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MALLORI MARIE WILSON
NPI 1174154553
Emergency Medicine in Agana Heights, GU

Active since February 04, 2020PECOS Enrolled
U.S. NAVAL HOSPITAL GUAM, AGANA HEIGHTS, GU 96910(671) 344-9340 Get Directions Write a Review

NPPES record last updated: June 9, 2025. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Jun 9, 2025, Jun 27, 2024, Apr 14, 2020 and 1 more (4 updates tracked since 2020).

About Mallori Marie Wilson NPPES

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

MALLORI MARIE WILSON (NPI 1174154553) is an individual emergency medicine provider in Agana Heights, Guam, licensed in Virginia (0101273537) and active in the NPI registry since February 2020. She is enrolled in Medicare PECOS and maintains a secondary practice location in Portsmouth.

NPPES Registry Identity

NPI1174154553
Entity TypeIndividualFemale
Primary Taxonomy207P00000X
Provider Legal NameMALLORI MARIE WILSON
Location AddressU.S. NAVAL HOSPITAL GUAMAgana Heights, GU 96910
Mailing AddressPsc 455 Box 208Fpo, AP 96540-0003 · (671) 344-9340
Phone(671) 344-9340
Sole ProprietorNo
Enumeration DateFebruary 4, 2020
Last NPPES UpdateJune 9, 20254 updates tracked since enumeration
NPPES CertifiedJune 9, 2025
✔ NPI 1174154553 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyEmergency MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207P00000X
Licenses✔ Licensed in VA · 0101273537✔ Licensed in GU · M-2478
Definition
An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury.

Secondary Practice Location 1

Location 1620 John Paul Jones CirPortsmouth, VA 23708-2111 · Phone (757) 953-0669

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mallori Marie Wilson 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.

Medicare Billing Reassignment

Medicare enrollment records show Mallori Wilson reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Guam Healthcare Development Incorporated
Clinic/Center
133 ROUTE 3
Dededo, GU 96929
  • Reassigned Medicare billing, Guam enrollment
  • 432 clinicians in this Medicare group
NPI 1326447939 (671) 645-5500

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 96910 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
$92.50 typical visit price
range $60.53 – $180.05
Typical copayment $23.12 (range $15.13 – $45.01)
Most-billed visit code 99203
Established Patient
$105.65 typical visit price
range $20.09 – $147.56
Typical copayment $26.41 (range $5.02 – $36.89)
Most-billed visit code 99214
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.

DR. EBENEZER ANIAGYEI PHARM.D
Pharmacist (Pharmacotherapy)
U.S. NAVAL HOSPITAL GUAM, FAREBHOLT AVE, BLDG 50
AGANA HEIGHTS, GU 96910
Guam (671) 344-9340
JAMIE LYNN FITCH M.D.
Surgery (Surgical Critical Care)
U.S. NAVAL HOSPITAL GUAM, FARENHOLT AVE, BLDG 50
AGANA HEIGHTS, GU 96910
Guam (671) 344-9235
MR. SHEEHAN MURPHY BYRNE LISW
Social Worker (Clinical)
U.S. NAVAL HOSPITAL GUAM, FARENHOLT AVE BLDG 50
AGANA HEIGHTS, GU 96910
Guam (671) 344-9463
RODGER BESLEY CARTER III DO
Family Medicine
U.S. NAVAL HOSPITAL GUAM, BLDG 50, FARENHOLT AVENUE
AGANA HEIGHTS, GU 96910
Guam (671) 344-9340
DR. ASHLEY ANN MARTIN DDS
Dentist
U.S. NAVAL HOSPITAL GUAM, BLDG 50, FARENHOLT AVENUE
AGANA HEIGHTS, GU 96910
Guam (671) 344-9340
DR. ELIZABETH GRACE CONLON MD
Family Medicine
U.S. NAVAL HOSPITAL GUAM, FARENHOLT AVE, BLDG 50
AGANA HEIGHTS, GU 96910
Guam (671) 344-9315
JUSTIN MICHAEL LODER PA-C
Physician Assistant
U.S. NAVAL HOSPITAL GUAM, FARENHOLT AVE, BLDG 50
AGANA HEIGHTS, GU 96910
Guam (671) 344-9315
DR. HENRY TAIT KEENAN MD
Pediatrics
U.S. NAVAL HOSPITAL GUAM, BLDG 50, FARENHOLT AVENUE
AGANA HEIGHTS, GU 96910
Guam (671) 344-9340

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 Mallori Wilson's NPI number?

The NPI number for Mallori Wilson is 1174154553. It was assigned to this individual provider in the NPPES registry on February 4, 2020.

Where is Mallori Wilson located?

Mallori Wilson practices at U.S. Naval Hospital Guam, Agana Heights, GU 96910. The listed phone number is (671) 344-9340.

What is Mallori Wilson's specialty?

The primary specialty registered for this NPI is Emergency Medicine with taxonomy code 207P00000X.

Is Mallori Wilson enrolled in Medicare?

Yes. Mallori Wilson is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Mallori Wilson's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Mallori Wilson reassigns Medicare benefits to Guam Healthcare Development Incorporated (Dededo, GU). 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 Mallori Wilson'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 Mallori Wilson was last updated on June 9, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 months 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.