Matthew Mallin, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

7548-123 Issued in WI

Practice address

1520 Madison Ave
Fort Atkinson, WI 53538-3100

Phone

(920) 563-5500

NPI assigned

Feb 25, 2021

Last updated

Oct 7, 2022By the provider in NPPES

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 WI

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir-myrecord.cerner.com/r4/8F7ruIta-JA7ecm4ommy-Q50dF1FkFe4/
• Direct secure messaging: matthew.mallin@direct.forthc.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Fort Healthcare Inc

  • Otolaryngology Physician
  • Fort Atkinson, WI
  • NPI 1417993361

  Clinical

  Medicare reassignment NPD
• Fort Healthcare Inc

  • Rural Health Clinic/Center
  • Fort Atkinson, WI
  • NPI 1417450115
  NPD

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

{
    "created_epoch": "1614211200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665100800000",
    "number": "1841884277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 CHEROKEE LN",
            "city": "FORT ATKINSON",
            "state": "WI",
            "postal_code": "535383006",
            "telephone_number": "608-322-8553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1520 MADISON AVE",
            "city": "FORT ATKINSON",
            "state": "WI",
            "postal_code": "535383100",
            "telephone_number": "920-563-5500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "500 McMillen St",
            "address_purpose": "LOCATION",
            "city": "Fort Atkinson",
            "state": "WI",
            "postal_code": "535381233",
            "country_code": "US",
            "telephone_number": "920-563-9542",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MALLIN",
        "first_name": "MATTHEW",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-02-25",
        "last_updated": "2022-10-07",
        "certification_date": "2022-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "7548-123",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Qingze LV, DMD
• Leah Clare Lyle, LMFT
• Elizabeth H Lynk, MD
• Matthew Walter Maciejewski, DPM
• Jill Mallin, PHD, LP
• Stephen Randall Marion, OD
• Betsy Martin Devine, PA C
• Emma Yvonne Martin, LPC-IT
• James Paul Martin, MD MPH
• Katherine Louise Martin, MS

• Clinical Social Worker in Fort Atkinson, WI
• Providers in Fort Atkinson, WI by specialty
• Clinical Social Worker in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.