NPIMap

Organization Active NPI

Ballantyne Medical Associates PLLC

  • Family Medicine Physician
  • Charlotte, NC
National Provider Identifier
1184776130
Registry record updated Aug 18, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2006-01723 Issued in NC
Legal business name
BALLANTYNE MEDICAL ASSOCIATES PLLC
Practice address
12311 Copper Way
Suite 100
Charlotte, NC 28277-3386
Phone
(704) 540-1640
Fax
(704) 540-1639
NPI assigned
Jan 18, 2007
Last updated
Aug 18, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2011

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

Authorized official

Name
Dr. Steven Robert BauerNPI 1053402875
Title
President
Phone
(704) 540-1640

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 2006-01723 NC Primary

Addresses

Primary practice location

12311 Copper Way
Suite 100
Charlotte, NC 28277-3386

Mailing address

12311 Copper Way
Suite 100
Charlotte, NC 28277-3386
Phone (704) 540-1640

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070314000444 NC Part B Supplier - Clinic/Group Practice 6305949223 Receives reassigned benefits from 7 practitioners
Practice locations: Charlotte, NC

National Provider Directory

National Provider Directory

Locations

15640 Don Lochman Ln
Ste A
Charlotte, NC 28277
Phone (704) 540-1640

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1313625600000",
    "number": "1184776130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12311 COPPER WAY",
            "address_2": "SUITE 100",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282773386",
            "telephone_number": "704-540-1640",
            "fax_number": "704-540-1639"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12311 COPPER WAY",
            "address_2": "SUITE 100",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282773386",
            "telephone_number": "704-540-1640",
            "fax_number": "704-540-1639"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BALLANTYNE MEDICAL ASSOCIATES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-18",
        "last_updated": "2011-08-18",
        "status": "A",
        "authorized_official_last_name": "BAUER",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "704-540-1640",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "2006-01723",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.