NPIMap

Individual provider Active NPI

Mallory Bagwell, DO

  • Internal Medicine Physician
  • Conway, AR
National Provider Identifier
1487399309
Registry record updated Jul 28, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
E18728 Issued in 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
Last updated
Jul 28, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X E18728 AR Primary

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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
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
I20250730003715 AR Practitioner - Internal Medicine 6608250402 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
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 IncGroup PAC ID 3173428414, shared by 26 NPIs, 129 clinicians

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

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
E18728ARMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Conway Regional Medical Center Inc Internal Medicine CurrentSince Aug 1, 2025 Accepting new patients
Conway Regional Medical Center, Inc. CurrentSince Aug 1, 2025 Accepting new patients
Conway Regional Medical Center, Inc CurrentSince Jan 1, 2026 Accepting new patients

Locations

1700 Altus St
Ste 110
Conway, AR 72032
Phone (501) 852-1366

2302 College Ave
Conway, AR 72034
Phone (501) 329-3831

2302 College Ave
Ste 100
Conway, AR 72034
Phone (501) 513-5385

Organizations & group practices 3

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.

Hospital & facility affiliations 6

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": "1651622400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785196800000",
    "number": "1487399309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9662",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720339662",
            "telephone_number": "501-852-1363",
            "fax_number": "501-852-1363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 ALTUS ST STE 110",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720324299",
            "telephone_number": "501-852-1366",
            "fax_number": "501-852-1367"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2302 College Ave Ste 100",
            "address_purpose": "LOCATION",
            "city": "Conway",
            "state": "AR",
            "postal_code": "720346297",
            "country_code": "US",
            "telephone_number": "501-513-5385",
            "fax_number": "501-513-5257",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BAGWELL",
        "first_name": "MALLORY",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-05-04",
        "last_updated": "2026-07-28",
        "certification_date": "2026-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AR",
            "license": "E18728",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Conway, AR

Sources for this page

Verify at the official NPI Registry.