Mallori Wisuri Hathaway, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

10003222A Issued in IN

Practice address

1428 N Gardner St
Scottsburg, IN 47170-8720

Phone

(812) 752-3512

Fax

(812) 752-8593

NPI assigned

Jun 27, 2020

Last updated

Nov 12, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Mallori Greer Wisuri Former name

Electronic endpoints 8

Medicare fee-for-service enrollment

Enrolled in IN

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

Specialty

Physician Assistant

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Forefront Dermatology SCGroup PAC ID 3779471701, 650 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Ascension St Vincent Salem Hospital, Salem, IN, CCN 151314
• Norton Scott Hospital Hospital, Scottsburg, IN, CCN 151334

Merit-based Incentive Payment System (MIPS)

Final score

97.45 of 100Reported as group

Promoting interoperability

97

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mallori.hathaway@forefrontdermatology.emadirect.md

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.

• Forefront Dermatology, S.C.

  • Dermatology Physician
  • Seymour, IN
  • NPI 1659796225
  Medicare reassignment Care Compare group
• Forefront Dermatology, S.C.

  • Dermatology Physician
  • Noblesville, IN
  • NPI 1588393607
  NPD
• Forefront Dermatology, S.C.

  • Dermatology Physician
  • Columbus, OH
  • NPI 1063365385
  NPD
• Forefront Dermatology, S.C.

  • Dermatology Physician
  • Manitowoc, WI
  • NPI 1578515904
  NPD (past)

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

• Norton Scott Hospital, LLC

  dba Norton Scott Hospital

  • Critical Access Hospital
  • Scottsburg, IN
  • NPI 1013251594
  Care Compare affiliation
• St Vincent Salem Hospital Inc

  • Critical Access Hospital
  • Salem, IN
  • NPI 1427388982
  Care Compare affiliation

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

{
    "created_epoch": "1593216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762905600000",
    "number": "1861019689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 YORK ST",
            "city": "MANITOWOC",
            "state": "WI",
            "postal_code": "542204630",
            "telephone_number": "920-663-9008",
            "fax_number": "920-684-1439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1428 N GARDNER ST",
            "city": "SCOTTSBURG",
            "state": "IN",
            "postal_code": "471708720",
            "telephone_number": "812-752-3512",
            "fax_number": "812-752-8593"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2130 W Sycamore St Ste 200",
            "address_purpose": "LOCATION",
            "city": "Kokomo",
            "state": "IN",
            "postal_code": "469016461",
            "country_code": "US",
            "telephone_number": "765-457-4455",
            "fax_number": "765-457-0056",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "244 Westwood Blvd",
            "address_purpose": "LOCATION",
            "city": "Columbus",
            "state": "IN",
            "postal_code": "472015687",
            "country_code": "US",
            "telephone_number": "812-669-0141",
            "fax_number": "888-358-7705",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "303 S Walnut St",
            "address_purpose": "LOCATION",
            "city": "Seymour",
            "state": "IN",
            "postal_code": "472742368",
            "country_code": "US",
            "telephone_number": "812-358-7705",
            "fax_number": "888-254-0293",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "415 S Landmark Ave",
            "address_purpose": "LOCATION",
            "city": "Bloomington",
            "state": "IN",
            "postal_code": "474035003",
            "country_code": "US",
            "telephone_number": "812-333-7433",
            "fax_number": "812-733-7435",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1263 Hospital Dr NW Ste 100",
            "address_purpose": "LOCATION",
            "city": "Corydon",
            "state": "IN",
            "postal_code": "471122173",
            "country_code": "US",
            "telephone_number": "812-783-2054",
            "fax_number": "812-733-7838",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "911 N Shelby St",
            "address_purpose": "LOCATION",
            "city": "Salem",
            "state": "IN",
            "postal_code": "471672304",
            "country_code": "US",
            "telephone_number": "812-883-8527",
            "fax_number": "812-883-8574",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "505 W Homer St Ste 201",
            "address_purpose": "LOCATION",
            "city": "Salem",
            "state": "IN",
            "postal_code": "471671698",
            "country_code": "US",
            "telephone_number": "812-883-0024",
            "fax_number": "812-883-8574",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HATHAWAY",
        "first_name": "MALLORI",
        "middle_name": "WISURI",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-27",
        "last_updated": "2025-11-12",
        "certification_date": "2025-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IN",
            "license": "10003222A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Mallori.Hathaway@forefrontdermatology.emadirect.md",
            "affiliation": "N",
            "address_1": "415 S Landmark Ave",
            "city": "Bloomington",
            "state": "IN",
            "country_code": "US",
            "postal_code": "474035003",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Mallori.Hathaway@forefrontdermatology.emadirect.md",
            "affiliation": "N",
            "address_1": "505 W Homer St Ste 201",
            "city": "Salem",
            "state": "IN",
            "country_code": "US",
            "postal_code": "471671698",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Mallori.Hathaway@forefrontdermatology.emadirect.md",
            "affiliation": "N",
            "address_1": "244 Westwood Blvd",
            "city": "Columbus",
            "state": "IN",
            "country_code": "US",
            "postal_code": "472015687",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Mallori.Hathaway@forefrontdermatology.emadirect.md",
            "affiliation": "N",
            "address_1": "1263 Hospital Dr NW Ste 100",
            "city": "Corydon",
            "state": "IN",
            "country_code": "US",
            "postal_code": "471122173",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Mallori.Hathaway@forefrontdermatology.emadirect.md",
            "affiliation": "N",
            "address_1": "2130 W Sycamore St Ste 200",
            "city": "Kokomo",
            "state": "IN",
            "country_code": "US",
            "postal_code": "469016461",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Mallori.Hathaway@forefrontdermatology.emadirect.md",
            "affiliation": "N",
            "address_1": "303 S Walnut St",
            "city": "Seymour",
            "state": "IN",
            "country_code": "US",
            "postal_code": "472742368",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Mallori.Hathaway@forefrontdermatology.emadirect.md",
            "affiliation": "N",
            "address_1": "911 N Shelby St",
            "city": "Salem",
            "state": "IN",
            "country_code": "US",
            "postal_code": "471672304",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Mallori.Hathaway@forefrontdermatology.emadirect.md",
            "affiliation": "N",
            "address_1": "1428 N Gardner St",
            "city": "Scottsburg",
            "state": "IN",
            "country_code": "US",
            "postal_code": "471708720",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "MALLORI",
            "last_name": "WISURI",
            "middle_name": "GREER",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Rupinder Gill, MD
• Nicole Catherine Grayson, LMFT
• Austin Thomas Hall, LSW
• Cinnamon Rose Hammond, OTR
• Mary L Harty, M.D.
• Hatton Family Support Services
• Shelby Lea Hawkins
• HDS Enterprises, Inc. D/B/a Visiting Angels of Southern Indiana (Visiting Angels of Southern Indiana)
• Health Centered Chiropractic
• Health Centered of Scottsburg, Inc

• Physician Assistant in Scottsburg, IN
• Providers in Scottsburg, IN by specialty
• Physician Assistant in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2025; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.