Individual provider Active NPI

Mallory Mariya Ragan Royall, FNP

  • Family Nurse Practitioner
  • Concord, NC
National Provider Identifier
1336692607
Registry record updated Jul 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
5008788 Issued in NC
Practice address
200 Medical Park Dr
Ste 430
Concord, NC 28025-2982
Phone
(704) 403-7070
NPI assigned
Aug 3, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 5008788 NC
Family Nurse Practitioner 363LF0000X 5008788 NC Primary

Addresses

Primary practice location

200 Medical Park Dr
Ste 430
Concord, NC 28025-2982

Mailing address

PO Box 19305
Charlotte, NC 28219-9305

Other practice location 1

8800 N Tryon St
Charlotte, NC 28262-3300
Phone (704) 863-6241

Other practice location 2

1000 Blythe Blvd
Charlotte, NC 28203-5812
Phone (704) 355-0720

Other practice location 3

2001 Vail Ave
Charlotte, NC 28207-1248
Phone (704) 304-6070

Other practice location 4

10628 Park Rd
Charlotte, NC 28210-8407
Phone (704) 667-7070

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address mroyall537171@CarolinasHealthcareSystem.direct-ci.com Atrium Health
CONNECT URL https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other ABILITY Network

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20160919002229 NC Practitioner - Nurse Practitioner 4486941481 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Carolinas Physicians Network IncGroup PAC ID 3375449655, shared by 56 NPIs, 2,324 clinicians

Practice addresses (Care Compare)

8800 N Tryon St
Charlotte, NC 28262-3300
Phone (704) 863-6000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94 of 100Reported as apm
Quality
81.63
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
5008788NCMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Scotland Regional Health Network CurrentSince Sep 4, 2016 Accepting new patients
Carolinas Physicians Network Inc Current Accepting new patients
Columbus Regional Health Network CurrentSince Sep 4, 2016 Accepting new patients
Carolinas Physicians Network Inc CurrentSince Sep 4, 2016 Accepting new patients
Scotland Regional Health Network CurrentSince Sep 4, 2016 Accepting new patients
Carolinas Physicians Network Inc CurrentSince Sep 19, 2016 Accepting new patients
Carolinas Physicians Network Inc CurrentSince Sep 4, 2016 Accepting new patients
Scotland Regional Health Network Current Accepting new patients
Columbus Regional Health Network CurrentSince Sep 4, 2016 Accepting new patients
Carolinas Physicians Network Inc Current Accepting new patients
Columbus Regional Health Network Past Accepting new patients
Carolinas Physicians Network, Inc Past Accepting new patients

Locations

100 N 6th St
Ste 900A
Minneapolis, MN 55403

1000 Blythe Blvd
Charlotte, NC 28203
Phone (704) 351-3791

14214 Ballantyne Lake Rd
Ste 300
Charlotte, NC 28277
Phone (704) 446-5070

2001 Vail Ave
Charlotte, NC 28207
Phone (704) 304-5000

10628 Park Rd
Charlotte, NC 28210
Phone (704) 543-2000

14214 Ballantyne Lake Rd
Ste 100
Charlotte, NC 28277
Phone (704) 667-2650

101 Hospital Dr
Columbus, NC 28722
Phone (828) 894-3311

920 Copperfield Blvd NE
Concord, NC 28025
Phone (980) 258-8657

200 Medical Park Dr
Ste 430
Concord, NC 28025
Phone (704) 403-5890

500 Lauchwood Dr
Laurinburg, NC 28352
Phone (856) 848-3227

612 Jefferson St
#28
Whiteville, NC 28472
Phone (910) 640-4064

500 Jefferson St
Whiteville, NC 28472
Phone (910) 642-1776

Interoperability endpoints

  • Direct secure messaging: mroyall537171@carolinashealthcaresystem.direct-ci.com

Organizations & group practices 12

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.

Hospital & facility affiliations 2

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": "1470182400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721001600000",
    "number": "1336692607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19305",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282199305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 MEDICAL PARK DR",
            "address_2": "STE 430",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280252982",
            "telephone_number": "704-403-7070"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8800 N Tryon St",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282623300",
            "country_code": "US",
            "telephone_number": "704-863-6241",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1000 Blythe Blvd",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282035812",
            "country_code": "US",
            "telephone_number": "704-355-0720",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2001 Vail Ave",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282071248",
            "country_code": "US",
            "telephone_number": "704-304-6070",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10628 Park Rd",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282108407",
            "country_code": "US",
            "telephone_number": "704-667-7070",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROYALL",
        "first_name": "MALLORY",
        "middle_name": "MARIYA RAGAN",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-03",
        "last_updated": "2024-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "5008788",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "5008788",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mroyall537171@CarolinasHealthcareSystem.direct-ci.com",
            "affiliation": "Y",
            "affiliationName": "Atrium Health",
            "address_1": "200 Medical Park Dr",
            "address_2": "Ste 430",
            "city": "Concord",
            "state": "NC",
            "country_code": "US",
            "postal_code": "280252982",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "ABILITY Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "100 N 6th St Ste 900A",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554031516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Concord, NC

Sources for this page

Verify at the official NPI Registry.