Individual provider Active NPI

Mallory McCord Aycock, PA-C

  • Physician Assistant
  • Kennesaw, GA
National Provider Identifier
1982987376
Registry record updated Jan 29, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
006613 Issued in GA
Practice address
750 Townpark Lane
Kaiser Permanente Townpark Medical Center
Kennesaw, GA 30144
Phone
(404) 256-9692
NPI assigned
Sep 22, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 29, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 6613 GA
Physician Assistant 363A00000X 006613 GA Primary

Addresses

Primary practice location

750 Townpark Lane
Kaiser Permanente Townpark Medical Center
Kennesaw, GA 30144

Mailing address

3495 Piedmont Road, NE
Nine Piedmont Center
Atlanta, GA 30305
Phone (404) 364-7070

Other names 1

  • Mallory Emma McCord Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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

Enrollment IDStateProvider typePAC IDDetails
I20121212000435 GA Practitioner - Physician Assistant 8820256878 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Medical College of Georgia School of Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Georgia Skin Cancer and Aestheitic Dermatology, LLCGroup PAC ID 0244328649, 25 clinicians

Practice addresses (Care Compare)

1180 Resurgence Dr
Suite 100
Watkinsville, GA 30677-7210

1180 Resurgence Dr
Suite 100
Watkinsville, GA 30677-7211
Phone 70654358583207

Hospital & facility affiliations

  • Piedmont Athens Regional Medical Center Hospital, Athens, GA, CCN 110074

Merit-based Incentive Payment System (MIPS)

Final score
85.62 of 100Reported as group
Quality
78.23
Promoting interoperability
100
Improvement activities
40
Cost
73.84

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1682SCMDOccupational Therapist
006613GAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Dermatology Affiliates, LLC Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: mallory@georgiaderm.emadirect.md

Organizations & group practices 2

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 1

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

NPI Registry JSON

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

{
    "created_epoch": "1316649600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1390953600000",
    "number": "1982987376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3495 PIEDMONT ROAD, NE",
            "address_2": "NINE PIEDMONT CENTER",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "30305",
            "telephone_number": "404-364-7070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 TOWNPARK LANE",
            "address_2": "KAISER PERMANENTE TOWNPARK MEDICAL CENTER",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "30144",
            "telephone_number": "404-256-9692"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AYCOCK",
        "first_name": "MALLORY",
        "middle_name": "MCCORD",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-09-22",
        "last_updated": "2014-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "6613",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "006613",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MALLORY",
            "last_name": "MCCORD",
            "middle_name": "EMMA",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Kennesaw, GA

Sources for this page

Verify at the official NPI Registry.