Active NPI
Mallory Zupke, PA-C
- Physician Assistant
- Fairlawn, OH
National Provider Identifier
1316560196
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- Practice address
- 3634 W Market St Ste 104
Fairlawn, OH 44333-4539 - Phone
- (558) 829-8315
- NPI assigned
- May 27, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | OH | Primary |
Addresses
Primary practice location
3634 W Market St Ste 104
Fairlawn, OH 44333-4539
Mailing address
3634 W Market St Ste 104
Fairlawn, OH 44333-4539
Phone (558) 829-8315
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Apr 1, 2025 through Apr 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1590537600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1739318400000",
"number": "1316560196",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3634 W MARKET ST STE 104",
"city": "FAIRLAWN",
"state": "OH",
"postal_code": "443334539",
"telephone_number": "558-829-8315"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3634 W MARKET ST STE 104",
"city": "FAIRLAWN",
"state": "OH",
"postal_code": "443334539",
"telephone_number": "558-829-8315"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ZUPKE",
"first_name": "MALLORY",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-05-27",
"last_updated": "2025-02-12",
"certification_date": "2025-02-12",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "OH",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairlawn, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.