MALLORY SHURTE TATE MD
NPI 1447644497
Specialist in San Diego, CA
About Mallory Shurte Tate Md NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MALLORY SHURTE TATE MD (NPI 1447644497) is an individual specialist in San Diego, California, licensed in California (A144255) and active in the NPI registry since March 2015. She is enrolled in Medicare PECOS and is a graduate of Louisiana State University School Of Medicine In New Orleans (2015).
NPPES Registry Identity
Specialties & Licenses 2
Other Names 1
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 Shurte Tate Md 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 Reassignment
Medicare enrollment records show Mallory Tate reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
San Diego, CA 92108
- Reassigned Medicare billing, California enrollment
- 13,921 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.
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.
SAN DIEGO, CA 92110
SAN DIEGO, CA 92110
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 Tate's NPI number?
The NPI number for Mallory Tate is 1447644497. It was assigned to this individual provider in the NPPES registry on March 26, 2015. The provider is also known as Mallory Susan Shurte MD.
Where is Mallory Tate located?
Mallory Tate practices at 3420 Kenyon St, San Diego, CA 92110. The listed phone number is (877) 496-0450.
What is Mallory Tate's specialty?
The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.
Is Mallory Tate enrolled in Medicare?
Yes. Mallory Tate 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 organization bills Medicare for Mallory Tate's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Mallory Tate reassigns Medicare benefits to Southern California Permanente Medical Group (San Diego, CA). 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 Mallory Tate'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 Tate was last updated on December 14, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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 Shurte Tate, MD · NPI 1447644497
Specialist provider in San Diego, California. Individual provider, active in the CMS NPPES registry since March 26, 2015.
## Identity
- **NPI:** 1447644497 (Entity type: Individual)
- **Enumerated:** March 26, 2015
- **Primary specialty:** Specialist · taxonomy 174400000X
- **State license:** A144255 (California)
- **Sole proprietor:** No
## Practice location
- **Address:** 3420 KENYON ST, San Diego, CA 92110-5001
- **Phone:** (877) 496-0450
## 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:** Southern California Permanente Medical Group (NPI 1023425972, San Diego, CA), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Louisiana State University School Of Medicine In New Orleans, class of 2015
## Record status
- **NPPES last updated:** December 14, 2021
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Source: [NPI Profile](https://npiprofile.com/npi/1447644497) · Data from the CMS NPPES public registry.