Active NPI
Matthew Lee Mallinger, BS, ATC, OTC
- Athletic Trainer
- Plymouth, MN
National Provider Identifier
1851837389
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 2000027256
- Practice address
- 2805 Campus Dr Ste 465
Plymouth, MN 55441-2680 - Phone
- (952) 946-9777
- Fax
- (952) 946-9888
- NPI assigned
- Jan 8, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 2000027256 | MN | Primary |
Addresses
Primary practice location
2805 Campus Dr Ste 465
Plymouth, MN 55441-2680
Mailing address
8100 W 78TH St Ste 230
Edina, MN 55439-2570
Phone (952) 946-9777
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Bachelor of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2000027256 | MN | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1483833600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1650326400000",
"number": "1851837389",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8100 W 78TH ST STE 230",
"city": "EDINA",
"state": "MN",
"postal_code": "554392570",
"telephone_number": "952-946-9777",
"fax_number": "952-946-9888"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2805 CAMPUS DR STE 465",
"city": "PLYMOUTH",
"state": "MN",
"postal_code": "554412680",
"telephone_number": "952-946-9777",
"fax_number": "952-946-9888"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MALLINGER",
"first_name": "MATTHEW",
"middle_name": "LEE",
"credential": "BS, ATC, OTC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-01-08",
"last_updated": "2022-04-19",
"certification_date": "2022-04-19",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "MN",
"license": "2000027256",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Plymouth, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.