Individual provider Active NPI

Ledyenska Baez Ballesteros, PA

  • Medical Physician Assistant
  • San Antonio, TX
National Provider Identifier
1114167962
Registry record updated Sep 28, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA05864 Issued in TX
Practice address
720 Pleasanton Rd
San Antonio, TX 78214-1306
Phone
(210) 921-3800
Fax
(210) 334-2861
NPI assigned
Mar 5, 2009
Last updated
Sep 28, 2017By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA05864 TX Primary

Addresses

Primary practice location

720 Pleasanton Rd
San Antonio, TX 78214-1306

Mailing address

720 Pleasanton Rd
San Antonio, TX 78214-1306
Phone (210) 921-3800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110308000484 TX Practitioner - Physician Assistant 1254513542 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
GMG Health Systems Associates PAGroup PAC ID 8123932647, 115 clinicians

Practice addresses (Care Compare)

720 Pleasanton Rd
San Antonio, TX 78214-1306
Phone (210) 921-3800

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA05864TXMDMedical Physician Assistant

Organizations & group practices 2

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": "1236211200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1506556800000",
    "number": "1114167962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "720 PLEASANTON RD",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782141306",
            "telephone_number": "210-921-3800",
            "fax_number": "210-921-3835"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "720 PLEASANTON RD",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782141306",
            "telephone_number": "210-921-3800",
            "fax_number": "210-334-2861"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BALLESTEROS",
        "first_name": "LEDYENSKA",
        "middle_name": "BAEZ",
        "name_prefix": "Mrs.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-03-05",
        "last_updated": "2017-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "TX",
            "license": "PA05864",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

Verify at the official NPI Registry.