Mallory Elizabeth Cusumano, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

2018004643 Issued in MO

Practice address

224 S Woods Mill Rd Ste 330S
Chesterfield, MO 63017-3497

Phone

(143) 576-7013

Fax

(314) 576-4047

NPI assigned

Jan 4, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other names 1

• Mallory Elizabeth Bates Former name

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Physical Therapy Spine and Sports Medicine LLCGroup PAC ID 3173654936, 123 clinicians

Rehabclinics Pta IncGroup PAC ID 0547237497, shared by 11 NPIs, 209 clinicians

St Lukes Orthopedics Woods Mill LLCGroup PAC ID 4284872144, 13 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Lukes Hospital Hospital, Chesterfield, MO, CCN 260179
• SSM Health Rehabilitation Hospital Inpatient rehabilitation facility, Richmond Heights, MO, CCN 263031

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• St. Lukes Orthopedics Woods Mill, LLC

  • Orthopaedic Surgery Physician
  • Chesterfield, MO
  • NPI 1699014928
  Medicare reassignment Care Compare group NPD
• Mercy Clinic Trauma and General Surgery, LLC

  • Trauma Surgery Physician
  • Saint Louis, MO
  • NPI 1699825695
  Medicare reassignment NPD
• Physical Therapy Spine & Sports Medicine LLC

  • Rehabilitation Clinic/Center
  • Ballwin, MO
  • NPI 1942524087
  Care Compare group
• St. Lukes Medical Group

  • Family Medicine Physician
  • Chesterfield, MO
  • NPI 1215308945
  NPD (past)

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

• SSM Select Rehab St Louis LLC

  • Rehabilitation Hospital
  • Richmond Heights, MO
  • NPI 1659511988

  Inpatient rehabilitation facility

  Care Compare affiliation
• St. Lukes Episcopal-Presbyterian Hospital

  • General Acute Care Hospital
  • Chesterfield, MO
  • NPI 1346251543
  Care Compare affiliation

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

{
    "created_epoch": "1515024000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747699200000",
    "number": "1740797398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 BAKER AVE",
            "city": "WEBSTER GROVES",
            "state": "MO",
            "postal_code": "631193735",
            "telephone_number": "636-236-5602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "224 S WOODS MILL RD STE 330S",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630173497",
            "telephone_number": "143-576-7013",
            "fax_number": "314-576-4047"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CUSUMANO",
        "first_name": "MALLORY",
        "middle_name": "ELIZABETH",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-01-04",
        "last_updated": "2025-05-20",
        "certification_date": "2025-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MO",
            "license": "2018004643",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MO",
            "license": "2018004643",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MALLORY",
            "last_name": "BATES",
            "middle_name": "ELIZABETH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Cunningham Vision Care Inc.
• Bradley Cunningham
• Edwin John Cunningham Jr., MD
• Thomas Joseph Cunningham, OD
• Elizabeth Ann Curtis, FNP-C
• Frances J Cutshall, PTA
• Timothy Joseph D'Agostino Sr., RPA
• MHD Daghostani, SURGICAL ASSISTANT
• John D Dahm, MD
• Timothy Joseph Dalaviras, LPC

• Nurse Practitioner in Chesterfield, MO
• Providers in Chesterfield, MO by specialty
• Nurse Practitioner in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2025; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.