept Orthopaedic Surgery, Ste 200",
            "city": "Chesterfield",
            "state": "MO",
            "country_code": "US",
            "postal_code": "630175705",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Chesterfield, MO

Sources for this page

Verify at the official NPI Registry.