NPIMap

Individual provider Active NPI

Mallory Quinn De Boom, PA

  • Physician Assistant
  • Saint Paul, MN
National Provider Identifier
1801540646
Registry record updated Sep 2, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
15407 Issued in MN
Practice address
225 Smith Ave N Ste 400
Saint Paul, MN 55102-2568
Phone
(651) 290-0133
NPI assigned
Feb 10, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X TN
Physician Assistant 363A00000X 4931 TN
Physician Assistant 363A00000X 15407 MN Primary

Addresses

Primary practice location

225 Smith Ave N Ste 400
Saint Paul, MN 55102-2568

Mailing address

2925 Chicago Ave
Minneapolis, MN 55407-1321
Phone (612) 262-9000

Other identifiers 1

IdentifierTypeStateIssuer
1191302OtherTNNCCPA CERTIFICATION

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mdeboom771374@excellian.direct.allina.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, MN2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20220404001802 TN Practitioner - Physician Assistant 2567858368 Reassigns benefits to 2 organizations
I20260206001864 MN Practitioner - Physician Assistant 2567858368 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of Tennessee, HSC, College of Medicine, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Allina Health SystemGroup PAC ID 4587573613, shared by 89 NPIs, 3,844 clinicians

Practice addresses (Care Compare)

1540 Lake St S
Forest Lake, MN 55025-2628
Phone (651) 464-7100

2004 Exeter Rd
Germantown, TN 38138-3945
Phone (901) 664-2111

225 Smith Ave N
Suite 400
St Paul, MN 55102-2568
Phone (651) 241-7176

Hospital & facility affiliations

  • Allina United Hospital Hospital, Saint Paul, MN, CCN 240038

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science, Physician Assistant

State licenses

LicenseStateTypeSpecialty
4931TNMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Prepostplus - Germantown PLLC CurrentSince Sep 3, 2025 Accepting new patients
Allina Health System CurrentSince Mar 9, 2026 Accepting new patients
Allina Health System CurrentSince Mar 9, 2026 Accepting new patients
Allina Health System CurrentSince Mar 9, 2026 Accepting new patients
Mid-South Cardiovascular Center, LLC PastSince Feb 1, 2022 Accepting new patients

Locations

440 Elm St E
Annandale, MN 55302
Phone (320) 682-5225

1540 Lake St S
Forest Lake, MN 55025
Phone (651) 464-7100

2925 Chicago Ave
#10957
Minneapolis, MN 55407
Phone (612) 262-8640

225 Smith Ave N
Ste 400
Saint Paul, MN 55102
Phone (651) 241-7176

9245 Poplar Ave
#5210
Germantown, TN 38138
Phone (210) 469-3830

9245 Poplar Ave
Ste 5210
Germantown, TN 38138

2004 Exeter Rd
Germantown, TN 38138
Phone (901) 664-2111

Organizations & group practices 9

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.

Hospital & facility affiliations 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1644451200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788307200000",
    "number": "1801540646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2925 CHICAGO AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554071321",
            "telephone_number": "612-262-9000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 SMITH AVE N STE 400",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551022568",
            "telephone_number": "651-290-0133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE BOOM",
        "first_name": "MALLORY",
        "middle_name": "QUINN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-02-10",
        "last_updated": "2026-09-02",
        "certification_date": "2026-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "TN",
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TN",
            "license": "4931",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "15407",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCCPA CERTIFICATION",
            "identifier": "1191302",
            "state": "TN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mdeboom771374@excellian.direct.allina.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/PDF/TXT",
            "address_1": "225 Smith Ave N Ste 400",
            "city": "Saint Paul",
            "state": "MN",
            "country_code": "US",
            "postal_code": "551022568",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Saint Paul, MN

Sources for this page

Verify at the official NPI Registry.