NPIMap

Organization Active NPI

Sujata S. Balulad, MD., PA

  • Clinical Cardiac Electrophysiology Physician
  • Leesburg, FL
National Provider Identifier
1154897130
Registry record updated Jul 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Cardiac Electrophysiology PhysicianTaxonomy code 207RC0001X
Legal business name
SUJATA S. BALULAD, MD., PA
Practice address
33041 Professional Dr Ste 101
Leesburg, FL 34788-3761
Phone
(352) 478-0010
Fax
(949) 577-4163
NPI assigned
Oct 17, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 4, 2023

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

Authorized official

Name
Dr. Sujata Shankarappa Balulad, MDNPI 1952501454
Title
Physician
Phone
(518) 573-1552

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Cardiac Electrophysiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RC0001X Primary

Addresses

Primary practice location

33041 Professional Dr Ste 101
Leesburg, FL 34788-3761

Mailing address

1095 Highway A1A Apt 2201
Satellite Beach, FL 32937
Phone (352) 478-0010

Other practice location 1

17154 SE 109th Terrace Rd
Summerfield, FL 34491-9017
Phone (352) 478-0010

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190401000702 FL Part B Supplier - Clinic/Group Practice 6800137829 Receives reassigned benefits from 3 practitioners
Practice locations: Leesburg, FL; Mount Dora, FL; Summerfield, FL; Tavares, FL; The Villages, FL

National Provider Directory

National Provider Directory

Locations

33041 Professional Dr
Leesburg, FL 34788
Phone (352) 315-1555

33041 Professional Dr
Ste 101
Leesburg, FL 34788
Phone (352) 365-1224

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1539734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1688428800000",
    "number": "1154897130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1095 HIGHWAY A1A APT 2201",
            "city": "SATELLITE BEACH",
            "state": "FL",
            "postal_code": "32937",
            "telephone_number": "352-478-0010",
            "fax_number": "949-577-4163"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33041 PROFESSIONAL DR STE 101",
            "city": "LEESBURG",
            "state": "FL",
            "postal_code": "347883761",
            "telephone_number": "352-478-0010",
            "fax_number": "949-577-4163"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "17154 SE 109th Terrace Rd",
            "address_purpose": "LOCATION",
            "city": "Summerfield",
            "state": "FL",
            "postal_code": "344919017",
            "country_code": "US",
            "telephone_number": "352-478-0010",
            "fax_number": "949-577-4163",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SUJATA S. BALULAD, MD., PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-17",
        "last_updated": "2023-07-04",
        "certification_date": "2023-07-04",
        "status": "A",
        "authorized_official_last_name": "BALULAD",
        "authorized_official_first_name": "SUJATA",
        "authorized_official_middle_name": "SHANKARAPPA",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "518-573-1552",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RC0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Leesburg, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.