NPIMap

Individual provider Active NPI

Gunwant S Mallik, MD

  • Neurological Surgery Physician
  • Powell, OH
National Provider Identifier
1376527663
Registry record updated Jul 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
License
35070094 Issued in OH
Practice address
25 Hidden Ravines Dr
Powell, OH 43065-9883
Phone
(614) 942-0132
Fax
(614) 942-0139
NPI assigned
Dec 1, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 24, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery Physician 207T00000X 35070094 OH Primary

Addresses

Primary practice location

25 Hidden Ravines Dr
Powell, OH 43065-9883

Mailing address

10169 Wellington Blvd
Powell, OH 43065-7671
Phone (614) 942-0132

Other identifiers 7

IdentifierTypeStateIssuer
208005968OtherOHAETNA
000000518235OtherOHBLUE CROSS/BLUE SHIELD
208005968OtherOHTRICARE NORTH REGION
208005968026OtherOHCARESOURCE
208005968OtherOHUNITED HEALTHCARE
0225723MedicaidOH
208005968OtherOHCIGNA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address gmallik15440@direct.ohiohealth.com OhioHealth Physician Group, Inc.

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070607000349 OH Practitioner - Neurosurgery 5294639514 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Neurosurgery
Education
Indiana University School of Medicine, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Genesis Medical Group, LLCGroup PAC ID 7719040385, 265 clinicians

Practice addresses (Care Compare)

25 Hidden Ravines Dr
Powell, OH 43065-9883
Phone (614) 832-7144

955 Bethesda Dr
Zanesville, OH 43701-1873
Phone (740) 450-6147

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Spinal fusion61
Laminectomy or laminotomy (partial removal of spine bones)1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35070094OHMDNeurological Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Premier Health Specialists Inc CurrentSince Jul 9, 2015 Accepting new patients
Ohiohealth Corporation CurrentSince May 2, 2024 Accepting new patients
Ohiohealth Corporation Neurological Surgery CurrentSince May 2, 2024 Accepting new patients
Premier Health Specialists Inc Current Accepting new patients
Premier Health Specialists Inc CurrentSince Jul 9, 2015 Accepting new patients
Neurological Associates, Inc Neurological Surgery Past Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients
Orthopedic Trauma Services LTD Past Accepting new patients

Locations

393 E Town St
Ste 116
Columbus, OH 43215
Phone (614) 566-9108

Dept L3652
Columbus, OH 43260

285 E State St
Ste 430
Columbus, OH 43215
Phone (614) 566-9777

931 Chatham Ln
Columbus, OH 43221
Phone (614) 451-3643

30 E Apple St
Ste 5254A
Dayton, OH 45409

335 Glessner Ave
Mansfield, OH 44903
Phone (419) 522-0320

335 Glessner Ave
Fl MOB2
Mansfield, OH 44903
Phone (567) 241-7037

450 N Hyatt St
Ste 304
Tipp City, OH 45371
Phone (937) 832-4773

Interoperability endpoints

  • Direct secure messaging: gmallik941968@direct.hfhs.org

Organizations & group practices 10

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 9

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": "1133395200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721779200000",
    "number": "1376527663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10169 WELLINGTON BLVD",
            "city": "POWELL",
            "state": "OH",
            "postal_code": "430657671",
            "telephone_number": "614-942-0132",
            "fax_number": "614-942-0139"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 HIDDEN RAVINES DR",
            "city": "POWELL",
            "state": "OH",
            "postal_code": "430659883",
            "telephone_number": "614-942-0132",
            "fax_number": "614-942-0139"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALLIK",
        "first_name": "GUNWANT",
        "middle_name": "S",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-12-01",
        "last_updated": "2024-07-24",
        "certification_date": "2024-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "OH",
            "license": "35070094",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "208005968",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "000000518235",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE NORTH REGION",
            "identifier": "208005968",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CARESOURCE",
            "identifier": "208005968026",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "208005968",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0225723",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "208005968",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "gmallik15440@direct.ohiohealth.com",
            "affiliation": "Y",
            "affiliationName": "OhioHealth Physician Group, Inc.",
            "address_1": "335 Glessner Ave Fl Mob2",
            "city": "Mansfield",
            "state": "OH",
            "country_code": "US",
            "postal_code": "449032269",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Powell, OH

Sources for this page

Verify at the official NPI Registry.