MALLORI WISURI HATHAWAY (PA-C) – Physician Assistant, NPI 1861019689
Physician Assistant
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Profile Insights
NPPES metrics only — not quality of care.
2,499 PHYSICIAN ASSISTANT in IN
Provider Addresses for MALLORI WISURI HATHAWAY (PA-C)
801 YORK ST
MANITOWOC, WI 542204630
Phone: (920) 663-9008
Fax: (920) 684-1439
Type: Mailing
1428 N GARDNER ST
SCOTTSBURG, IN 471708720
Phone: (812) 752-3512
Fax: (812) 752-8593
Type: Location
14505 OLD 24 E
NEW HAVEN, IN 467749013
Phone:
Type: Mailing
244 Westwood Blvd
Columbus, IN 472015687
Phone: (812) 669-0141
Fax: (888) 358-7705
Type: Location
303 S Walnut St
Seymour, IN 472742368
Phone: (812) 358-7705
Fax: (888) 254-0293
Type: Location
415 S Landmark Ave
Bloomington, IN 474035003
Phone: (812) 333-7433
Fax: (812) 733-7435
Type: Location
505 W Homer St Ste 201
Salem, IN 471671698
Phone: (812) 883-0024
Fax: (812) 883-8574
Type: Location
911 N Shelby St
Salem, IN 471672304
Phone: (812) 883-8527
Fax: (812) 883-8574
Type: Location
2130 W Sycamore St Ste 200
Kokomo, IN 469016461
Phone: (765) 457-4455
Fax: (765) 457-0056
Type: Location
1263 Hospital Dr NW Ste 100
Corydon, IN 471122173
Phone: (812) 783-2054
Fax: (812) 733-7838
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 58 Open Payments records for all available years, with a total value of $1,038.
Total Amount is formed as General ($1,038) + Research ($0) + Ownership ($0) = $1,038.
Last reported payment date: 2024-12-19 • Largest payer in this snapshot: ABBVIE INC. ($348).
Total Amount
$1,038
General + Research + Ownership
Payments
58
Total payment records
General Amount
$1,038
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-12-19
Latest reported date
Top Companies
Largest payers in this snapshot
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: 2021-04-13
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 |
|---|---|---|---|---|
| I20210413001214 | I | Physician Assistant | IN | 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.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| J7345 | Aminolevulinic acid hcl for topical administration, 10% gel, 10 mg | 8,800 | 36 | $0 |
| 17003 | Destruction of precancer skin growth, 2-14 growths | 1,660 | 250 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 788 | 592 | $0 |
| 17000 | Destruction of precancer skin growth, 1 growth | 451 | 337 | $0 |
| 17110 | Destruction of skin growth, 1-14 growths | 305 | 249 | $0 |
Insurance plans in this area (ZIP 54220)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | WI | |
| Physician Assistant | VA | |
| - | VA | |
| D E R M A T O L O G Y | TX | |
| - | WI | |
| D E R M A T O L O G Y | AL | |
| D E R M A T O L O G Y | WI | |
| - | WI | |
| Physician Assistant | NY | |
| D E R M A T O L O G Y | WA |
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