Individual provider Active NPI

Mallory Lane Henry, PA

  • Physician Assistant
  • Saint Louis, MO
National Provider Identifier
1851617526
Registry record updated Apr 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2013012266 Issued in MO
Practice address
1600 S Brentwood Blvd
Div Neurology General, Ste 600
Saint Louis, MO 63144-1320
Phone
(314) 362-1408
Fax
(314) 362-0338
NPI assigned
Apr 20, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2025

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 2013012266 MO Primary

Addresses

Primary practice location

1600 S Brentwood Blvd
Div Neurology General, Ste 600
Saint Louis, MO 63144-1320

Mailing address

PO Box 7412011
Chicago, IL 60674-2011
Phone (314) 362-1408

Other identifiers 1

IdentifierTypeStateIssuer
220047038MedicaidMO

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Washington University

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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
I20140128001501 MO Practitioner - Physician Assistant 7315111986 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Washington UniversityGroup PAC ID 9830008770, 2,968 clinicians

Practice addresses (Care Compare)

1600 S Brentwood Blvd
Suite 600
Saint Louis, MO 63144-1334
Phone (314) 362-1408

4455 Duncan Ave
Saint Louis, MO 63110-1111
Phone (314) 362-1408

Merit-based Incentive Payment System (MIPS)

Final score
84.2 of 100Reported as group
Quality
71.6
Promoting interoperability
100
Improvement activities
40
Cost
75.75

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Washington University CurrentSince Jun 15, 2015 Accepting new patients
Washington University CurrentSince Jun 15, 2015 Accepting new patients

Locations

4455 Duncan Ave
Saint Louis, MO 63110
Phone (314) 658-3800

1600 S Brentwood Blvd
Ste 600
Saint Louis, MO 63144
Phone (314) 362-4342

660 S Euclid Ave
#8111
Saint Louis, MO 63110
Phone (314) 362-3281

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1271721600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744848000000",
    "number": "1851617526",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7412011",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606742011",
            "telephone_number": "314-362-1408",
            "fax_number": "314-362-0338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 S BRENTWOOD BLVD",
            "address_2": "DIV NEUROLOGY GENERAL, STE 600",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631441320",
            "telephone_number": "314-362-1408",
            "fax_number": "314-362-0338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENRY",
        "first_name": "MALLORY",
        "middle_name": "LANE",
        "name_prefix": "Mrs.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-04-20",
        "last_updated": "2025-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MO",
            "license": "2013012266",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "220047038",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "Y",
            "affiliationName": "Washington University",
            "address_1": "1600 S Brentwood Blvd",
            "address_2": "Div Neurology General, Ste 600",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631441320",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.