MALLORY MILLER PENDERGRASS AG-ACNP
NPI 1629475348
Nurse Practitioner - Acute Care in Jackson, TN

NPI Status: Active since November 24, 2014

Contact Information

620 SKYLINE DR
JACKSON, TN
ZIP 38301
Phone: (731) 541-6900

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  • Individual
  • Female
  • Nurse Practitioner
  • Acute Care
  • PECOS Enrolled

About MALLORY PENDERGRASS

This page provides the complete NPI Profile along with additional information for Mallory Pendergrass, a provider established in Jackson, Tennessee with a medical specialization in Nurse Practitioner, focusing in acute care . The healthcare provider is registered in the NPI registry with number 1629475348 assigned on November 2014. The practitioner's primary taxonomy code is 363LA2100X with license number 19221 (TN). The provider is registered as an individual and her NPI record was last updated July 2025.

NPI
1629475348
Provider Name
MALLORY MILLER PENDERGRASS AG-ACNP
Gender
Female
Entity Type
Individual
Location Address
620 SKYLINE DR JACKSON, TN 38301
Location Phone
(731) 541-6900
Mailing Address
620 SKYLINE DR JACKSON, TN 38301
Mailing Phone
(731) 541-0249
Is Sole Proprietor?
No
Enumeration Date
11-24-2014
Last Update Date
07-21-2025
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A nurse practitioner (NP) like Mallory Pendergrass is an experienced registered nurse with a master’s or doctoral degree and advanced clinical training. Nurse practitioners can work in many different specialties including primary care, pediatrics, cardiology, emergency, women’s health, oncology or geriatrics. Nurse practitioners provide services like physical exams, order laboratory tests, manage diseases, write prescriptions, etc.

Location Map

Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification

Nurse Practitioner Acute Care

Taxonomy Code
363LA2100X
Type
Physician Assistants & Advanced Practice Nursing Providers
License No.
19221
License State
TN

Medicare Participation & PECOS Enrollment Status

Mallory Pendergrass is enrolled in PECOS and is eligible to order or refer health care services for Medicare patients. The provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.

What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.

  • Is the provider registered in PECOS? Yes

  • Eligible to Order or Refer Part B Clinical Laboratory and Imaging: Yes

  • Eligible to Order or Refer Durable Medical Equipment (DMEPOS): Yes

  • Eligible to Order or Refer a Home Health Agency (HHA): Yes

  • Eligible to Order or Refer Power Mobility Devices: Yes

Areas of Expertise

The following services and procedures, recently provided to Medicare patients, illustrate the range of care this provider offers. This list reflects the variety of services available to all patients visiting the practice and is based on 2022 Medicare dataset. In general, the more frequently a provider treats specific conditions or performs particular procedures, the more experienced they become in addressing similar patient needs. The provider has delivered many of the services listed below to Medicare patients. Please note that this list does not include services provided to patients who are not covered by Medicare.

Critical care, first 30-74 minutes

Critical care involves immediate and constant attention by a team of specially-trained health professionals. It's for patients with life-threatening conditions, requiring first 30-74 minutes of intense monitoring and treatment.

This service was performed 130 times for 71 patients

Follow-up hospital inpatient care per day, typically 25 minutes

Follow-up hospital inpatient care involves daily check-ups while you're admitted in the hospital. Typically, a healthcare provider spends about 25 minutes each day reviewing your condition, adjusting treatment if needed, and answering any questions you might have.

This service was performed 68 times for 58 patients

Follow-up hospital inpatient care per day, typically 35 minutes

Follow-up hospital inpatient care per day typically involves a 35-minute check-up by your healthcare provider. This service includes monitoring your health progress, adjusting your treatment plan if needed, and answering any questions you may have about your condition or care.

This service was performed 62 times for 33 patients

Initial hospital inpatient care per day, typically 70 minutes

Initial hospital inpatient care per day, typically 70 minutes, refers to the daily medical service provided to patients admitted to the hospital. This includes a comprehensive evaluation, diagnosis, treatment plan, and monitoring of your health condition. It ensures your well-being during your hospital stay.

This service was performed 29 times for 28 patients

Physician Visit Costs

The pricing information below displays the copayment minimum, maximum and average amount that patients under Medicare are charged when visiting this provider as a new or established patient. Please keep in mind that these prices are just for reference purposes, and the actual prices charged by the provider might be different.

For patients covered under private health plans the prices below are also useful as healthcare pricing for private insurance is usually established as a function of Medicare prices. Private insurance covered patients should check their individual plans to determine the exact pricing.

The prices below reflect the costs for new and established patients in the 38301 ZIP code area.

New Patients Visit Costs *

The most utilized procedure code for new patients office visits is 99203

  • Average New Patient Price $81.53
  • Minimum New Patient Price $52.64
  • Maximum New Patient Price $160.89
  • Average New Patient Copayment $20.38
  • Minimum New Patient Copayment $13.16
  • Maximum New Patient Copayment $40.22

Established Patients Visit Costs *

The most utilized procedure code for established patients office visits is 99214

  • Average Established Patient Price $93.6
  • Minimum Established Patient Price $16.72
  • Maximum Established Patient Price $131.41
  • Average Established Patient Copayment $23.4
  • Minimum Established Patient Copayment $4.18
  • Maximum Established Patient Copayment $32.85

* The physician office visit costs information is generated by statistical analysis of similar providers in the same geographical area. The pricing information above IS NOT the amount charged by this provider.

