Active NPI
Bopanna B Ballachanda, PH.D.
- Audiologist
- Albuquerque, NM
National Provider Identifier
1164427050
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Audiologist
- License
- 2084
- Practice address
- 6709 Academy Rd NE Ste B
Albuquerque, NM 87109-3363 - Phone
- (505) 207-7550
- Fax
- (505) 207-7559
- NPI assigned
- Jun 16, 2005
- Last updated
- Mar 9, 2022
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Audiologist | 231H00000X | 2084 | NM | Primary |
Addresses
Primary practice location
6709 Academy Rd NE Ste B
Albuquerque, NM 87109-3363
Mailing address
11907 San Rafael Ave NE
Albuquerque, NM 87122-1035
Phone (505) 385-5601
Other practice location 1
7920 Wyoming Blvd NE Ste A
Albuquerque, NM 87109-6021
Phone (505) 299-4327
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2084 | NM | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sonus-USA, Inc. | Past | Accepting new patients | |
| Sonus-Texas, Inc. | Past | Accepting new patients |
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.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1118880000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1646784000000",
"number": "1164427050",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11907 SAN RAFAEL AVE NE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871221035",
"telephone_number": "505-385-5601"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6709 ACADEMY RD NE STE B",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871093363",
"telephone_number": "505-207-7550",
"fax_number": "505-207-7559"
}
],
"practiceLocations": [
{
"address_1": "7920 Wyoming Blvd NE Ste A",
"address_purpose": "LOCATION",
"city": "Albuquerque",
"state": "NM",
"postal_code": "871096021",
"country_code": "US",
"telephone_number": "505-299-4327",
"fax_number": "505-299-4328",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BALLACHANDA",
"first_name": "BOPANNA",
"middle_name": "B",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-06-16",
"last_updated": "2022-03-09",
"certification_date": "2022-03-09",
"status": "A"
},
"taxonomies": [
{
"code": "231H00000X",
"taxonomy_group": "",
"desc": "Audiologist",
"state": "NM",
"license": "2084",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Albuquerque, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.