Individual provider Active NPI

Jedidiah Amos Ballard, DO

  • Emergency Medicine Physician
  • Augusta, GA
National Provider Identifier
1023329976
Registry record updated May 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
DO-05225 Issued in IA
Practice address
1120 15TH St
Augusta, GA 30912-0004
Phone
(706) 724-6100
NPI assigned
Jun 25, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 1, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 19065 MT
Emergency Medicine Physician 207P00000X DO-05225 IA Primary
Emergency Medicine Physician 207P00000X 074216 GA

Addresses

Primary practice location

1120 15TH St
Augusta, GA 30912-0004

Mailing address

1499 Walton Way
Suite 1400
Augusta, GA 30901-2603
Phone (706) 724-6100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA, IA, VI3 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20150728005577 GA Practitioner - Emergency Medicine 8224342738 Reassigns benefits to 3 organizations
I20190529001161 IA Practitioner - Emergency Medicine 8224342738 Reassigns benefits to 2 organizations
I20191029000339 VI Practitioner - Emergency Medicine 8224342738 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
1838NEMDChiropractor
074216GAMDEmergency Medicine Physician
19065MTMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Governor Juan F. Luis Hospital & Medical Center CurrentSince Sep 25, 2019 Accepting new patients
Au Medical Associates Inc CurrentSince Jun 1, 2015 Accepting new patients
Wellstar Medical Group, LLC Current Accepting new patients
Au Medical Associates Inc CurrentSince Jun 1, 2015 Accepting new patients
Alegent Creighton Clinic CurrentSince Aug 31, 2023 Accepting new patients
Wellstar Medical Group, LLC CurrentSince Nov 1, 2023 Accepting new patients
Alegent Creighton Clinic CurrentSince Aug 31, 2023 Accepting new patients
Au Medical Associates Emergency Medicine Billing Services, LLC Emergency Medicine CurrentSince Sep 1, 2015 Accepting new patients
New Century Physicians of Iowa PC Emergency Medicine CurrentSince Mar 30, 2019 Accepting new patients
Governor Juan F. Luis Hospital & Medical Center CurrentSince Sep 25, 2019 Accepting new patients

Locations

1120 15th St
Augusta, GA 30912
Phone (706) 721-3873

1499 Walton Way
Ste 1400
Augusta, GA 30901
Phone (706) 721-4951

1120 15th St
Bldg O107
Augusta, GA 30912

5150 Stilesboro Rd NW
Ste 220
Kennesaw, GA 30152
Phone (770) 424-8222

610 Sparta Rd
Sandersville, GA 31082
Phone (478) 240-2000

800 Mercy Dr
Ste 220
Council Bluffs, IA 51503
Phone (712) 388-2660

800 Mercy Dr
Council Bluffs, IA 51503
Phone (712) 328-5000

2771 Solution Ctr
Chicago, IL 60677

7500 Mercy Rd
Omaha, NE 68124
Phone (402) 398-5880

16901 Lakeside Hills Ct
Omaha, NE 68130
Phone (402) 572-6500

4007 Estate Diamond Ruby
St Croix, VI 00820
Phone (340) 772-7423

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1277424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682899200000",
    "number": "1023329976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1499 WALTON WAY",
            "address_2": "SUITE 1400",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309012603",
            "telephone_number": "706-724-6100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 15TH ST",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309120004",
            "telephone_number": "706-724-6100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BALLARD",
        "first_name": "JEDIDIAH",
        "middle_name": "AMOS",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-06-25",
        "last_updated": "2023-05-01",
        "certification_date": "2023-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MT",
            "license": "19065",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IA",
            "license": "DO-05225",
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "GA",
            "license": "074216",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Augusta, GA

Sources for this page

Verify at the official NPI Registry.