Active NPI
Samuel Ryan Balle
- Pharmacist
- Muncie, IN
National Provider Identifier
1063015691
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 26021154A
- Practice address
- 201 S Tillotson Ave
Muncie, IN 47304-4356 - Phone
- (765) 287-0074
- NPI assigned
- Nov 17, 2020
- Last updated
- Nov 17, 2020
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 26021154A | IN | Primary |
Addresses
Primary practice location
201 S Tillotson Ave
Muncie, IN 47304-4356
Mailing address
201 S Tillotson Ave
Muncie, IN 47304-4356
Phone (765) 287-0074
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 26021154A | IN | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hook-Superx LLC | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1605571200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1605571200000",
"number": "1063015691",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "201 S TILLOTSON AVE",
"city": "MUNCIE",
"state": "IN",
"postal_code": "473044356",
"telephone_number": "765-287-0074"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "201 S TILLOTSON AVE",
"city": "MUNCIE",
"state": "IN",
"postal_code": "473044356",
"telephone_number": "765-287-0074"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BALLE",
"first_name": "SAMUEL",
"middle_name": "RYAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-11-17",
"last_updated": "2020-11-17",
"certification_date": "2020-11-17",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IN",
"license": "26021154A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Muncie, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.