Mallory Noelle Luckey, M.D.
Individual provider Active NPI Neurology Physician · Banner Elk, NC
NPI 1770932170 · NPPES record last updated Apr 4, 2024
Key facts
- NPI
- 1770932170
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Neurology Physician 2084N0400X
- License
- 302609 (NY)
- Practice address
- 640 Puddingstone Pkwy
Banner Elk, NC 28604-7418 - Phone
- (864) 237-4021
- Fax
- (864) 778-8417
- NPI assigned
- Jun 7, 2016
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 21
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Neurology
- Education
- Other, 2016
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Physician Affiliate Group of New York PC
Icahn School of Medicine at Mount Sinai
Practice addresses (Care Compare)
234 E 149 St
Bronx, NY 10451-5504
Phone (718) 579-6101
2601 Ocean Pkwy
Brooklyn, NY 11235-7745
Phone (718) 616-5356
7901 Broadway
Elmhurst, NY 11373-1329
Phone (718) 334-4952
Hospital & facility affiliations
- Lincoln Medical & Mental Health Center
- Elmhurst Hospital Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (4 enrollments) in NY, SC, GA, NC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210126002565 | NY | Practitioner - Neurology | 4183902356 | Reassigns benefits to 8 organizations |
| I20221228000390 | SC | Practitioner - Neurology | 4183902356 | |
| I20230502000494 | GA | Practitioner - Neurology | 4183902356 | Reassigns benefits to 3 organizations |
| I20230907003641 | NC | Practitioner - Neurology | 4183902356 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LL39661 | SC | MD | Internal Medicine Physician |
| ME159060 | FL | MD | Neurology Physician |
| 302609 | NY | MD | Neurology Physician |
Practice roles (21 of 25)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St Charles Hospital Corp | Current |
Accepting new patients | |
| Mercy Medical Center | Internal Medicine | Current |
Accepting new patients |
| Lakeland Medical Practices | Internal Medicine | Current |
Accepting new patients |
| Piedmont Athens Hospitalist Physicians LLC | Internal Medicine | Current |
Accepting new patients |
| St. Joseph Hospital | Current |
Accepting new patients | |
| Mercy Medical Center | Internal Medicine | Current | Accepting new patients |
| Icahn School of Medicine at Mount Sinai | Current |
Accepting new patients | |
| Icahn School of Medicine at Mount Sinai | Current |
Accepting new patients | |
| Icahn School of Medicine at Mount Sinai | Current | Accepting new patients | |
| Upson County Hospital Inc | Current |
Accepting new patients | |
| St. Catherine of Siena Medical Center | Current |
Accepting new patients | |
| Good Samaritan Hospital Medical Center | Current | Accepting new patients | |
| Physician Affiliate Group of New York PC | Current |
Accepting new patients | |
| Piedmont Hospitalist Physicians LLC | Internal Medicine | Current |
Accepting new patients |
| Icahn School of Medicine at Mount Sinai | Neurology | Current |
Accepting new patients |
| Good Samaritan Hospital Medical | Current |
Accepting new patients | |
| Upson County Hospital Inc | Neurology | Current |
Accepting new patients |
| Lakeland Medical Practices | Internal Medicine | Current |
Accepting new patients |
| Piedmont Athens Specialty Care LLC | Past | Accepting new patients | |
| Hospital Authority of the City of Bainbridge and Decatur County | Past | Accepting new patients | |
| New York City Health and Hospitals Corporation | Internal Medicine | Past | Accepting new patients |
Locations
11215 Metro Pkwy
Ste 1
Fort Myers, FL 33966
Phone (239) 208-2206
1199 Prince Ave
Athens, GA 30606
Phone (706) 354-3520
1968 Ptree Rd NW
Atlanta, GA 30309
Phone (404) 605-2222
35 Collier Rd NW
Ste 635
Atlanta, GA 30309
Phone (404) 367-3000
801 W Gordon St
Thomaston, GA 30286
Phone (706) 647-4371
3950 Hollywood Rd
Ste 280
Saint Joseph, MI 49085
Phone (269) 408-0990
1234 Napier Ave
Saint Joseph, MI 49085
Phone (269) 982-4941
4295 Hempstead Tpke
Bethpage, NY 11714
Phone (516) 520-2250
2601 Ocean Pkwy
Brooklyn, NY 11235
Phone (718) 616-5354
7901 Broadway
Rm A119
Elmhurst, NY 11373
Phone (718) 334-3915
2510 30th Ave
Long Island City, NY 11102
Phone (718) 267-4245
506 Malcolm X Blvd
New York, NY 10037
Phone (212) 939-1000
200 Belle Terre Rd
Prt Jefferson, NY 11777
Phone (631) 474-6000
1000 N Village Ave
Rockville Ctr, NY 11570
Phone (516) 705-1012
50 Route 25A
Smithtown, NY 11787
Phone (631) 465-6225
1000 Montauk Hwy
West Islip, NY 11795
Phone (516) 705-2689
Networks
- Healthfirst Medicare Network H3359
- Healthfirst Medicare Network H9678
- Healthfirst Medicare Network H5989
- Healthfirst Medicare Network H1722
Interoperability endpoints
- mallory.luckey.1@5072.direct.athenahealth.com
- mroberts259678@nychhc.direct-ci.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | 2022-01271 | NC | |
| Neurology Physician | 2084N0400X | ME159060 | FL | |
| Neurology Physician | 2084N0400X | 2023006973 | MO | |
| Neurology Physician | 2084N0400X | MD214178 | OR | |
| Internal Medicine Physician | 207R00000X | LL39661 | SC | |
| Neurology Physician | 2084N0400X | 302609 | NY | Yes |
Addresses
Primary practice location
640 Puddingstone Pkwy
Banner Elk, NC 28604-7418
Mailing address
640 Puddingstone Pkwy
Banner Elk, NC 28604-7418
Phone (864) 237-4021
Other practice location 1
11215 Metro Pkwy Ste 1
Fort Myers, FL 33966-1206
Phone (239) 208-2212
Other practice location 2
2790 Clay Edwards Dr Ste 1235
North Kansas City, MO 64116-3276
Phone (816) 472-5157
Other providers in Banner Elk, NC
- Jonathan Bratter, DO Facog PA
- Robert Jones
- David Paul Kimmel
- Billy Joel King
- Stephanie Knowles
- Margaret Kirk Counseling, PLLC
- Bethany Daneil McCabe
- Riley McKay
- Georgia McLean
- John McManus
All providers in Banner Elk, NC · Neurology Physician in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 4, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.