Gregory V Mallis, PSY.D

Primary specialty

PsychologistTaxonomy code 103T00000X

License

6301015440 Issued in MI

Practice address

1870 Leonard St SE
Grand Rapids, MI 49505-5650

Phone

(616) 956-1122

Fax

(616) 956-8033

NPI assigned

Jun 7, 2013

Sex

Male

Sole proprietor

No

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

Enrolled in MI

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Pine Rest Christian Mental Health ServicesGroup PAC ID 4981506508, 354 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Pine Rest Christian Mental Health Services

  • Psychologist
  • Grand Rapids, MI
  • NPI 1780695411
  Medicare reassignment Care Compare group NPD
• Pine Rest Christian Mental Health Services

  • Professional Counselor
  • Grand Rapids, MI
  • NPI 1386015683
  NPD

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

{
    "created_epoch": "1370563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1370563200000",
    "number": "1780022194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1870 LEONARD STREET SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495055650",
            "telephone_number": "616-956-1122",
            "fax_number": "616-956-8033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1870 LEONARD ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495055650",
            "telephone_number": "616-956-1122",
            "fax_number": "616-956-8033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALLIS",
        "first_name": "GREGORY",
        "middle_name": "V",
        "credential": "PSY.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-06-07",
        "last_updated": "2013-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MI",
            "license": "6301015440",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James Malleis, MD
• Robert Mallen, MD
• Logan Mallery
• Lauren Mallett
• Emily Reynolds Malling, M.D.
• Lauren Mallory, PT, DPT
• Mark David Malnor, MD
• Madeline Irene Maloley
• Kathryn Woods Malone, LMSW
• Rachel Marie Malone

• Psychologist in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2013; 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.