Active NPI
Renee Heather Ballentine, DO
- Family Medicine Physician
- Tustin, CA
National Provider Identifier
1043387046
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 20A8509
- Practice address
- 1451 Irvine Blvd
Tustin, CA 92780-3804 - Phone
- (714) 838-8878
- NPI assigned
- Nov 29, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 20A8509 | CA | Primary |
Addresses
Primary practice location
1451 Irvine Blvd
Tustin, CA 92780-3804
Mailing address
1451 Irvine Blvd
Tustin, CA 92780-3804
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00AX85090 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20A8509 | CA | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164758400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1488931200000",
"number": "1043387046",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1451 IRVINE BLVD",
"city": "TUSTIN",
"state": "CA",
"postal_code": "927803804"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1451 IRVINE BLVD",
"city": "TUSTIN",
"state": "CA",
"postal_code": "927803804",
"telephone_number": "714-838-8878"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BALLENTINE",
"first_name": "RENEE",
"middle_name": "HEATHER",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-29",
"last_updated": "2017-03-08",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "CA",
"license": "20A8509",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00AX85090",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tustin, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.