Active NPI
Kathleen D Balthasar, DDS
- Dentist
- Buffalo, NY
National Provider Identifier
1144315003
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 044862-1
- Practice address
- 155 Lawn Ave
Buffalo, NY 14207-1816 - Phone
- (716) 875-2904
- Fax
- (716) 875-6717
- NPI assigned
- Oct 4, 2006
- Last updated
- Nov 13, 2015
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 044862-1 | NY | Primary |
Addresses
Primary practice location
155 Lawn Ave
Buffalo, NY 14207-1816
Mailing address
155 Lawn Ave
Buffalo, NY 14207-1816
Phone (716) 875-2904
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 722046 | Other | NY | AETNA |
| 400151 | Other | NY | INDEPENDENT HEALTH |
| 00075551300 | Other | NY | BC/BS |
| 10596 | Other | NY | DORAL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 044862-1 | NY | MD | Dentist |
| 044862 | NY | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159920000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1447372800000",
"number": "1144315003",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "155 LAWN AVE",
"city": "BUFFALO",
"state": "NY",
"postal_code": "142071816",
"telephone_number": "716-875-2904",
"fax_number": "716-875-6717"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "155 LAWN AVE",
"city": "BUFFALO",
"state": "NY",
"postal_code": "142071816",
"telephone_number": "716-875-2904",
"fax_number": "716-875-6717"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BALTHASAR",
"first_name": "KATHLEEN",
"middle_name": "D",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-04",
"last_updated": "2015-11-13",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NY",
"license": "044862-1",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "722046",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "INDEPENDENT HEALTH",
"identifier": "400151",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC/BS",
"identifier": "00075551300",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DORAL",
"identifier": "10596",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Buffalo, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.