MISS MALLORY KATHERINE WILLENBORG (PA-C) – Emergency Medicine Physician, NPI 1598213886
Emergency Medicine Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for MISS MALLORY KATHERINE WILLENBORG (PA-C)
1255, Northeast 95th Street, Miami Shores, Miami-Dade County, Florida, 33138, United States
MIAMI SHORES, FL 331382549
Phone: (305) 450-6031
Type: Mailing
400, Pepper Avenue, West Colton, Colton, San Bernardino County, California, 92324, United States
COLTON, CA 923241801
Phone: (909) 580-1000
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
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: 2016-12-13
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 |
|---|---|---|---|---|
| I20161213002443 | I | Physician Assistant | CA | 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 |
|---|---|---|---|---|
| 99285 | Emergency department visit with high level of medical decision making | 44 | 43 | $0 |
| 99284 | Emergency department visit with moderate level of medical decision making | 30 | 30 | $0 |
Insurance plans in this area (ZIP 33138)
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