Reviews for MALLORY MILLER PENDERGRASS AG-ACNP

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NPI Validation Check Digit Calculation


The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.

Start with the original NPI number, the last digit is the check digit and is not used in the calculation.
1629475348
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
2649871038
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 6 + 4 + 9 + 8 + 7 + 1 + 0 + 3 + 8 + 24 = 72
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
80 - 72 = 88

The NPI number 1629475348 is valid because the calculated check digit 8 using the Luhn validation algorithm matches the last digit of the original NPI number.

Other Providers at the Same Location


The following 20 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1821094608 JULIE A MCBROOM CRNA
Individual
Nurse Anesthetist, Certified Registered620 SKYLINE DR
JACKSON, TN 38301
(731) 668-1853
1730162876DR. NATHAN JOHN HOELDTKE M.D.
Individual
Obstetrics & Gynecology (Maternal & Fetal Medicine)620 SKYLINE DR MID-SOUTH PERINATAL ASSOCIATES
JACKSON, TN 38301
(731) 541-6939
1811967961MR. CARL WILLIAM SISCO CRNA
Individual
Nurse Anesthetist, Certified Registered620 SKYLINE DR
JACKSON, TN 38301
(731) 541-7070
1346275906 PRISCILLA SIOSON-AHERRERA MD
Individual
Internal Medicine (Infectious Disease)620 SKYLINE DR
JACKSON, TN 38301
(731) 541-6472
1942225727JACKSON MADISON COUNTY GENERAL HOSPITAL
Organization
General Acute Care Hospital620 SKYLINE DR
JACKSON, TN 38301
(731) 541-5000
1982623591 JULIE TAN ANTIQUE MD
Individual
Internal Medicine (Infectious Disease)620 SKYLINE DR
JACKSON, TN 38301
(731) 541-6472
1972603785DR. ANASTASIOS L GEORGIOU M.D.
Individual
Radiology (Radiation Oncology)620 SKYLINE DR RADIATION ONCOLOGY DEPT
JACKSON, TN 38301
(731) 541-6250
1649418427DR. HANS S BEZ D.O.
Individual
Emergency Medicine620 SKYLINE DR
JACKSON, TN 38301
(731) 541-6574
1821226218 SHELLEY JELINEK CRNA
Individual
Nurse Anesthetist, Certified Registered620 SKYLINE DR
JACKSON, TN 38301
(731) 668-1853
1497983878 DANA WILSON RN
Individual
Nurse Anesthetist, Certified Registered620 SKYLINE DR
JACKSON, TN 38301
(731) 668-1853
1689981896MRS. CHERYL L HARPER CRNA
Individual
Nurse Anesthetist, Certified Registered620 SKYLINE DR
JACKSON, TN 38301
(731) 541-7070
1730496944 TRAVIS L CARTER III CRNA
Individual
Nurse Anesthetist, Certified Registered620 SKYLINE DR
JACKSON, TN 38301
(731) 541-7070
1699068395MR. DANIEL PHILLIP CLEMENTS PA-C
Individual
Physician Assistant (Medical)620 SKYLINE DR
JACKSON, TN 38301
(731) 541-6574
1073891578MRS. JACLYN MARIE UTLEY OTR/L
Individual
Community Health Worker620 SKYLINE DR
JACKSON, TN 38301
(731) 541-7942
1154605202 KRISTI DEE MCCUAN RD
Individual
Dietitian, Registered620 SKYLINE DR
JACKSON, TN 38301
(731) 541-5000
1700160843 KELLY MARYANN PORTER RD
Individual
Dietitian, Registered620 SKYLINE DR
JACKSON, TN 38301
(731) 541-5000
1669756623 ASHLEY ANN MOORE RD
Individual
Dietitian, Registered620 SKYLINE DR
JACKSON, TN 38301
(731) 541-5000
1598049637 ELIZABETH ANDREA BLOW RD
Individual
Dietitian, Registered620 SKYLINE DR
JACKSON, TN 38301
(731) 541-5000
1922382977 SAMARA Y WRIGHT RD
Individual
Dietitian, Registered620 SKYLINE DR
JACKSON, TN 38301
(731) 541-5000
1083999007 DEBRA B WHITBY RD
Individual
Dietitian, Registered620 SKYLINE DR
JACKSON, TN 38301
(731) 541-5000

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1629475348, enumerated in the NPI registry as an "individual" on November 24, 2014

The provider is located at 620 Skyline Dr Jackson, Tn 38301 and the phone number is (731) 541-6900

The provider's speciality is Nurse Practitioner with taxonomy code 363LA2100X with a focus in Acute Care

Yes, as of June 20, 2025 the provider is registered in PECOS and is eligible to order health care services or supplies for Medicare patients. If you are a beneficiary the provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.

Medicare beneficiaries should expect a typical cost of $81.53 with an average copayment of $20.38 for new patient appointments. Established patients should expect a typical charge of $93.6 and an average copayment of 23.4. Please review your insurance plan or contact the provider directly to determine your specific costs.

The most common procedures or services performed by this practitioner are: Critical care, first 30-74 minutes, Follow-up hospital inpatient care per day, typically 25 minutes, Follow-up hospital inpatient care per day, typically 35 minutes and Initial hospital inpatient care per day, typically 70 minutes.

This NPI record was last updated on November 24, 2014. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
NPI Profile data is regularly updated with the latest NPI registry information, if you would like to update or remove your NPI Profile in this website please contact us.