Mallory Fossa, PNP-PC is a medicare enrolled "Anesthesiology - Pediatric Anesthesiology" in Hartford, Connecticut. She graduated from nursing school in 2015 and has 9 years of diverse experience with area of expertise as Nurse Practitioner. She is a member of the group practice Connecticut Children's Specialty Group, Inc, Connecticut Children's Specialty Group, Inc and her current practice location is
282 Washington St, Hartford, Connecticut. You can reach out to her office (for appointments etc.) via phone at
(860) 837-5207.
Mallory Fossa is licensed to practice in California (license number 95003548) and she also participates in the medicare program. She
accepts medicare assignments (which means she accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and her NPI Number is 1780059030.
Provider's Profile
| Full Name | Mallory Fossa |
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| Gender | Female |
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| Speciality | Nurse Practitioner |
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| Experience | 9 Years |
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| Location | 282 Washington St, Hartford, Connecticut |
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| Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Mallory Fossa graduated from nursing school in 2015
NPI Data:
- NPI Number: 1780059030
- Provider Enumeration Date: 12/10/2015
- Last Update Date: 09/12/2022
Medicare PECOS Information:
- PECOS PAC ID: 1557632106
- Enrollment ID: I20190822002533
Medical Identifiers
Medical identifiers for Mallory Fossa such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1780059030 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 363LP0200X | Nurse Practitioner - Pediatrics | 95003548 (California) | Secondary |
| 363LP0200X | Nurse Practitioner - Pediatrics | 12.008276 (Connecticut) | Secondary |
| 207LP3000X | Anesthesiology - Pediatric Anesthesiology | 95003548 (California) | Primary |
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
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| Connecticut Children's Specialty Group, Inc | 6002720117 | 133 |
| Connecticut Children's Specialty Group, Inc | 6002720117 | 133 |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Mallory Fossa allows following entities to bill medicare on her behalf.
| Entity Name | Connecticut Children's Specialty Group, Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1669448882
PECOS PAC ID: 6002720117
Enrollment ID: O20031113000468 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mallory Fossa is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Mallory Fossa, PNP-PC
3701 Wilshire Blvd, Suite 600,
Los Angeles, CA 90010-2814
Ph: (323) 361-3550 | Mallory Fossa, PNP-PC
282 Washington St,
Hartford, CT 06106-3322
Ph: (860) 837-5207 |
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