Mallory Marie Berg, FNP-C

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

209.016365 Issued in IL

Practice address

8100 W 119TH St
Palos Park, IL 60464-3041

Phone

(708) 361-3300

NPI assigned

Sep 11, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

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.

• Southwest Pediatrics, LTD.

  • Pediatrics Physician
  • Palos Park, IL
  • NPI 1427094416

  Single Specialty

  NPD (past)

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

{
    "created_epoch": "1505088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1720507767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10129 BUELL CT",
            "city": "OAK LAWN",
            "state": "IL",
            "postal_code": "604533802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8100 W 119TH ST",
            "city": "PALOS PARK",
            "state": "IL",
            "postal_code": "604643041",
            "telephone_number": "708-361-3300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9400 Bormet Dr",
            "address_purpose": "LOCATION",
            "city": "Mokena",
            "state": "IL",
            "postal_code": "604488371",
            "country_code": "US",
            "telephone_number": "708-479-7337",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BERG",
        "first_name": "MALLORY",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "FNP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-09-11",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "209.016365",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Zainah Azar, PA-C
• B M Khan DO PC
• Linda G Baer, PSYD
• Brian Edwin Bailey, D.M.D.
• Jonathan L. Belgrad, M.D.
• Roy C Bliley, M.D.
• Bridget Ann Boam
• Emilee Anne Caldwell
• Bienvenido Camacho
• Noel Camba, M.D.

• Pediatrics Physician in Palos Park, IL
• Providers in Palos Park, IL by specialty
• Pediatrics Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.