NPIMap

Individual provider Active NPI

Mallorie Leigh Willis, APRN, CNM

  • Advanced Practice Midwife
  • Louisville, KY
National Provider Identifier
1720830102
Registry record updated Jun 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Advanced Practice MidwifeTaxonomy code 367A00000X
License
CNM9215 Issued in KY
Practice address
4123 Dutchmans LN Ste 507
Louisville, KY 40207-4730
Phone
(502) 423-9595
Fax
(502) 719-0161
NPI assigned
Apr 1, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Advanced Practice Midwife 367A00000X CNM9215 KY Primary

Addresses

Primary practice location

4123 Dutchmans LN Ste 507
Louisville, KY 40207-4730

Mailing address

PO Box 776351
Chicago, IL 60677-6351

Other practice location 1

1455 Webb Ln
Bedford, KY 40006-8746
Phone (502) 663-1873

Other names 1

  • Mallorie Leigh Dean Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
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
I20240802003020 KY Practitioner - Certified Nurse Midwife (CNM) 3577000991 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Nurse Midwife (CNM)
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Community Medical Associates IncGroup PAC ID 7012811284, 1,368 clinicians

Practice addresses (Care Compare)

4123 Dutchmans LN
Suite 507
Louisville, KY 40207-4730
Phone (502) 259-3250

Hospital & facility affiliations

  • Norton Hospitals, Inc Hospital, Louisville, KY, CCN 180088

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Midwife

State licenses

LicenseStateTypeSpecialty
CNM9215KYMDAdvanced Practice Midwife

Practice roles

OrganizationSpecialtyStatusNew patients
Community Medical Associates, Inc. Current Accepting new patients
Community Medical Associates, Inc. CurrentSince Aug 1, 2024 Accepting new patients
Community Medical Associates, Inc. CurrentSince Aug 1, 2024 Accepting new patients
Norton Hospitals, Inc Past Accepting new patients

Locations

825 Barret Ave
Louisville, KY 40204
Phone (502) 272-5165

4123 Dutchmans Ln
Ste 507
Louisville, KY 40207
Phone (502) 259-3250

4123 Dutchmans Ln
Ste 601
Louisville, KY 40207
Phone (502) 423-9595

200 E Chestnut St
Louisville, KY 40202
Phone (502) 446-8000

Interoperability endpoints

  • Direct secure messaging: mwillis294694@direct.nortonhealthcare.org

Organizations & group practices 4

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 14

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1711929600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719446400000",
    "number": "1720830102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 776351",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606776351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4123 DUTCHMANS LN STE 507",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402074730",
            "telephone_number": "502-423-9595",
            "fax_number": "502-719-0161"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1455 Webb Ln",
            "address_purpose": "LOCATION",
            "city": "Bedford",
            "state": "KY",
            "postal_code": "400068746",
            "country_code": "US",
            "telephone_number": "502-663-1873",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "MALLORIE",
        "middle_name": "LEIGH",
        "name_prefix": "Mrs.",
        "credential": "APRN, CNM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-04-01",
        "last_updated": "2024-06-27",
        "certification_date": "2024-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "KY",
            "license": "CNM9215",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MALLORIE",
            "last_name": "DEAN",
            "middle_name": "LEIGH",
            "credential": "BSN, RN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.