NPIMap

Individual provider Active NPI

Grant W Mallory, MD

  • Neurological Surgery Physician
  • Eau Claire, WI
National Provider Identifier
1568690477
Registry record updated Jun 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
License
81713 Issued in WI
Practice address
1400 Bellinger St
Eau Claire, WI 54703-5222
Phone
(715) 838-5222
NPI assigned
Jun 30, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery Physician 207T00000X 100503 WI
Neurological Surgery Physician 207T00000X 53091 MN
Neurological Surgery Physician 207T00000X 81713 WI Primary

Addresses

Primary practice location

1400 Bellinger St
Eau Claire, WI 54703-5222

Mailing address

PO Box 860912
Minneapolis, MN 55486-0912
Phone (715) 838-5222

Other practice location 1

3551 Roger Brooke Dr
Fort Sam Houston, TX 78234-4504
Phone (210) 916-3482

Other practice location 2

200 1st St SW
Rochester, MN 55905-0002
Phone (303) 803-6953

Other identifiers 2

IdentifierTypeStateIssuer
ENROLLEDMedicaidMN
ENROLLEDMedicaidIA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address gmallory1964217@ehrdirect.mayoclinicmsg.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, WI2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20180427001227 TX Practitioner - Neurosurgery 4284829565 Reassigns benefits to 3 organizations
I20230328000204 WI Practitioner - Neurosurgery 4284829565 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Neurosurgery
Education
Georgetown University School of Medicine, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1400 Bellinger St
Eau Claire, WI 54703-5222
Phone (715) 838-5222

700 W Ave S
La Crosse, WI 54601-4783
Phone (608) 785-0940

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Spinal fusion58
Laminectomy or laminotomy (partial removal of spine bones)36

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
100503WIMDNeurological Surgery Physician
81713WIMDNeurological Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mayo Clinic Health System-Northwest Wisconsin Region, Inc. Current Accepting new patients
Acute Care Surgical Affiliates of Texas PA CurrentSince Aug 1, 2023 Accepting new patients
Neurosurgical Associates of San Antonio, P.a. Neurological Surgery CurrentSince Aug 10, 2022 Accepting new patients
Mayo Clinic Health System-Southwest Wisconsin Region, Inc. CurrentSince Jun 3, 2025 Accepting new patients
Mayo Clinic Health System-Southwest Wisconsin Region, Inc. Current Accepting new patients
Mayo Clinic Health System-Northwest Wisconsin Region, Inc. CurrentSince Mar 13, 2023 Accepting new patients
Neurosurgical Affiliates of Texas, PA Neurological Surgery CurrentSince Dec 4, 2023 Accepting new patients
Neurosurgical Associates of San Antonio, P.a. Neurological Surgery CurrentSince Aug 10, 2022 Accepting new patients
Mayo Clinic Health System-Northwest Wisconsin Region, Inc. CurrentSince Mar 13, 2023 Accepting new patients
Mayo Clinic Health System-Northwest Wisconsin Region, Inc. Past Accepting new patients

Locations

200 1st St SW
Rochester, MN 55905
Phone (507) 266-4850

600 Elizabeth St
Corpus Christi, TX 78404
Phone (361) 325-2511

613 Elizabeth St
Ste 200
Corpus Christi, TX 78404
Phone (361) 434-0966

4410 Medical Dr
Ste 610
San Antonio, TX 78229
Phone (210) 477-5733

733 W Clairemont Ave
Eau Claire, WI 54701
Phone (715) 838-3806

1400 Bellinger St
Eau Claire, WI 54703
Phone (715) 838-3311

700 West Ave S
La Crosse, WI 54601
Phone (608) 791-4156

800 E Blackhawk Ave
Prairie du Chien, WI 53821
Phone (608) 326-0808

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 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": "1246320000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748908800000",
    "number": "1568690477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 860912",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554860912",
            "telephone_number": "715-838-5222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 BELLINGER ST",
            "city": "EAU CLAIRE",
            "state": "WI",
            "postal_code": "547035222",
            "telephone_number": "715-838-5222"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3551 Roger Brooke Dr",
            "address_purpose": "LOCATION",
            "city": "Fort Sam Houston",
            "state": "TX",
            "postal_code": "782344504",
            "country_code": "US",
            "telephone_number": "210-916-3482",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "200 1st St SW",
            "address_purpose": "LOCATION",
            "city": "Rochester",
            "state": "MN",
            "postal_code": "559050002",
            "country_code": "US",
            "telephone_number": "303-803-6953",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MALLORY",
        "first_name": "GRANT",
        "middle_name": "W",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-30",
        "last_updated": "2025-06-03",
        "certification_date": "2025-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "WI",
            "license": "100503",
            "primary": false
        },
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "MN",
            "license": "53091",
            "primary": false
        },
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "WI",
            "license": "81713",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ENROLLED",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ENROLLED",
            "state": "IA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "gmallory1964217@ehrdirect.mayoclinicmsg.org",
            "affiliation": "N",
            "address_1": "1400 Bellinger St",
            "city": "Eau Claire",
            "state": "WI",
            "country_code": "US",
            "postal_code": "547035222",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Eau Claire, WI

Sources for this page

Verify at the official NPI Registry.