Mallory Kirsch, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

60837937 Issued in WA

Practice address

11545 E Radisson Rd
Mount Vernon, IL 62864-6861

Phone

(618) 316-3727

NPI assigned

Jul 25, 2018

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MT

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Stillwater Hospital Association, Inc.

  dba Stillwater Billings Clinic

  • Critical Access Hospital
  • Columbus, MT
  • NPI 1053488387
  Medicare reassignment

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

{
    "created_epoch": "1532476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593561600000",
    "number": "1891272597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11545 E RADISSON RD",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628646861",
            "telephone_number": "618-316-3727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11545 E RADISSON RD",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628646861",
            "telephone_number": "618-316-3727"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1016 Tacoma Ave",
            "address_purpose": "LOCATION",
            "city": "Sunnyside",
            "state": "WA",
            "postal_code": "989442263",
            "country_code": "US",
            "telephone_number": "509-837-1760",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIRSCH",
        "first_name": "MALLORY",
        "credential": "DPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-07-25",
        "last_updated": "2020-07-01",
        "certification_date": "2020-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "60837937",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "SC",
            "license": "9868",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Justin Kim
• King City Physician Company, LLC
• King City Surgery Center, S.C.
• Misty Dawn King, RN
• Janelle Renee Kirby, FNP-C
• Melissa Klausman, CNM, WHNP-BC
• Klein & Cook Orthodontics LLC
• Klein Orthodontics LLC
• Aaron Leonard Klein, M.D.
• Christopher Klein, DMD,M.S.

• Physical Therapist in Mount Vernon, IL
• Providers in Mount Vernon, IL by specialty
• Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.