DR. MALLORY WEAVER DO
NPI 1376235861
Student in an Organized Health Care Education/Training Program in Peoria, IL

Q: What is Mallory Weaver's NPI number?

The NPI number for Mallory Weaver is 1376235861. It was assigned to this individual provider in the NPPES registry on May 23, 2023.

Q: What is Mallory Weaver's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Q: When was this NPI record last updated?

The NPPES record for Mallory Weaver was last updated on May 23, 2023. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since May 23, 2023PECOS Enrolled

815 MAIN ST STE C, PEORIA, IL 61602(309) 672-4977 Get Directions Write a Review

NPPES record last updated: May 23, 2023. Verified against the NPPES registry weekly; last sync: July 19, 2026.

On this page

About Dr. Mallory Weaver Do NPPES

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

DR. MALLORY WEAVER DO (NPI 1376235861) is an individual student in an organized health care education/training program in Peoria, Illinois, licensed in (90200000X) and active in the NPI registry since May 2023. She is enrolled in Medicare PECOS, is affiliated with Methodist Medical Center Of Illinois, and is a graduate of At Still Un Of Hlth Sciences, Col Of Osteo Med, Mesa (2023).

NPPES Registry Identity

NPI1376235861

Entity TypeIndividualFemale

Primary Taxonomy390200000X

Provider Legal NameDR. MALLORY WEAVERCredential: DO

Location Address815 MAIN ST STE CPeoria, IL 61602-1080

Mailing Address1179 N Bluff Lake DrEast Peoria, IL 61611-1281

Phone(309) 672-4977

Sole ProprietorYes

Medical School CMSAt Still Un Of Hlth Sciences, Col Of Osteo Med, MesaGraduated 2023

Enumeration DateMay 23, 2023

NPPES CertifiedMay 23, 2023

✔ NPI 1376235861 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care

Taxonomy Code390200000X

License✔ Licensed · 90200000X

Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

815 MAIN ST STE C, Peoria, IL 61602

Open in Google Maps ↗

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

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

PECOS PAC ID4082195185

PECOS Enrollment IDI20260526000172

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.

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Methodist Medical Center Of Illinois

Acute Care Hospitals · Peoria, IL

2/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number140209

Location221 N E Glen Oak AvePeoria, IL 61636 · Peoria County

Emergency services Birthing friendly

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.

JEFFREY S. LEMAN MD

Family Medicine