JARED EMERSON MALLALIEU D.O.
NPI 1033393996
Surgery in Severna Park, MD
About Jared Emerson Mallalieu D.o. NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
JARED EMERSON MALLALIEU D.O. (NPI 1033393996) is an individual surgery provider in Severna Park, Maryland, licensed in Maryland (H68311) and active in the NPI registry since December 2007. He is enrolled in Medicare PECOS.
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 5
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Jared Emerson Mallalieu D.o. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Jared Mallalieu reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Severna Park, MD 21146
- Reassigned Medicare billing, Maryland enrollment
- 3 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 21146 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 3
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
SEVERNA PARK, MD 21146
SEVERNA PARK, MD 21146
SEVERNA PARK, MD 21146
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Jared Mallalieu's NPI number?
The NPI number for Jared Mallalieu is 1033393996. It was assigned to this individual provider in the NPPES registry on December 27, 2007.
Where is Jared Mallalieu located?
Jared Mallalieu practices at 484 Ritchie Hwy Ste A, Severna Park, MD 21146. The listed phone number is (410) 544-4600.
What is Jared Mallalieu's specialty?
The primary specialty registered for this NPI is Surgery with taxonomy code 208600000X.
Is Jared Mallalieu enrolled in Medicare?
Yes. Jared Mallalieu is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Jared Mallalieu's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Jared Mallalieu reassigns Medicare benefits to Ross Van Antwerp Do Mph PA Laser Center Of Maryland (Severna Park, MD). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Jared Mallalieu's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Jared Mallalieu was last updated on June 25, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Jared Emerson Mallalieu, D.O. · NPI 1033393996
Surgery physician in Severna Park, Maryland. Individual provider, active in the CMS NPPES registry since December 27, 2007.
## Identity
- **NPI:** 1033393996 (Entity type: Individual)
- **Enumerated:** December 27, 2007
- **Primary specialty:** Surgery · taxonomy 208600000X
- **State license:** H68311 (Maryland)
- **Sole proprietor:** No
## Practice location
- **Address:** 484 RITCHIE HWY STE A, Severna Park, MD 21146-2961
- **Phone:** (410) 544-4600 · **Fax:** (410) 544-0997
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** Ross Van Antwerp Do Mph PA Laser Center Of Maryland (NPI 1356537443, Severna Park, MD), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** June 25, 2015
- **Other identifiers:** Other 417363500 (MD); Other 1622382ZF69 (MD); Other 95050303 (MD); and 2 more
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Source: [NPI Profile](https://npiprofile.com/npi/1033393996) · Data from the CMS NPPES public registry.