NPIMap

Individual provider Active NPI

Roger Lee Mallory, MD

  • Nephrology Physician
  • Colorado Springs, CO
National Provider Identifier
1962488494
Registry record updated Feb 11, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
39036 Issued in CO
Practice address
1914 Lelaray St
Colorado Springs, CO 80909-2800
Phone
(719) 632-7641
Fax
(719) 632-2925
NPI assigned
Dec 16, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 11, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 39036 CO Primary

Addresses

Primary practice location

1914 Lelaray St
Colorado Springs, CO 80909-2800

Mailing address

1914 Lelaray St
Colorado Springs, CO 80909-2800
Phone (719) 632-7641

Other identifiers 1

IdentifierTypeStateIssuer
37275038MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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
I20040318001491 CO Practitioner - NephrologyPractitioner - Internal Medicine 3577460708 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
Medical College of Georgia School of Medicine, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1910 Lelaray St
Colorado Springs, CO 80909-2800
Phone (719) 632-7641

1914 Lelaray St
Colorado Springs, CO 80909-2800
Phone (719) 632-7641

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Pikes Peak Nephrology Associates PC Nephrology CurrentSince Dec 1, 2000 Accepting new patients
Pikes Peak Nephrology Associates PC Nephrology CurrentSince Dec 1, 2000 Accepting new patients
Transtreme, LLC Past Accepting new patients

Locations

2115 Stuart Ave
Alamosa, CO 81101
Phone (719) 589-3000

1914 Lelaray St
Colorado Springs, CO 80909
Phone (719) 955-2651

2002 Lelaray St
Ste 100
Colorado Springs, CO 80909
Phone (719) 799-6401

850 Eagleridge Blvd
Ste 100
Pueblo, CO 81008
Phone (866) 493-7217

Interoperability endpoints

  • Direct secure messaging: rmallory@pikes.curemd.direct-ci.com

Organizations & group practices 3

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 19

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

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1134691200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1455148800000",
    "number": "1962488494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1914 LELARAY ST",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809092800",
            "telephone_number": "719-632-7641",
            "fax_number": "719-632-2925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1914 LELARAY ST",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809092800",
            "telephone_number": "719-632-7641",
            "fax_number": "719-632-2925"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALLORY",
        "first_name": "ROGER",
        "middle_name": "LEE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-16",
        "last_updated": "2016-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "CO",
            "license": "39036",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "37275038",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Colorado Springs, CO

Sources for this page

Verify at the official NPI Registry.