RYAN HOLLEY - MALLO (DNP, FNP-C) – Primary Care Nurse Practitioner, NPI 1992094403
Primary Care Nurse Practitioner
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
8,106 NURSE PRACTITIONER in MI
Provider Addresses for RYAN HOLLEY - MALLO (DNP, FNP-C)
100 MICHIGAN ST NE
MC 845
GRAND RAPIDS, MI 495032560
Phone:
Type: Mailing
5991 95TH AVE
EVART, MI 496319386
Phone: (231) 832-8700
Fax: (231) 734-6438
Type: Location
41800 W 11 MILE RD STE 109
NOVI, MI 483751818
Phone: (248) 660-1220
Type: Location
550 CHERRY ST SE
GRAND RAPIDS, MI 495034748
Phone: (616) 235-7272
Fax: (231) 734-6438
Type: Location
100 CHERRY ST SE # MC845
GRAND RAPIDS, MI 495034526
Phone: (616) 965-8209
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 2 Open Payments records for all available years, with a total value of $149.
Total Amount is formed as General ($149) + Research ($0) + Ownership ($0) = $149.
Last reported payment date: 2024-06-26 • Largest payer in this snapshot: Tempus AI, Inc ($125).
Total Amount
$149
General + Research + Ownership
Payments
2
Total payment records
General Amount
$149
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-06-26
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Tempus AI, Inc | $125 |
| ABBVIE INC. | $24 |
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: 2012-10-30
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
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20121030000180 | I | Nurse Practitioner | MI | TBD |
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.
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.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 49503)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Family Practice, Emergency Medicine | MI | |
| Nurse Practitioner | GA | |
| Nurse Practitioner | MI | |
| Nurse Practitioner | MI | |
| Nurse Practitioner | OH | |
| Nurse Practitioner | OH | |
| Physician Assistant | MI | |
| Nurse Practitioner | TN | |
| Nurse Practitioner | OH | |
| Nurse Practitioner | NC |
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