Individual provider Active NPI

Mallory Cohen, MD

  • Pediatric Gastroenterology Physician
  • Loma Linda, CA
National Provider Identifier
1306263587
Registry record updated Sep 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Gastroenterology PhysicianTaxonomy code 2080P0206X
License
A166894 Issued in CA
Practice address
11175 Campus St
CP- A1120
Loma Linda, CA 92350-1700
Phone
(909) 558-4773
NPI assigned
Mar 25, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Gastroenterology Physician 2080P0206X A166894 CA Primary

Addresses

Primary practice location

11175 Campus St
CP- A1120
Loma Linda, CA 92350-1700

Mailing address

11175 Campus St
CP- A1120
Loma Linda, CA 92350-1700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20200629001758 CA Practitioner - GastroenterologyPractitioner - Pediatric Medicine 7911200522 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
GastroenterologyAlso: Pediatric Medicine
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Faculty Physicians and Surgeons of LlusmGroup PAC ID 1153227814, 1,313 clinicians

Practice addresses (Care Compare)

25845 Barton Rd
Suite F
Loma Linda, CA 92354-3899
Phone (909) 558-2828

Merit-based Incentive Payment System (MIPS)

Final score
88.87 of 100Reported as group
Quality
72.13
Promoting interoperability
80
Improvement activities
40
Cost
77.36

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A166894CAMDPediatric Gastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Faculty Physicians and Surgeons of Llusm Current Accepting new patients
Faculty Physicians and Surgeons of Llusm CurrentSince Jul 1, 2020 Accepting new patients
Physicians' Hospital of Murrieta, LLC Past Accepting new patients
Loma Linda University Children'S Hospital Past Accepting new patients
Faculty Physicians and Surgeons of Llusm Past Accepting new patients
Loma Linda University Medical Center Past Accepting new patients
Riverside Healthcare System, L.P. Past Accepting new patients
Unsom Multi-Spec GRP Pract S Past Accepting new patients

Locations

File Number 54701
Los Angeles, CA 90074
Phone (909) 651-4300

26780 Barton Rd
Redlands, CA 92373
Phone (909) 558-5174

Interoperability endpoints

  • Direct secure messaging: mcohen308616@direct.llu.edu

Organizations & group practices 8

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": "1395705600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632960000000",
    "number": "1306263587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11175 CAMPUS ST",
            "address_2": "CP- A1120",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923501700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11175 CAMPUS ST",
            "address_2": "CP- A1120",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923501700",
            "telephone_number": "909-558-4773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COHEN",
        "first_name": "MALLORY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-03-25",
        "last_updated": "2021-09-30",
        "certification_date": "2021-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "CA",
            "license": "A166894",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Loma Linda, CA

Sources for this page

Verify at the official NPI Registry.