Mallory Bagwell, DO
Individual provider Active NPI Internal Medicine Physician · Conway, AR
NPI 1487399309 · NPPES record last updated Jul 28, 2026
Key facts
- NPI
- 1487399309
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- E18728 (AR)
- Practice address
- 1700 Altus St Ste 110
Conway, AR 72032-4299 - Phone
- (501) 852-1366
- Fax
- (501) 852-1367
- NPI assigned
- May 4, 2022
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Hospital & facility affiliations 6
Medicare Care Compare profile
- Specialty
- Internal Medicine
- Education
- New York College of Osteo Medicine of New York Institute of Technology, 2022
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Conway Regional Medical Center Inc
Practice addresses (Care Compare)
1700 Altus St
Suite 110
Conway, AR 72032-4299
Phone (501) 852-1366
2302 College Ave
Suite 100
Conway, AR 72034-6297
Phone (501) 513-5385
Hospital & facility affiliations
- Conway Regional Medical Center, Inc
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250730003715 | AR | Practitioner - Internal Medicine | 6608250402 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| E18728 | AR | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Conway Regional Medical Center Inc | Internal Medicine | Current |
Accepting new patients |
| Conway Regional Medical Center, Inc. | Current |
Accepting new patients | |
| Conway Regional Medical Center, Inc | Current |
Accepting new patients |
Locations
2302 College Ave
Ste 100
Conway, AR 72034
Phone (501) 513-5385
1700 Altus St
Ste 110
Conway, AR 72032
Phone (501) 852-1366
2302 College Ave
Conway, AR 72034
Phone (501) 329-3831
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | E18728 | AR | Yes |
Addresses
Primary practice location
1700 Altus St Ste 110
Conway, AR 72032-4299
Mailing address
PO Box 9662
Conway, AR 72033-9662
Phone (501) 852-1363
Other practice location 1
2302 College Ave Ste 100
Conway, AR 72034-6297
Phone (501) 513-5385
Other providers in Conway, AR
- Jessica Aytes
- B a Scroggins, Inc.
- B. Brooks Lawrence, M.D., P.a.
- Haley Loren Bachusz
- Annette Bacon
- Allison Bailey
- Jamie Bailey
- Payton Bailey
- Sydney Laine Bailey
- Baker Ambulatory Surgery Center
All providers in Conway, AR · Internal Medicine Physician in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 28, 2026. 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.