Charles Hunt Ballard, D.O.
Individual provider Active NPI Family Medicine Physician · Eastvale, CA
NPI 1043357262 · NPPES record last updated Jul 30, 2025
Key facts
- NPI
- 1043357262
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 20A10039 (CA)
- Practice address
- 12742 Limonite Ave
Eastvale, CA 92880-9630 - Phone
- (951) 739-2712
- NPI assigned
- Jan 30, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- College of Osteo Med of the Pacific at Pomona, 1990
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Riverside Medical Clinic Inc
Practice addresses (Care Compare)
6405 Day St
Riverside, CA 92507-0901
Phone (951) 697-5556
7117 Brockton Ave
Riverside, CA 92506-2658
Phone (951) 683-6370
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20090130000237 | CA | Practitioner - Family Practice | 0244283810 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 735 | HI | MD | Behavioral Analyst |
| 20A10039 | CA | MD | Family Medicine Physician |
| DOS735 | HI | MD | Family Medicine Physician |
| 10039 | CA | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Riverside Medical Clinic, Inc | Family Medicine | Current |
Accepting new patients |
| Riverside Medical Clinic, Inc | Family Medicine | Current |
Accepting new patients |
| Riverside Medical Clinic, Inc | Current | Accepting new patients |
Locations
818 Magnolia Ave
Corona, CA 92879
Phone (562) 213-9978
12742 Limonite Ave
Eastvale, CA 92880
Phone (951) 739-2712
6405 Day St
Riverside, CA 92507
Phone (909) 683-6370
3660 Arlington Ave
Riverside, CA 92506
Phone (951) 782-3789
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | DOS735 | HI | |
| Family Medicine Physician | 207Q00000X | 20A10039 | CA | Yes |
Addresses
Primary practice location
12742 Limonite Ave
Eastvale, CA 92880-9630
Mailing address
12742 Limonite Ave
Eastvale, CA 92880-9630
Phone (951) 739-2712
Other practice location 1
818 Magnolia Ave
Corona, CA 92879-3106
Phone (951) 493-6852
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| ZZZ31887Z | Other | CA | SITE ZZZ |
Other providers in Eastvale, CA
- William Ernesto Argueta
- Arthur Shaw, DDS, Inc.
- Caroline Ault
- Mitzi Hazelle Baguioro
- Samantha Baird
- Barouir Deirmenjian Dental Corporation
- Ingrid Bates
- Isabel Batres
- Beachman Psychiatry & Addiction Medical Clinic, Inc.
- Rica Motomal Beck
All providers in Eastvale, CA · Family Medicine Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 30, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.