MALLORY LYNN PARK (MSN, CRNP, FNP-C) – General Practice Physician, NPI 1114755345
General Practice Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
11,473 NURSE PRACTITIONER in PA
Provider Addresses for MALLORY LYNN PARK (MSN, CRNP, FNP-C)
101 JENKS ST
BROOKVILLE, PA 158252303
Phone:
Type: Mailing
250 W MAIN ST
RIDGWAY, PA 158531611
Phone: (814) 772-8122
Type: Location
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 $33.
Total Amount is formed as General ($33) + Research ($0) + Ownership ($0) = $33.
Last reported payment date: 2024-11-19 • Largest payer in this snapshot: Lilly USA, LLC ($17).
Total Amount
$33
General + Research + Ownership
Payments
2
Total payment records
General Amount
$33
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-11-19
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Lilly USA, LLC | $17 |
| AstraZeneca Pharmaceuticals LP | $16 |
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: 2024-11-15
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 |
|---|---|---|---|---|
| I20241115004072 | I | Nurse Practitioner | PA | 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 15825)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Physician Assistant | PA | |
| - | PA | |
| - | PA | |
| - | PA | |
| Internal Medicine | MD | |
| Nurse Practitioner | PA | |
| - | PA | |
| Diagnostic Radiology | TX | |
| Physician Assistant | PA | |
| Internal Medicine | PA |
Reviews
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