NPIMap

Individual provider Active NPI

Jacob George Malooly, PA-C

  • Physician Assistant
  • Wisconsin Rapids, WI
National Provider Identifier
1932526910
Registry record updated Jun 23, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
3306-23 Issued in WI
Practice address
2031 Peach St
Wisconsin Rapids, WI 54494-5181
Phone
(715) 423-0122
NPI assigned
Mar 27, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2014

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 3306-23 WI Primary

Addresses

Primary practice location

2031 Peach St
Wisconsin Rapids, WI 54494-5181

Mailing address

2031 Peach St
Wisconsin Rapids, WI 54494-5181
Phone (715) 423-0122

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140716002514 WI Practitioner - Physician Assistant 9335365956 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aspirus Rhinelander and Tomahawk Hospitals and Clinics, Inc.Group PAC ID 9335059856, shared by 17 NPIs, 566 clinicians

Practice addresses (Care Compare)

2031 Peach St
Wisconsin Rapids, WI 54494-5181
Phone (715) 423-0122

410 Dewey St
Wisconsin Rapids, WI 54494-4715
Phone (715) 423-6060

420 Dewey St
Wisconsin Rapids, WI 54494-4714
Phone (715) 422-7750

824 Illinois Ave
Stevens Point, WI 54481-3112
Phone (715) 344-1600

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.65 of 100Reported as group
Quality
87.9
Promoting interoperability
100
Improvement activities
40
Cost
73.87

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Aspirus Riverview Hospital & Clinics, Inc. Current Accepting new patients
Aspirus Medical Group, Inc. CurrentSince Jun 23, 2014 Accepting new patients
Aspirus Medical Group, Inc. CurrentSince Jun 23, 2014 Accepting new patients

Locations

29980 Network Pl
Chicago, IL 60673

2720 Plaza Dr
Ste 1400A
Wausau, WI 54401
Phone (715) 847-0426

4005 Community Center Dr
Weston, WI 54476
Phone (715) 241-5400

420 Dewey St
Wisconsin Rapids, WI 54494
Phone (715) 421-7474

410 Dewey St
Wisconsin Rapids, WI 54494
Phone (715) 421-5257

2031 Peach St
Wisconsin Rapids, WI 54494
Phone (715) 423-0122

Organizations & group practices 4

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.

Hospital & facility affiliations 33

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

View all 33

NPI Registry JSON

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

{
    "created_epoch": "1395878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1403481600000",
    "number": "1932526910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2031 PEACH ST",
            "city": "WISCONSIN RAPIDS",
            "state": "WI",
            "postal_code": "544945181",
            "telephone_number": "715-423-0122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2031 PEACH ST",
            "city": "WISCONSIN RAPIDS",
            "state": "WI",
            "postal_code": "544945181",
            "telephone_number": "715-423-0122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALOOLY",
        "first_name": "JACOB",
        "middle_name": "GEORGE",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-03-27",
        "last_updated": "2014-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "3306-23",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wisconsin Rapids, WI

Sources for this page

Verify at the official NPI Registry.