Fabian A Mendoza Ballesteros, M.D

Primary specialty

Rheumatology PhysicianTaxonomy code 207RR0500X

License

MD436636 Issued in PA

Practice address

211 S 9TH St
Suite 600
Philadelphia, PA 19107-6810

Phone

(215) 955-8430

Fax

(215) 923-5828

NPI assigned

May 20, 2008

Last updated

Nov 20, 2014By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Rheumatology

Education

Other, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Jefferson University PhysiciansGroup PAC ID 7911819180, 1,528 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Thomas Jefferson University Hospital Hospital, Philadelphia, PA, CCN 390174
• Jefferson Stratford Hospital Hospital, Stratford, NJ, CCN 310086

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Jefferson University Physicians

  • General Practice Physician
  • Philadelphia, PA
  • NPI 1326093675
  Medicare reassignment Care Compare group NPD
• Jefferson University Physicians

  dba Jefferson GI

  • Gastroenterology Physician
  • Phila, PA
  • NPI 1205898723
  NPD (past)

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

• Thomas Jefferson University Hospitals Inc

  • General Acute Care Hospital
  • Philadelphia, PA
  • NPI 1215916002
  Care Compare affiliation
• Kennedy University Hospital Inc.

  • General Acute Care Hospital
  • Stratford, NJ
  • NPI 1386746592
  Care Compare affiliation

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

{
    "created_epoch": "1211241600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1416441600000",
    "number": "1164689840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 S 9TH ST",
            "address_2": "SUITE 600",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191076810",
            "telephone_number": "215-955-8430",
            "fax_number": "215-923-5828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 S 9TH ST",
            "address_2": "SUITE 600",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191076810",
            "telephone_number": "215-955-8430",
            "fax_number": "215-923-5828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MENDOZA BALLESTEROS",
        "first_name": "FABIAN",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-05-20",
        "last_updated": "2014-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RR0500X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Rheumatology",
            "state": "NY",
            "license": "003041",
            "primary": false
        },
        {
            "code": "207RR0500X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Rheumatology",
            "state": "PA",
            "license": "MD436636",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102331909",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0197271",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mendful Minds Wellness Center, LLC
• Matthew Mendillo, APRN,FNP-C
• Mending Hearts and Lives, LLC
• Matthew Thomas Mendlik, MD
• Michael L Mendlow, DDS
• Fadiana Mendoza Fernandez
• Edsel Mendoza, RPT
• Jose A Mendoza, MD
• Melodee Arevalo Mendoza, CRNP
• Naomi Mendoza

• Rheumatology Physician in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Rheumatology Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2014; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.