Individual provider Active NPI

Kenneth A Ballweg, QMHP

  • Mental Health Counselor
  • Tillamook, OR
National Provider Identifier
1174765770
Registry record updated Mar 27, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Practice address
906 Main Ave
Tillamook, OR 97141-3816
Phone
(503) 842-8201
Fax
(503) 812-1870
NPI assigned
Mar 27, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 27, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X Primary

Addresses

Primary practice location

906 Main Ave
Tillamook, OR 97141-3816

Mailing address

906 Main Ave
Tillamook, OR 97141-3816
Phone (503) 842-8201

Other identifiers 1

IdentifierTypeStateIssuer
197749MedicaidOR

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)
Not enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Tillamook Family Counseling Center PastSince Mar 5, 2016 Accepting new patients
Tillamook Family Counseling Center Past Accepting new patients

Interoperability endpoints

  • FHIR API: https://api.qualifacts.org/api/fhir/tfcc/r4/

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1238112000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1238112000000",
    "number": "1174765770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "906 MAIN AVE",
            "city": "TILLAMOOK",
            "state": "OR",
            "postal_code": "971413816",
            "telephone_number": "503-842-8201",
            "fax_number": "503-812-1870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "906 MAIN AVE",
            "city": "TILLAMOOK",
            "state": "OR",
            "postal_code": "971413816",
            "telephone_number": "503-842-8201",
            "fax_number": "503-812-1870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BALLWEG",
        "first_name": "KENNETH",
        "middle_name": "A",
        "credential": "QMHP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-03-27",
        "last_updated": "2009-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "197749",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tillamook, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.