Brenda Susan Mallory, M.D.

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

01084397A Issued in IN

Practice address

601 W 2ND St
Bloomington, IN 47403-2317

Phone

(812) 353-6821

NPI assigned

Jun 1, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in NE

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: bmallory438107@direct.nebraskamed.com

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.

• Nebraska Methodist Hospital

  • Emergency Medicine Physician
  • Omaha, NE
  • NPI 1689628372

  Physical Medicine & Rehabilitation

  Medicare reassignment NPD

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

{
    "created_epoch": "1117584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598918400000",
    "number": "1992707111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 858",
            "address_2": "MC A410",
            "city": "HERSHEY",
            "state": "PA",
            "postal_code": "170330858",
            "telephone_number": "800-243-1455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 W 2ND ST",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474032317",
            "telephone_number": "812-353-6821"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1135 Olde W Chocolate Ave Ste 101",
            "address_purpose": "LOCATION",
            "city": "Hummelstown",
            "state": "PA",
            "postal_code": "170369188",
            "country_code": "US",
            "telephone_number": "717-531-7010",
            "fax_number": "717-531-7102",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MALLORY",
        "first_name": "BRENDA",
        "middle_name": "SUSAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-01",
        "last_updated": "2020-09-01",
        "certification_date": "2020-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "PA",
            "license": "MD440148",
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "NY",
            "license": "191473-1",
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "IN",
            "license": "01084397A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01417674",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1024982060001",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NY STATE LICENSE",
            "identifier": "191473-1",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Anna Main, AU.D.
• Amy C Makice, MSW, LCSW
• Paulina M Makowska, LMT
• Gabriela Malave, OD
• Victor Malinovsky, O.D.
• Cacy Malone, RBT
• Destinee Malone, RBT-21-158532
• Richard K Malone, MD
• Megan Elizabeth Maloy Shepley
• Judy Lynn Malschick, MSW

• Physical Medicine & Rehabilitation Physician in Bloomington, IN
• Providers in Bloomington, IN by specialty
• Physical Medicine & Rehabilitation Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 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; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.