MALLORI WISURI HATHAWAY PA-C
NPI 1861019689
Physician Assistant in Scottsburg, IN

Q: What is Mallori Hathaway's NPI number?

The NPI number for Mallori Hathaway is 1861019689. It was assigned to this individual provider in the NPPES registry on June 27, 2020. The provider is also known as Mallori Greer Wisuri.

Q: What is Mallori Hathaway's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Q: When was this NPI record last updated?

The NPPES record for Mallori Hathaway was last updated on November 12, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 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.

Active since June 27, 2020PECOS EnrolledAccepts Medicare Assignment

92.35/100

CMS Quality Rating

1428 N GARDNER ST, SCOTTSBURG, IN 47170(812) 752-3512(812) 752-8593 Get Directions Write a Review

NPPES record last updated: November 12, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Nov 12, 2025, Jun 19, 2025, Sep 17, 2021 and 4 more (7 updates tracked since 2020).

On this page

About Mallori Wisuri Hathaway Pa-c NPPES

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

MALLORI WISURI HATHAWAY PA-C (NPI 1861019689) is an individual physician assistant in Scottsburg, Indiana, licensed in Indiana (10003222A) and active in the NPI registry since June 2020. She is enrolled in Medicare PECOS, is affiliated with Ascension St Vincent Salem, and maintains 7 additional practice locations.

NPPES Registry Identity

NPI1861019689

Entity TypeIndividualFemale

Primary Taxonomy363A00000X

Provider Legal NameMALLORI WISURI HATHAWAYCredential: PA-C

Location Address1428 N GARDNER STScottsburg, IN 47170-8720

Mailing Address801 York StManitowoc, WI 54220-4630 · (920) 663-9008 · Fax (920) 684-1439

Phone(812) 752-3512

Fax(812) 752-8593

Sole ProprietorNo

Medical School CMSOtherGraduated 2021

Enumeration DateJune 27, 2020

Last NPPES UpdateNovember 12, 20257 updates tracked since enumeration

NPPES CertifiedNovember 12, 2025

✔ NPI 1861019689 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363A00000X

License✔ Licensed in IN · 10003222A

Definition

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

1428 N GARDNER ST, Scottsburg, IN 47170

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Other Names 1

Former Name (1)Mallori Greer Wisuri

Secondary Practice Locations 7

Location 1505 W Homer St Ste 201Salem, IN 47167-1698 · Phone (812) 883-0024 · Fax (812) 883-8574

Location 2415 S Landmark AveBloomington, IN 47403-5003 · Phone (812) 333-7433 · Fax (812) 733-7435

Location 3911 N Shelby StSalem, IN 47167-2304 · Phone (812) 883-8527 · Fax (812) 883-8574

Location 42130 W Sycamore St Ste 200Kokomo, IN 46901-6461 · Phone (765) 457-4455 · Fax (765) 457-0056

Location 51263 Hospital Dr NW Ste 100Corydon, IN 47112-2173 · Phone (812) 783-2054 · Fax (812) 733-7838

Location 6303 S Walnut StSeymour, IN 47274-2368 · Phone (812) 358-7705 · Fax (888) 254-0293

Location 7244 Westwood BlvdColumbus, IN 47201-5687 · Phone (812) 669-0141 · Fax (888) 358-7705

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter from Meridian, Ambetter Health and more.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Mallori Wisuri Hathaway Pa-c 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.

PECOS PAC ID5294143251

PECOS Enrollment IDI20210413001214

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.

Areas of Expertise CMS Part B claims 17

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Aminolevulinic acid hcl for topical administration, 10% gel, 10 mg J7345

Aminolevulinic acid hcl is a topical gel used to treat certain skin conditions. It works by making affected skin cells more sensitive to light, which is then used to destroy these cells. The gel is applied by a healthcare professional.

5,800 services27 patients

Destruction of precancer skin growth, 2-14 growths 17003

This procedure involves removing 2-14 precancerous skin growths. The growths are treated to prevent them from potentially developing into skin cancer. The process is safe, with minimal discomfort, and promotes healthier skin.

1,402 services231 patients

Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213

This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.

847 services606 patients

Destruction of precancer skin growth, 1 growth 17000

"Destruction of precancer skin growth" is a procedure that eliminates a single precancerous skin growth. This is done to prevent it from developing into skin cancer. The growth may be removed using various methods such as cryotherapy (freezing), laser therapy, or topical medications.

454 services331 patients

Destruction of skin growth, 1-14 growths 17110

"Destruction of skin growth" refers to a procedure where 1-14 abnormal skin growths are removed. This is done using methods such as freezing, burning, or laser therapy. It helps prevent the growth from causing discomfort or turning into a more serious condition.

306 services230 patients

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214

This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.

