MALLORY A. BOOTH (PA-C) – Medical Physician Assistant, NPI 1073960118

MALLORY A. BOOTH (PA-C) is a healthcare provider. based in Macon, Georgia. specializing in PHYSICIAN ASSISTANT. They hold the professional credentials PA-C. They hold a License No. 10676 (GA). The NPI Number for MALLORY A. BOOTH (PA-C) is 1073960118

Main info

Female
12 Years Of Experience
Accepts Medicare Assignment
Name
MALLORY A. BOOTH (PA-C)
NPI
1073960118
Phone
(478) 743-7068
Address
800 1ST ST STE 410
Enumeration Date
18 May 2016
Last Update Date
6 May 2026

Doctor Profile

Medical School Name
OTHER
Secondary Phone
2053333330
Graduation Year
2014 (12 years ago)
PAC ID
5890188874
Group Practice PAC ID
0042436644
Professional Enrollment ID
I20231006001899
Address ID
AL354062288TU1224XNEXX401
Data current as of
3 June 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience44
Completeness85
Years active:10State licenses:1Digital endpointsOther names

4,430 PHYSICIAN ASSISTANT in GA

Provider Addresses for MALLORY A. BOOTH (PA-C)

  • 800 1ST ST STE 410

    MACON, GA 312018306

    Phone: (478) 743-7068

    Fax: (478) 741-1354

    Type: Mailing

  • 1050 Ruby Tyler Pkwy

    Tuscaloosa, AL 354042958

    Phone: (478) 743-7068

    Fax: (478) 741-1354

    Type: Location

  • 4515 SOUTHLAKE PKWY STE 200

    HOOVER, AL 352443319

    Phone: (205) 313-7246

    Fax: (205) 939-1911

    Type: Mailing

  • 114 Sutherlin Dr Ste C-1

    Warner Robins, GA 310882259

    Phone: (478) 743-7068

    Fax: (478) 741-1354

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 105 Open Payments records for all available years, with a total value of $2,319.

Total Amount is formed as General ($2,319) + Research ($0) + Ownership ($0) = $2,319.

Last reported payment date: 2024-10-07 • Largest payer in this snapshot: ABBVIE INC. ($263).

Total Amount

$2,319

General + Research + Ownership

Payments

105

Total payment records

General Amount

$2,319

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-10-07

Latest reported date

Top Companies

Largest payers in this snapshot

View all Open Payments →|Open Payments Risk Radar →

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2023-10-06

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20231006001899IPhysician AssistantALTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
99214Established patient office or other outpatient visit, 30-39 minutes4541$0
View full utilization report →

Insurance plans in this area (ZIP 31201)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 0042436644View full group profile
NameSpecialtyState
-AL
O T O L A R Y N G O L O G YAL
Nurse PractitionerAL
Qualified AudiologistAL

Reviews

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Frequently asked questions

What is the 10-digit NPI for MALLORY A. BOOTH (PA-C)?
MALLORY A. BOOTH (PA-C) — NPI 1073960118 — is the standard way to identify this listing.
Does the file indicate MALLORY A. BOOTH (PA-C) is practicing under active NPI?
Directory data currently reports MALLORY A. BOOTH (PA-C) as active.
What is MALLORY A. BOOTH (PA-C)'s primary classification?
Medical Physician Assistant is the headline specialty for MALLORY A. BOOTH (PA-C) here. Clinical services aligned with this taxonomy classification.
Where should I expect MALLORY A. BOOTH (PA-C) on a map?
Expect Macon, Georgia as a primary anchor for MALLORY A. BOOTH (PA-C) unless the record lists multiple sites.
Is specialty guaranteed by NPI alone?
Taxonomy selections describe intent; scope of practice still follows state law.

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