Active NPI
Jordan Mallery, MD
- Psychiatry Physician
- Madison, WI
National Provider Identifier
1356950752
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- REL100660-851
- Practice address
- 6001 Research Park Blvd
Madison, WI 53719-1176 - Phone
- (608) 232-3171
- NPI assigned
- Jul 31, 2020
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | REL100660-851 | WI | Primary |
Addresses
Primary practice location
6001 Research Park Blvd
Madison, WI 53719-1176
Mailing address
6001 Research Park Blvd
Madison, WI 53719-1176
Phone (608) 232-3171
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| REL100660-851 | WI | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1596153600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1778544000000",
"number": "1356950752",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6001 RESEARCH PARK BLVD",
"city": "MADISON",
"state": "WI",
"postal_code": "537191176",
"telephone_number": "608-232-3171"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6001 RESEARCH PARK BLVD",
"city": "MADISON",
"state": "WI",
"postal_code": "537191176",
"telephone_number": "608-232-3171"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MALLERY",
"first_name": "JORDAN",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-07-31",
"last_updated": "2026-05-12",
"certification_date": "2026-05-12",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "WI",
"license": "REL100660-851",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Madison, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2026; 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.