Active NPI
Shawn P Mallady, O.D.
- Optometrist
- Danville, IL
National Provider Identifier
1891772331
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 046-008619
- Practice address
- 1104 N Vermilion St
Danville, IL 61832-3094 - Phone
- (217) 442-2631
- Fax
- (217) 442-0119
- NPI assigned
- Dec 27, 2005
- Last updated
- Oct 9, 2014
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Optometrist | 152W00000X | 046-008619 | IL | Primary |
Addresses
Primary practice location
1104 N Vermilion St
Danville, IL 61832-3094
Mailing address
1104 N Vermilion St
Danville, IL 61832-3094
Phone (217) 442-2631
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Optometry
- Education
- Illinois College of Optometry at Chicago, 1993
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1104 N Vermilion St
Danville, IL 61832-3094
Phone (217) 442-2631
Merit-based Incentive Payment System (MIPS)
- Final score
- 64.15 of 100
- Quality
- 77.89
- Improvement activities
- 40
- Cost
- 10
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 046-008619 | IL | MD | Optometrist |
Organizations & group practices 1
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.
-
dba Leon Optometric Clinic
- Ophthalmology Physician
- Danville, IL
- NPI 1336246552
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1135641600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1412812800000",
"number": "1891772331",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1104 N VERMILION ST",
"city": "DANVILLE",
"state": "IL",
"postal_code": "618323094",
"telephone_number": "217-442-2631",
"fax_number": "217-442-0119"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1104 N VERMILION ST",
"city": "DANVILLE",
"state": "IL",
"postal_code": "618323094",
"telephone_number": "217-442-2631",
"fax_number": "217-442-0119"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MALLADY",
"first_name": "SHAWN",
"middle_name": "P",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-12-27",
"last_updated": "2014-10-09",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "IL",
"license": "046-008619",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Danville, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2014; 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.