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MALLORY BOURG
NPI 1164816831
Physician Assistant in Baton Rouge, LA

Active since March 20, 2015PECOS Enrolled
7777 HENNESSY BLVD, SUITE 701, BATON ROUGE, LA 70808(225) 765-5864(225) 765-2013 Get Directions Write a Review

NPPES record last updated: September 29, 2023. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Mallory Bourg NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MALLORY BOURG (NPI 1164816831) is an individual physician assistant in Baton Rouge, Louisiana, licensed in Louisiana (200789) and active in the NPI registry since March 2015. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1164816831
Entity TypeIndividualFemale
Primary Taxonomy363A00000X
Provider Legal NameMALLORY BOURG
Location Address7777 HENNESSY BLVD, SUITE 701Baton Rouge, LA 70808-4300
Mailing Address5959 S Sherwood Forest BlvdBaton Rouge, LA 70816-6038 · (225) 526-0006 · Fax (225) 765-9291
Phone(225) 765-5864
Fax(225) 765-2013
Sole ProprietorNo
Enumeration DateMarch 20, 2015
Last NPPES UpdateSeptember 29, 2023
NPPES CertifiedSeptember 29, 2023
✔ NPI 1164816831 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
License✔ Licensed in LA · 200789
Definition
A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.
7777 HENNESSY BLVD, Baton Rouge, LA 70808
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mallory Bourg is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

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.

Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213
This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
11 services11 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 70808 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$83.60 typical visit price
range $53.43 – $164.73
Typical copayment $20.90 (range $13.35 – $41.18)
Most-billed visit code 99203
Established Patient
$67.06 typical visit price
range $16.64 – $133.62
Typical copayment $16.76 (range $4.16 – $33.40)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

SARA ADAMS MARTIN MD
Anesthesiology
7777 HENNESSY BLVD, SUITE 301
BATON ROUGE, LA 70808
East Baton Rouge Parish (225) 214-6438
CELESTE BUUCK FNP
Nurse Practitioner
7777 HENNESSY BLVD, SUITE 1000
BATON ROUGE, LA 70808
East Baton Rouge Parish (225) 767-3900
PAMELA STANLEY NP
Nurse Practitioner (Acute Care)
7777 HENNESSY BLVD, SUITE 701
BATON ROUGE, LA 70808
East Baton Rouge Parish (225) 765-5864
EYE SPECIALISTS EYEWEAR
Durable Medical Equipment & Medical Supplies
7777 HENNESSY BLVD, SUITE 5000
BATON ROUGE, LA 70808
East Baton Rouge Parish (225) 768-7777
DR. JOHN MCALISTER WHITAKER M.D.
Surgery
7777 HENNESSY BLVD, SUITE 612
BATON ROUGE, LA 70808
East Baton Rouge Parish (225) 769-5656
PAULLA DANIELLE BROUILLETTE PA
Physician Assistant
7777 HENNESSY BLVD, OUR LADY OF THE LAKE MED CNTR -- ER DEPT
BATON ROUGE, LA 70808
East Baton Rouge Parish (888) 447-2450
OUR LADY OF THE LAKE ADVANCED HEALTH SOLUTIONS
Surgery
7777 HENNESSY BLVD, SUITE 612
BATON ROUGE, LA 70808
East Baton Rouge Parish (225) 769-5656
AMY MARTIN MCMILLAN CRNA
Nurse Anesthetist, Certified Registered
7777 HENNESSY BLVD, SUITE 301
BATON ROUGE, LA 70808
East Baton Rouge Parish (225) 214-6438

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 Bourg's NPI number?

The NPI number for Mallory Bourg is 1164816831. It was assigned to this individual provider in the NPPES registry on March 20, 2015.

Where is Mallory Bourg located?

Mallory Bourg practices at 7777 Hennessy Blvd Suite 701, Baton Rouge, LA 70808. The listed phone number is (225) 765-5864.

What is Mallory Bourg's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Is Mallory Bourg enrolled in Medicare?

Yes. Mallory Bourg is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Mallory Bourg was last updated on September 29, 2023. 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.