MALLORY RICH SHATLOCK NURSE PRACTITIONER
NPI 1548728249
Nurse Practitioner in Winston Salem, NC
About Mallory Rich Shatlock Nurse Practitioner NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MALLORY RICH SHATLOCK NURSE PRACTITIONER (NPI 1548728249) is an individual nurse practitioner in Winston Salem, North Carolina, licensed in North Carolina (5021115) and active in the NPI registry since March 2019. She is enrolled in Medicare PECOS, is affiliated with Novant Health Forsyth Medical Center, and maintains a secondary practice location in Birmingham.
NPPES Registry Identity
Specialties & Licenses 2
Secondary Practice Location 1
Accepted Insurance
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 Rich Shatlock Nurse Practitioner 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 Reassignments
2Medicare enrollment records show Mallory Shatlock reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Winston Salem, NC 27103
- Reassigned Medicare billing, North Carolina enrollment
- 2,998 clinicians in this Medicare group
Birmingham, AL 35294
- Reassigned Medicare billing, Alabama enrollment
- 4,494 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.
Hospital Affiliations CMS Care Compare
Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.
Novant Health Forsyth Medical Center
Acute Care Hospitals · Winston-Salem, NCPhysician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 27103 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 16
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
WINSTON SALEM, NC 27103
WINSTON SALEM, NC 27103
WINSTON SALEM, NC 27103
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 Shatlock's NPI number?
The NPI number for Mallory Shatlock is 1548728249. It was assigned to this individual provider in the NPPES registry on March 12, 2019.
Where is Mallory Shatlock located?
Mallory Shatlock practices at 190 Kimel Park Dr Ste 155, Winston Salem, NC 27103. The listed phone number is (336) 765-6637.
What is Mallory Shatlock's specialty?
The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.
Is Mallory Shatlock enrolled in Medicare?
Yes. Mallory Shatlock 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 organizations bill Medicare for Mallory Shatlock's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Mallory Shatlock reassigns Medicare benefits to 2 organizations: Novant Health Medical Group, LLC (Winston Salem, NC) and University Of Alabama Health Services Foundation, PC (Birmingham, AL). Each 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 Shatlock's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Mallory Shatlock accept?
Health plans from Blue Cross and Blue Shield of NC list Mallory Shatlock as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
Is Mallory Shatlock affiliated with any hospitals?
According to CMS data, Mallory Shatlock is affiliated with Novant Health Forsyth Medical Center.
When was this NPI record last updated?
The NPPES record for Mallory Shatlock was last updated on December 30, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 22 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.
# Mallory Rich Shatlock, NURSE PRACTITIONER · NPI 1548728249
Nurse Practitioner physician in Winston Salem, North Carolina. Individual provider, active in the CMS NPPES registry since March 12, 2019.
## Identity
- **NPI:** 1548728249 (Entity type: Individual)
- **Enumerated:** March 12, 2019
- **Primary specialty:** Nurse Practitioner · taxonomy 363L00000X
- **State license:** 5021115 (North Carolina)
- **Sole proprietor:** No
## Practice location
- **Address:** 190 KIMEL PARK DR STE 155, Winston Salem, NC 27103-6946
- **Phone:** (336) 765-6637 · **Fax:** (336) 765-6964
## 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:** 2 organizations under Medicare reassignment (form CMS-855R): Novant Health Medical Group, LLC (NPI 1023349404, Winston Salem, NC); University Of Alabama Health Services Foundation, PC (NPI 1366638330, Birmingham, AL) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2020
## Record status
- **NPPES last updated:** December 30, 2024
---
Source: [NPI Profile](https://npiprofile.com/npi/1548728249) · Data from the CMS NPPES public registry.