David S Ballestas MD PA

Primary specialty

SpecialistTaxonomy code 174400000X

License

H87694 Issued in FL

Legal business name

DAVID S BALLESTAS MD PA

Practice address

2525 Harbor Blvd
Suite 102
Port Charlotte, FL 33952-5317

Phone

(941) 629-7593

Fax

(941) 625-2751

NPI assigned

Sep 20, 2007

Organization subpart

No

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

Authorized official

Name

Dr. David S. Ballestas, M.D.NPI 1609969419

Title

Owner/President

Phone

(941) 629-7593

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Medical Pavilion Clinic Doing business as

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• David S Ballestas, MD

  • Internal Medicine Physician
  • Port Charlotte, FL
  • NPI 1609969419

  FL

  Medicare reassignment Authorized official
• Ricardo Guzman Matos, APRN

  • Family Nurse Practitioner
  • Cape Coral, FL
  • NPI 1205570975

  FL, Single Specialty

  Medicare reassignment NPD
• Michael James Lawson, ARNP

  • Nurse Practitioner
  • Port Charlotte, FL
  • NPI 1043449960

  FL

  Medicare reassignment

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

{
    "created_epoch": "1190246400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210291200000",
    "number": "1093901282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2525 HARBOR BLVD",
            "address_2": "SUITE 102",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339525317",
            "telephone_number": "941-629-7593",
            "fax_number": "941-625-2751"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2525 HARBOR BLVD",
            "address_2": "SUITE 102",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339525317",
            "telephone_number": "941-629-7593",
            "fax_number": "941-625-2751"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVID S BALLESTAS MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-20",
        "last_updated": "2008-05-09",
        "status": "A",
        "authorized_official_last_name": "BALLESTAS",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "941-629-7593",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "FL",
            "license": "H87694",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP NUMBER",
            "identifier": "40389",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medical Pavilion Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jillian Dano, PHARMD
• Travis Darrow, OTR/L
• David a Butler DO LLC
• David M Kanuck D P M PA
• David M Klein, M.D., Ophthalmologist, P.a.
• David W Rowe, DMD, PA
• Helene Michelle Davidson, ARNP
• Caleb Davis, FNP-BC
• Daniel Davis
• Marissa Davis, MA CCC-SLP

• Specialist in Port Charlotte, FL
• Providers in Port Charlotte, FL by specialty
• Specialist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.