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MALLORY FOSSA PNP-PC
NPI 1780059030
Anesthesiology - Pediatric Anesthesiology in Hartford, CT

Active since December 10, 2015PECOS Enrolled
282 WASHINGTON ST, HARTFORD, CT 06106(860) 837-5207 Get Directions Write a Review

NPPES record last updated: September 12, 2022. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Sep 12, 2022, Jul 12, 2019, Dec 10, 2015 (3 updates tracked since 2015).

About Mallory Fossa Pnp-pc NPPES

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

MALLORY FOSSA PNP-PC (NPI 1780059030) is an individual pediatric anesthesiology provider in Hartford, Connecticut, licensed in California (95003548) and active in the NPI registry since December 2015. She is enrolled in Medicare PECOS and maintains a secondary practice location in Los Angeles.

NPPES Registry Identity

NPI1780059030
Entity TypeIndividualFemale
Primary Taxonomy207LP3000X
Provider Legal NameMALLORY FOSSACredential: PNP-PC
Location Address282 WASHINGTON STHartford, CT 06106-3322
Mailing Address3701 Wilshire Blvd, Suite 600Los Angeles, CA 90010-2814 · (323) 361-3550 · Fax (323) 361-8502
Phone(860) 837-5207
Sole ProprietorYes
Enumeration DateDecember 10, 2015
Last NPPES UpdateSeptember 12, 20223 updates tracked since enumeration
NPPES CertifiedSeptember 12, 2022
✔ NPI 1780059030 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyAnesthesiology · Pediatric AnesthesiologyAllopathic & Osteopathic Physicians
Taxonomy Code207LP3000X
License✔ Licensed in CA · 95003548
Definition
An anesthesiologist who has had additional skill and experience in and is primarily concerned with the anesthesia, sedation, and pain management needs of infants and children. A pediatric anesthesiologist generally provides services including the evaluation of complex medical problems in infants and children when surgery is necessary, planning and care for children before and after surgery, pain control, anesthesia and sedation for any procedures out of the operating room such as MRI, CT scan, and radiation therapy.
Also ListedNurse Practitioner · PediatricsTaxonomy 363LP0200X · License 95003548 (CA), 12.008276 (CT)
282 WASHINGTON ST, Hartford, CT 06106
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Secondary Practice Location 1

Location 14650 W Sunset Blvd, MS #12; 4th Floor McAllister BuildingLos Angeles, CA 90027-6062 · Phone (323) 361-7686

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mallory Fossa Pnp-pc 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 Mallory Fossa reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Yale University
31 mi
Adult Mental Health
95 CIRCULAR AVE
Hamden, CT 06514
  • Reassigned Medicare billing, Connecticut enrollment
  • 3,728 clinicians in this Medicare group
NPI 1134391824 (203) 288-6253

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 06106 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
$138.84 typical visit price
range $60.82 – $183.10
Typical copayment $34.71 (range $15.20 – $45.77)
Most-billed visit code 99204
Established Patient
$75.55 typical visit price
range $19.76 – $149.26
Typical copayment $18.88 (range $4.94 – $37.31)
Most-billed visit code 99213
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. IRFAN AHMED WARSY MBBS
Pediatrics (Pediatric Cardiology)
282 WASHINGTON ST
HARTFORD, CT 06106
Capitol Planning Region (860) 545-9147
RYAN CIARLO MD
Pediatrics
282 WASHINGTON ST
HARTFORD, CT 06106
Capitol Planning Region (860) 837-5560
EUNICE HA-YOUNG KIM
Student in an Organized Health Care Education/Training Program
282 WASHINGTON ST
HARTFORD, CT 06106
Capitol Planning Region (860) 545-8340
JAMES HAGADORN MD
Pediatrics (Neonatal-Perinatal Medicine)
282 WASHINGTON ST
HARTFORD, CT 06106
Capitol Planning Region (860) 545-8950
CRAIG SCHRAMM MD
Pediatrics (Pediatric Pulmonology)
282 WASHINGTON ST
HARTFORD, CT 06106
Capitol Planning Region (860) 545-9440
NICOLE LYNN BOONE PA
Physician Assistant (Surgical)
282 WASHINGTON ST
HARTFORD, CT 06106
Capitol Planning Region (860) 545-9000
SRAVYA GOURISHETTI
Student in an Organized Health Care Education/Training Program
282 WASHINGTON ST
HARTFORD, CT 06106
Capitol Planning Region (860) 545-9000
SARAH FULLER MD
Emergency Medicine
282 WASHINGTON ST
HARTFORD, CT 06106
Capitol Planning Region (860) 545-9000

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 Fossa's NPI number?

The NPI number for Mallory Fossa is 1780059030. It was assigned to this individual provider in the NPPES registry on December 10, 2015.

Where is Mallory Fossa located?

Mallory Fossa practices at 282 Washington St, Hartford, CT 06106. The listed phone number is (860) 837-5207.

What is Mallory Fossa's specialty?

The primary specialty registered for this NPI is Anesthesiology, specializing in Pediatric Anesthesiology, with taxonomy code 207LP3000X.

Is Mallory Fossa enrolled in Medicare?

Yes. Mallory Fossa is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Mallory Fossa's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Mallory Fossa reassigns Medicare benefits to Yale University (Hamden, CT). 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 Fossa'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 Fossa was last updated on September 12, 2022. 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.