Individual provider Active NPI

Craig Mallory, PA-C

  • Physician Assistant
  • Southfield, MI
National Provider Identifier
1801329628
Registry record updated Apr 8, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601008170 Issued in MI
Practice address
16001 W 9 Mile Rd
Southfield, MI 48075-4818
Phone
(248) 849-3137
NPI assigned
Apr 8, 2017
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 8, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 5601008170 MI Primary

Addresses

Primary practice location

16001 W 9 Mile Rd
Southfield, MI 48075-4818

Mailing address

PO Box 100
Royal Oak, MI 48068-0100
Phone (248) 849-3137

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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

Enrollment IDStateProvider typePAC IDDetails
I20170731002606 MI Practitioner - Physician Assistant 2264703859 Reassigns benefits to 15 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
First Choice Urgent Care PCGroup PAC ID 9739221912, 45 clinicians

Practice addresses (Care Compare)

23455 Michigan Ave
Dearborn, MI 48124-1908

2446 Elizabeth Lake Rd
Waterford, MI 48328-3310
Phone (248) 309-3344

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Henry Ford Health St. John Hospital CurrentSince Aug 1, 2019 Accepting new patients
Henry Ford Health St. John Hospital CurrentSince Aug 1, 2019 Accepting new patients
Seton Health Corporation of Southeastern Michigan CurrentSince Nov 1, 2018 Accepting new patients
Rochester Urgent Care, P. C. CurrentSince Apr 12, 2023 Accepting new patients
Lakeside Urgent Care, P.C. CurrentSince Apr 12, 2023 Accepting new patients
Somerset Urgent Care PLLC CurrentSince Apr 12, 2023 Accepting new patients
First Choice Medical Group PLLC Past Accepting new patients
Oxford Urgent Care, LLC Past Accepting new patients

Locations

44472 Hayes Rd
Clinton Twp, MI 48038
Phone (586) 412-0890

22101 Moross Rd
Detroit, MI 48236
Phone (313) 343-3248

1225 S Latson Rd
Ste 130
Howell, MI 48843
Phone (517) 338-2360

47601 Grand River Ave
Novi, MI 48374
Phone (248) 465-4100

215 E Auburn Rd
Rochester Hills, MI 48307
Phone (248) 853-2009

2952 S Rochester Rd
Rochester Hills, MI 48307
Phone (248) 853-2009

74 S Elk St
Sandusky, MI 48471
Phone (810) 487-4676

22255 Greenfield Rd
Ste 550
Southfield, MI 48075
Phone (586) 226-6161

1500 W Big Beaver Rd
Ste 104
Troy, MI 48084
Phone (248) 649-4444

31200 Mound Rd
Warren, MI 48092
Phone (248) 850-8395

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/20203/brand/1/csg/1/fhir/r4

Organizations & group practices 23

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.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1491609600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1491609600000",
    "number": "1801329628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 100",
            "city": "ROYAL OAK",
            "state": "MI",
            "postal_code": "480680100",
            "telephone_number": "248-849-3137"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16001 W 9 MILE RD",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480754818",
            "telephone_number": "248-849-3137"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALLORY",
        "first_name": "CRAIG",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-04-08",
        "last_updated": "2017-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601008170",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southfield, MI

Sources for this page

Verify at the official NPI Registry.