NPIMap

Organization Active NPI

A Balanced Life Medical Services LLC

  • General Practice Physician
  • Morton, IL
National Provider Identifier
1003270802
Registry record updated Apr 7, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
036074050 Issued in IL
Legal business name
A BALANCED LIFE MEDICAL SERVICES LLC
Practice address
430 W Edgewood CT
Morton, IL 61550-2402
Phone
(309) 525-5012
NPI assigned
Apr 7, 2016
Last updated
Apr 7, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2016

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

Authorized official

Name
Dr. Michael Ahearn, MD
Title
Business Owner
Phone
(309) 883-9330

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208D00000X 036074050 IL Primary

Addresses

Primary practice location

430 W Edgewood CT
Morton, IL 61550-2402

Mailing address

430 W Edgewood CT
Morton, IL 61550-2402
Phone (309) 525-5012

National Provider Directory

National Provider Directory

Locations

340 E Courtland St
Morton, IL 61550

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1459987200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459987200000",
    "number": "1003270802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "430 W EDGEWOOD CT",
            "city": "MORTON",
            "state": "IL",
            "postal_code": "615502402",
            "telephone_number": "309-525-5012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "430 W EDGEWOOD CT",
            "city": "MORTON",
            "state": "IL",
            "postal_code": "615502402",
            "telephone_number": "309-525-5012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "A BALANCED LIFE MEDICAL SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-07",
        "last_updated": "2016-04-07",
        "status": "A",
        "authorized_official_last_name": "AHEARN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "BUSINESS OWNER",
        "authorized_official_telephone_number": "309-883-9330",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": "IL",
            "license": "036074050",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Morton, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.