Paul A Balliet, OD
Individual provider Active NPI Optometrist · Bismarck, ND
NPI 1174560080 · NPPES record last updated Dec 15, 2020
Key facts
- NPI
- 1174560080
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 448 (ND)
- Practice address
- 200 S 5TH St
Bismarck, ND 58504-5675 - Phone
- (701) 222-3937
- Fax
- (701) 222-8805
- NPI assigned
- May 31, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Southern California College of Optometry, 1986
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Dakota Eye Institute PC
Practice addresses (Care Compare)
200 S 5TH St
Bismarck, ND 58504-5675
Phone (701) 222-3937
Merit-based Incentive Payment System (MIPS)
- Final score
- 82.05 of 100
- Quality
- 92.92
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 47.25
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ND
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100105000753 | ND | Practitioner - Optometry | 5597806059 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 448 | ND | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dakota Eye Institute PC | Optometrist | Current |
Accepting new patients |
Locations
3119 N 14th St
Bismarck, ND 58503
Phone (701) 222-3937
200 S 5th St
Bismarck, ND 58504
Phone (701) 222-3937
114 N Broadway St
Ste 1
Linton, ND 58552
Phone (701) 254-4450
Interoperability endpoints
- pballiet@dakotaeye.emadirect.md
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 448 | ND | Yes |
Addresses
Primary practice location
200 S 5TH St
Bismarck, ND 58504-5675
Mailing address
200 S 5TH St
Bismarck, ND 58504-5675
Phone (701) 222-3937
Other practice location 1
3119 N 14th St
Bismarck, ND 58503-0664
Phone (701) 222-3937
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1454550 | Medicaid | ND |
Other providers in Bismarck, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 15, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.