146 services114 patients

Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more 99212

This is a routine check-up for patients who have previously seen the doctor. During this 10-19 minute visit, the doctor will review your health status, discuss any concerns, and manage ongoing treatments or medications. It's a chance to ensure your health is on track.

144 services124 patients

Biopsy of related skin growth, first growth 11102

A biopsy of a skin growth involves taking a small sample of the growth to examine it under a microscope. This helps determine if the growth is harmful. The procedure is typically quick, with minimal discomfort. It's a crucial step in ensuring your skin's health.

140 services134 patients

New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more 99203

This service involves an initial office or outpatient visit for a new patient. The healthcare professional will spend 30-44 minutes understanding your health history, current issues, and discussing possible treatment plans. It's a comprehensive evaluation to start your healthcare journey.

119 services119 patients

New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more 99204

This is a first-time office or outpatient visit lasting between 45-59 minutes. The healthcare provider evaluates your health, discusses your medical history, and may suggest further tests or treatments. It's an opportunity to ask questions and understand your health better.

55 services55 patients

Destruction of skin growth, 15 or more growths 17111

"Destruction of skin growth" refers to a procedure where unwanted skin growths, such as warts or moles, are removed. In this case, 15 or more growths are treated. Techniques may include freezing, burning, or laser therapy. It's a safe, quick process to improve skin health.

50 services31 patients

Application of light with debridement to destroy precancer skin growth 96574

This procedure involves applying a special light source to the skin after removing dead tissue (debridement). The light helps destroy precancerous growths, preventing them from developing into skin cancer. It's a safe and effective method to keep your skin healthy.

47 services27 patients

Destruction of precancer skin growth, 15 or more growths 17004

This procedure involves removing 15 or more precancerous skin growths to prevent them from developing into cancer. It's done using various methods like freezing, creams, or minor surgery. The goal is to protect your health by stopping cancer before it starts.

45 services34 patients

Biopsy of related skin growth, each additional growth 11103

A biopsy of related skin growth is a procedure where a small piece of skin growth is removed for testing. If additional growths are identified, they may also be biopsied. This helps in diagnosing skin conditions and planning appropriate treatment.

42 services28 patients

New patient office or other outpatient visit with straightforward medical decision making, if using time, 15 minutes or more 99202

This service involves an initial visit to the doctor's office or other outpatient setting. It typically lasts between 15-29 minutes. The doctor will review your medical history, conduct a physical examination, and discuss your health concerns. It's a chance to establish your health baseline and address any immediate medical issues.

29 services29 patients

Injection, triamcinolone acetonide, not otherwise specified, 10 mg J3301

Triamcinolone acetonide is a medication used to reduce inflammation in the body. It's given as a 10 mg injection for conditions like allergies, arthritis, or skin problems. The injection helps to decrease swelling, redness, and itching.

19 services13 patients

Injection into skin growth, 1-7 growths 11900

This procedure involves injecting medication into 1-7 skin growths. The medication helps to reduce the size of the growths or completely eliminate them. It's a simple, quick, and usually painless process performed by a medical professional.

18 services13 patients

Hospital Affiliations CMS Care Compare

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

Ascension St Vincent Salem

Critical Access Hospitals · Salem, IN

OwnershipVoluntary non-profit - Private

CMS Certification Number151314

Location911 N Shelby StSalem, IN 47167 · Washington County

Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 47170 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

$82.04 typical visit price

range $53.07 – $161.76

Typical copayment $20.51 (range $13.26 – $40.44)

Most-billed visit code 99203

Established Patient

$66.48 typical visit price

range $16.93 – $132.22

Typical copayment $16.62 (range $4.23 – $33.05)

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.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

92.35/100

MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program

Individually scored

Quality

88.53

Promoting Interoperability

Improvement Activities

Reported Quality Measures

Advance Care Plan

99%1,435 patients4/55-star benchmark: 100%

Immunizations for Adolescents

Patients HPV: 93% · 42 patients

Patients meningococcal: 95% · 42 patients

Patients Tdap: 95% · 42 patients

93%42 patients

Melanoma: Continuity of Care - Recall System

100%154 patients

Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention

Patients combinedPopulations: 99% · 1,323 patients

Patients screened: 99% · 1,323 patients

98%250 patients4/55-star benchmark: 100%

Provide Patients Electronic Access to Their Health Information

74%1,630 patients3/55-star benchmark: 100%

Tobacco Use and Help with Quitting Among Adolescents

100%488 patients5/55-star benchmark: 100%

Providers report different measures because they deliver different services; reporting more or less information is not a reflection of quality. Star ratings appear only where CMS assigned them.

Other Providers at the Same Location NPPES 5

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

FOREFRONT DERMATOLOGY, S.C.

Dermatology