Susan L Mallory, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

G78212 Issued in CA

Practice address

6480 Pentz Rd
Suite E
Paradise, CA 95969-3672

Phone

(530) 877-5437

Fax

(530) 877-5692

NPI assigned

Jul 18, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: smallory46650@enloedirect.org
• Direct secure messaging: susan.mallory.1@10649.direct.athenahealth.com

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.

• Paradise Medical Group, Inc.

  • Family Medicine Physician
  • Paradise, CA
  • NPI 1235111006

  Pediatrics

  NPD (past)

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

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1304899200000",
    "number": "1730107400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6470 PENTZ RD",
            "address_2": "SUITE A",
            "city": "PARADISE",
            "state": "CA",
            "postal_code": "959693674",
            "telephone_number": "530-872-6650",
            "fax_number": "530-872-6653"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6480 PENTZ RD",
            "address_2": "SUITE E",
            "city": "PARADISE",
            "state": "CA",
            "postal_code": "959693672",
            "telephone_number": "530-877-5437",
            "fax_number": "530-877-5692"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALLORY",
        "first_name": "SUSAN",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-18",
        "last_updated": "2011-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "G78212",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ01920Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kandida De la Cruz Madery, PHARM.D.
• Anne Elizabeth Magnuson, M.S., R.D.
• Barbra Quimpo Maguire, PMHNP
• Michael Eugene Maguire, PH.D
• Sirisha Mahankali, M.D.
• Latisha Lee Maniord
• Donald E Mansell, M.D.
• Maqui Holdings, LLC
• Allison Beth March
• Lorraine Marchant

• Pediatrics Physician in Paradise, CA
• Providers in Paradise, CA by specialty
• Pediatrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.