MALLORY LYNN PARK MSN, CRNP, FNP-C
NPI 1114755345
General Practice in Ridgway, PA
About Mallory Lynn Park Msn, Crnp, Fnp-c NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MALLORY LYNN PARK MSN, CRNP, FNP-C (NPI 1114755345) is an individual general practice provider in Ridgway, Pennsylvania, licensed in Pennsylvania (SP030067) and active in the NPI registry since July 2024. She is enrolled in Medicare PECOS and is a graduate of Other (2023).
NPPES Registry Identity
Specialties & Licenses 2
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Mallory Lynn Park Msn, Crnp, Fnp-c is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
Medicare Billing Reassignments
2Medicare enrollment records show Mallory Park reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Du Bois, PA 15801
- Reassigned Medicare billing, Pennsylvania enrollment
- 65 clinicians in this Medicare group
Liverpool, NY 13090
- Reassigned Medicare billing, Pennsylvania enrollment
- Medicare enrollment name: Wellnow Urgent Care, P.C.
- 56 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.
Areas of Expertise CMS Part B claims
Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.
Other Providers at the Same Location NPPES 4
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
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 Mallory Park's NPI number?
The NPI number for Mallory Park is 1114755345. It was assigned to this individual provider in the NPPES registry on July 22, 2024.
Where is Mallory Park located?
Mallory Park practices at 250 W Main St, Ridgway, PA 15853. The listed phone number is (814) 772-8122.
What is Mallory Park's specialty?
The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.
Is Mallory Park enrolled in Medicare?
Yes. Mallory Park is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
Which organizations bill Medicare for Mallory Park's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Mallory Park reassigns Medicare benefits to 2 organizations: Dubois Regional Medical Center (Du Bois, PA) and Wellnow Urgent Care, PC (Liverpool, NY). Each 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 Mallory Park'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 Mallory Park was last updated on July 22, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.
# Mallory Lynn Park, MSN, CRNP, FNP-C · NPI 1114755345
General Practice physician in Ridgway, Pennsylvania. Individual provider, active in the CMS NPPES registry since July 22, 2024.
## Identity
- **NPI:** 1114755345 (Entity type: Individual)
- **Enumerated:** July 22, 2024
- **Primary specialty:** General Practice · taxonomy 208D00000X
- **State license:** SP030067 (Pennsylvania)
- **Sole proprietor:** No
## Practice location
- **Address:** 250 W MAIN ST, Ridgway, PA 15853-1611
- **Phone:** (814) 772-8122
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** 2 organizations under Medicare reassignment (form CMS-855R): Dubois Regional Medical Center (NPI 1245410554, Du Bois, PA); Wellnow Urgent Care, PC (NPI 1669825162, Liverpool, NY) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2023
## Record status
- **NPPES last updated:** July 22, 2024
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Source: [NPI Profile](https://npiprofile.com/npi/1114755345) · Data from the CMS NPPES public registry.