NPIMap

Individual provider Active NPI

Christopher W Ballard, M.D.

  • Family Medicine Physician
  • Fairfield, IL
National Provider Identifier
1164428165
Registry record updated Mar 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036110162 Issued in IL
Practice address
213 NW 10TH Street
Suite a
Fairfield, IL 62837
Phone
(618) 842-4617
Fax
(618) 842-4743
NPI assigned
Jun 23, 2005
Last updated
Mar 3, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036110162 IL Primary

Addresses

Primary practice location

213 NW 10TH Street
Suite a
Fairfield, IL 62837

Mailing address

213 NW 10TH St
Suite a
Fairfield, IL 62837-1219
Phone (618) 842-4617

Other identifiers 2

IdentifierTypeStateIssuer
036110162MedicaidIL
820900OtherMEDICARE GROUP

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address cballard@direct.horizonhealthcare.nextgenshare.com Direct Fairfield Memorial Hospital Association

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040626000034 IL Practitioner - Family Practice 2062498447 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Southern Illinois University School of Medicine, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

213 NW 10TH St
Suite a
Fairfield, IL 62837-1219

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036110162ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Fairfield Memorial Hospital Association Current Accepting new patients
Fairfield Memorial Hospital Association CurrentSince May 1, 2008 Accepting new patients
Fairfield Memorial Hospital Association Family Medicine CurrentSince May 1, 2008 Accepting new patients

Locations

213 NW 10th St
Ste A
Fairfield, IL 62837
Phone (618) 842-4617

303 NW 11th St
Fairfield, IL 62837
Phone (618) 842-2611

Interoperability endpoints

  • Direct secure messaging: cballard@direct.horizonhealthcare.nextgenshare.com
  • Direct secure messaging: cballard@yourcarecommunity.org
  • FHIR API: https://api.platform.athenahealth.com/11356/brand/1/csg/161/fhir/r4
  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 3

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.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1119484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614729600000",
    "number": "1164428165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "213 NW 10TH ST",
            "address_2": "SUITE A",
            "city": "FAIRFIELD",
            "state": "IL",
            "postal_code": "628371219",
            "telephone_number": "618-842-4617",
            "fax_number": "618-842-4743"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "213 NW 10TH STREET",
            "address_2": "SUITE A",
            "city": "FAIRFIELD",
            "state": "IL",
            "postal_code": "62837",
            "telephone_number": "618-842-4617",
            "fax_number": "618-842-4743"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BALLARD",
        "first_name": "CHRISTOPHER",
        "middle_name": "W",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-23",
        "last_updated": "2021-03-03",
        "certification_date": "2021-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036110162",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036110162",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP",
            "identifier": "820900",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cballard@direct.horizonhealthcare.nextgenshare.com",
            "affiliation": "Y",
            "endpointDescription": "Horizon Healthcare",
            "affiliationName": "Fairfield Memorial Hospital Association",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "213 NW 10th St",
            "address_2": "Suite A",
            "city": "Fairfield",
            "state": "IL",
            "country_code": "US",
            "postal_code": "628371219",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fairfield, IL

Sources for this page

Verify at the official NPI Registry.