Mallory M. Johansen

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA.0004112 Issued in CO

Practice address

501 E. Hampden Ave.
Englewood, CO 80113-2702

Phone

(303) 788-6911

Fax

(303) 306-7753

NPI assigned

Sep 19, 2014

Last updated

Jun 10, 2015By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Mallory Johansen Professional name

Medicare fee-for-service enrollment

Enrolled in CO

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

Specialty

Physician Assistant

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Carepoint Emergency Medicine, PLLCGroup PAC ID 7810291432, 160 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Carepoint Emergency Medicine, PLLC

  • Emergency Medicine Physician
  • Denver, CO
  • NPI 1134590318
  Medicare reassignment Care Compare group
• Carepoint P.C.

  • Emergency Medicine Physician
  • Denver, CO
  • NPI 1275516346
  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1411084800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1433894400000",
    "number": "1457753626",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 173862",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802173862",
            "telephone_number": "303-306-7783",
            "fax_number": "303-306-7753"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 E. HAMPDEN AVE.",
            "city": "ENGLEWOOD",
            "state": "CO",
            "postal_code": "801132702",
            "telephone_number": "303-788-6911",
            "fax_number": "303-306-7753"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHANSEN",
        "first_name": "MALLORY",
        "middle_name": "M.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-09-19",
        "last_updated": "2015-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "PA.0004112",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "96028343",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MALLORY",
            "last_name": "JOHANSEN",
            "credential": "PA",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Corey Jewell
• Danielle Rebecca Jewell, MS, LPC
• JJ's Optical
• Winston Joe
• Scott J Joggerst, DO
• Mark R Johansen, MD
• John C Moore MD PC
• John H. McVicker, MD
• Leena John
• Rebecca John, MD

• Physician Assistant in Englewood, CO
• Providers in Englewood, CO by specialty
• Physician Assistant in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2015; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.