Andrea Elaine Balluch-Dean, CNP
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Canfield, OH
NPI 1134560758 · NPPES record last updated Jul 11, 2023
Key facts
- NPI
- 1134560758
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- APRN.CNP.14803 (OH)
- Practice address
- 3610 Mercedes PL
Canfield, OH 44406-8139 - Phone
- (724) 866-1750
- Fax
- (724) 618-4128
- NPI assigned
- Jul 11, 2013
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2013
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
3610 Mercedes PL
Canfield, OH 44406-8139
Phone (724) 866-1750
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130924000972 | OH | Practitioner - Nurse Practitioner | 5294979639 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Certified Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 341812 | OH | MD | Registered Nurse |
| 14803 | OH | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| New Leaf Mental Health & Wellness, LLC | Psychiatric/Mental Health | Current |
Accepting new patients |
Locations
143 Boardman Canfield Rd
Youngstown, OH 44512
Phone (234) 200-0854
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 341812 | OH | |
| Family Nurse Practitioner | 363LF0000X | 14803 | OH | |
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | APRN.CNP.14803 | OH | Yes |
Addresses
Primary practice location
3610 Mercedes PL
Canfield, OH 44406-8139
Mailing address
143 Boardman Canfield Rd Ste 324
Boardman, OH 44512-4804
Phone (724) 866-1750
Other providers in Canfield, OH
- Amber Layne Ausnehmer
- Julie Nicole Austalosh
- Emiy E Ayers
- Annette Bailey
- Booker Ted Bair
- Barak Podiatry,LLC
- Joseph Michael Barak
- Taylor Barger
- Shannon Marie Barillare
- Pamela A Barkett
All providers in Canfield, OH · Psychiatric/Mental Health Nurse Practitioner in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 11, 2023. 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.