Individual provider Active NPI

Michele Marie Ballister, DNP APRN CRNA CHSE

  • Certified Registered Nurse Anesthetist
  • Lagrange, GA
National Provider Identifier
1003054586
Registry record updated Apr 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
3758 Issued in SC
Practice address
1514 Vernon Rd
Lagrange, GA 30240-4131
Phone
(706) 822-1411
NPI assigned
Jan 22, 2009
Last updated
Apr 29, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 29, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 289363 GA
Certified Registered Nurse Anesthetist 367500000X 3758 SC Primary

Addresses

Primary practice location

1514 Vernon Rd
Lagrange, GA 30240-4131

Mailing address

PO Box 603484
Charlotte, NC 28260-3484
Phone (803) 765-1838

Other practice location 1

2095 Henry Tecklenburg Dr
Charleston, SC 29414-5733
Phone (843) 402-1436

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC, GA, NC, ME4 enrollments

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
I20090210000546 SC Practitioner - Certified Registered Nurse Anesthetist (Crna) 4880759745 Reassigns benefits to 3 organizations
I20221130001832 GA Practitioner - Certified Registered Nurse Anesthetist (Crna) 4880759745 Reassigns benefits to 1 organization
I20250210001618 NC Practitioner - Certified Registered Nurse Anesthetist (Crna) 4880759745 Reassigns benefits to 1 organization
I20250320000100 ME Practitioner - Certified Registered Nurse Anesthetist (Crna) 4880759745

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sentry Anesthesia Management, LLCGroup PAC ID 9436372323, 170 clinicians

Practice addresses (Care Compare)

1514 Vernon Rd
Lagrange, GA 30240-4131
Phone (706) 882-1411

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3758SCMDSpeech-Language Pathologist
289363GAMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Sentry Anesthesia Management, LLC CurrentSince Sep 26, 2022 Accepting new patients
Medical University Hospital Authority Nurse Anesthetist, Certified Registered CurrentSince Jan 15, 2009 Accepting new patients
CHS Anesthesia Services Group Inc CurrentSince Sep 9, 2024 Accepting new patients
Medstream Anesthesia PLLC Nurse Anesthetist, Certified Registered CurrentSince Aug 7, 2025 Accepting new patients
Medical University Hospital Authority CurrentSince Jan 15, 2009 Accepting new patients
Bon Secours St Francis Xavier Hospital, Inc. Current Accepting new patients
Eastern Maine Medical Center CurrentSince Apr 7, 2025 Accepting new patients
Eastern Maine Medical Center CurrentSince Apr 7, 2025 Accepting new patients
Bon Secours St. Francis Xavier Hospital, Inc. Nurse Anesthetist, Certified Registered CurrentSince Jan 29, 2024 Accepting new patients
Bon Secours St. Francis Xavier Hospital, Inc. CurrentSince Jan 29, 2024 Accepting new patients
Apollomd Group Services, LLC Past Accepting new patients

Locations

126 US Highway 280 W
Americus, GA 31719
Phone (229) 924-6011

5126 Hospital Dr NE
Covington, GA 30014
Phone (770) 385-4340

601 S 8th St
Griffin, GA 30224
Phone (770) 228-2721

1514 Vernon Rd
Lagrange, GA 30240
Phone (706) 812-2369

489 State St
Bangor, ME 04401
Phone (207) 973-8837

1 Poston Rd
Ste 110
Charleston, SC 29407
Phone (843) 876-1347

171 Ashley Ave
Charleston, SC 29425
Phone (843) 792-2123

2095 Henry Tecklenburg Dr
Charleston, SC 29414
Phone (843) 402-1037

1106 Chuck Dawley Blvd
Ste 100
Mt Pleasant, SC 29464
Phone (843) 245-9498

2669 Kinard St
Newberry, SC 29108
Phone (803) 276-7570

501 Robertson Blvd
Walterboro, SC 29488
Phone (843) 549-2000

Organizations & group practices 11

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1232582400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714348800000",
    "number": "1003054586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 603484",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282603484",
            "telephone_number": "803-765-1838",
            "fax_number": "803-765-1732"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1514 VERNON RD",
            "city": "LAGRANGE",
            "state": "GA",
            "postal_code": "302404131",
            "telephone_number": "706-822-1411"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2095 Henry Tecklenburg Dr",
            "address_purpose": "LOCATION",
            "city": "Charleston",
            "state": "SC",
            "postal_code": "294145733",
            "country_code": "US",
            "telephone_number": "843-402-1436",
            "fax_number": "843-402-1833",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BALLISTER",
        "first_name": "MICHELE",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "DNP APRN CRNA CHSE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-01-22",
        "last_updated": "2024-04-29",
        "certification_date": "2024-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "GA",
            "license": "289363",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "SC",
            "license": "3758",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lagrange, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.