CAROLYN T MALLILLIN MD
NPI 1194719971
Family Medicine in Louisville, KY

Q: What is Carolyn Mallillin's NPI number?

The NPI number for Carolyn Mallillin is 1194719971. It was assigned to this individual provider in the NPPES registry on September 7, 2005.

Q: What is Carolyn Mallillin's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Q: When was this NPI record last updated?

The NPPES record for Carolyn Mallillin was last updated on January 14, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.

Active since September 07, 2005PECOS Enrolled

1900 BLUEGRASS AVE STE 300, LOUISVILLE, KY 40215(502) 361-1222 Get Directions Write a Review

NPPES record last updated: January 14, 2021. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About Carolyn T Mallillin Md NPPES

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

CAROLYN T MALLILLIN MD (NPI 1194719971) is an individual family medicine provider in Louisville, Kentucky, licensed in Wisconsin (45207) and active in the NPI registry since September 2005. She is enrolled in Medicare PECOS and maintains a secondary practice location in Poplar Bluff.

NPPES Registry Identity

NPI1194719971

Entity TypeIndividualFemale

Primary Taxonomy207Q00000X

Provider Legal NameCAROLYN T MALLILLINCredential: MD

Location Address1900 BLUEGRASS AVE STE 300Louisville, KY 40215-1183

Mailing Address174 China Blue LnCape Girardeau, MO 63701-3800

Phone(502) 361-1222

Sole ProprietorNo

Enumeration DateSeptember 7, 2005

Last NPPES UpdateJanuary 14, 2021

NPPES CertifiedJanuary 14, 2021

✔ NPI 1194719971 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207Q00000X

License✔ Licensed in WI · 45207

Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

1900 BLUEGRASS AVE STE 300, Louisville, KY 40215

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Secondary Practice Location 1

Location 11500 N Westwood BlvdPoplar Bluff, MO 63901-3318 · Phone (573) 686-4151

Other Identifiers 1

Medicaid34336500WI

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Carolyn T Mallillin Md 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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 40215 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

$82.24 typical visit price

range $52.76 – $162.27

Typical copayment $20.56 (range $13.19 – $40.56)

Most-billed visit code 99203

Established Patient

$93.94 typical visit price

range $16.53 – $131.99

Typical copayment $23.48 (range $4.13 – $32.99)

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 9

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

LADY CHRISTINE LIM ONG SIO MD

Pain Medicine (Interventional Pain Medicine)