Individual provider Active NPI

Jason Markos Mallis II, PA-C

  • Physician Assistant
  • Pensacola, FL
National Provider Identifier
1831862044
Registry record updated Oct 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9118897 Issued in FL
Practice address
5147 N 9TH Ave Ste 103
Pensacola, FL 32504-8770
Phone
(850) 416-1900
Fax
(850) 416-1958
NPI assigned
Jul 26, 2021
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 3, 2024

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 PA9118897 FL Primary

Addresses

Primary practice location

5147 N 9TH Ave Ste 103
Pensacola, FL 32504-8770

Mailing address

4205 Belfort Rd Ste 4015
Jacksonville, FL 32216-3623
Phone (904) 450-6063

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA, FL2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20221108000172 LA Practitioner - Physician Assistant 1153798905 Reassigns benefits to 1 organization
I20240813002569 FL Practitioner - Physician Assistant 1153798905 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sacred Heart Health System IncGroup PAC ID 3779491386, 373 clinicians

Practice addresses (Care Compare)

4501 N Davis Hwy
Suite a
Pensacola, FL 32504-2724
Phone (850) 476-9000

4501 N Davis Hwy
Suite C
Pensacola, FL 32503-2724
Phone (850) 416-4960

5147 N 9TH Ave
Suite 103
Pensacola, FL 32504-8770
Phone (850) 416-1900

5151 N 9TH Ave
Suite 200
Pensacola, FL 32504-8721
Phone (850) 416-4188

Hospital & facility affiliations

  • Sacred Heart Hospital Hospital, Pensacola, FL, CCN 100025

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Ochsner Clinic LLC CurrentSince Sep 23, 2022 Accepting new patients
Sacred Heart Health System Inc CurrentSince Jul 30, 2024 Accepting new patients
Ochsner Clinic LLC CurrentSince Sep 23, 2022 Accepting new patients
Sacred Heart Health System, Inc. CurrentSince Jul 30, 2024 Accepting new patients
Sacred Heart Health System, Inc. Past Accepting new patients
Ochsner Clinic LLC Past Accepting new patients

Locations

4205 Belfort Rd
Ste 4015
Jacksonville, FL 32216
Phone (904) 296-5691

4501 N Davis Hwy
Ste A
Pensacola, FL 32503
Phone (850) 476-9000

5147 N 9th Ave
Ste 103
Pensacola, FL 32504
Phone (850) 416-1900

1514 Jefferson Hwy
New Orleans, LA 70121

Interoperability endpoints

  • Direct secure messaging: jason.mallis.1@9582.direct.athenahealth.com

Organizations & group practices 6

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 1

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

NPI Registry JSON

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

{
    "created_epoch": "1627257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727913600000",
    "number": "1831862044",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4205 BELFORT RD STE 4015",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322163623",
            "telephone_number": "904-450-6063",
            "fax_number": "904-539-4091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5147 N 9TH AVE STE 103",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325048770",
            "telephone_number": "850-416-1900",
            "fax_number": "850-416-1958"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALLIS",
        "first_name": "JASON",
        "middle_name": "MARKOS",
        "name_prefix": "Mr.",
        "name_suffix": "II",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-07-26",
        "last_updated": "2024-10-03",
        "certification_date": "2024-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9118897",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pensacola, FL

Sources for this page

Verify at the official NPI Registry.