Mallory C Edwards, PA-C
Individual provider Active NPI Physician Assistant · Granville, NY
NPI 1467876409 · NPPES record last updated Apr 22, 2024
Key facts
- NPI
- 1467876409
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 017372 (NY)
- Practice address
- 79 North St
Granville, NY 12832-1137 - Phone
- (518) 642-0612
- NPI assigned
- Feb 11, 2014
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 23
Hospital & facility affiliations 6
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2013
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Kaleida Health
Practice addresses (Care Compare)
100 High St
Buffalo, NY 14203-1126
Phone (716) 859-5600
1540 Maple Rd
Williamsville, NY 14221-3647
Phone (716) 568-3600
445 Tremont St
North Tonawanda, NY 14120-6150
Phone (716) 694-4500
Hospital & facility affiliations
- Kaleida Health
Merit-based Incentive Payment System (MIPS)
- Final score
- 99.06 of 100
- Quality
- 87.72
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 75.82
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NY, NM
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140418000543 | NY | Practitioner - Physician Assistant | 2961634282 | Reassigns benefits to 8 organizations |
| I20240102003081 | NM | Practitioner - Physician Assistant | 2961634282 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Eastern Great Lakes Pathology PC | Current | Accepting new patients | |
| Mercy Hospital of Buffalo | Current |
Accepting new patients | |
| Kaleida Health | Current |
Accepting new patients | |
| University at Buffalo Pathologists, Inc | Current | Accepting new patients | |
| Eastern Niagara Medical Group | Current |
Accepting new patients | |
| Mercy Hospital of Buffalo | Current |
Accepting new patients | |
| Sisters of Charity Hospital of Buffalo, New York | Current | Accepting new patients | |
| Sisters of Charity Hospital of Buffalo New York | Current |
Accepting new patients | |
| Kaleida Health | Current |
Accepting new patients |
Locations
565 Abbott Rd
Buffalo, NY 14220
Phone (716) 826-7000
565 Abbott Rd
Rm 8632
Buffalo, NY 14220
Phone (607) 798-5671
Elm and Carlton St
Buffalo, NY 14263
144 Genesee St
Fl 3
Buffalo, NY 14203
Phone (716) 601-3690
2157 Main St
#H
Buffalo, NY 14214
Phone (716) 862-1501
4949 Harlem Rd
Buffalo, NY 14226
Phone (716) 204-3201
100 High St
Buffalo, NY 14203
Phone (716) 632-3700
100 High St
#13282
Buffalo, NY 14203
521 East Ave
Lockport, NY 14094
Phone (716) 434-9111
908 Niagara Falls Blvd
Ste 208
North Tonawanda, NY 14120
Phone (716) 649-1613
445 Tremont St
North Tonawanda, NY 14120
Phone (716) 690-2291
1540 Maple Rd
Williamsville, NY 14221
Phone (716) 568-3514
Interoperability endpoints
- mallory.edwards.1@24694.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 017372 | NY | Yes |
Addresses
Primary practice location
79 North St
Granville, NY 12832-1137
Mailing address
79 North St
Granville, NY 12832-1137
Other practice location 1
17875 Von Karman Ave Ste 150&250
Irvine, CA 92614-6200
Phone (855) 433-1680
Other providers in Granville, NY
- Michelle Karen Daigle
- W Marvin Day
- Laurie Ann Dennison
- Grace Nichole Deyoung
- Donna P Johnson Physical Therapy PC
- Claudia H Ellis
- Alyssa Evans
- Family Dentistry PC
- Fortitude Physical Therapy, PLLC
- Freds Pharmacy LLC
All providers in Granville, NY · Physician Assistant in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 22, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.