Jacob Balinky, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

200750104NP Issued in OR

Practice address

3716 NE MLK Blvd
Portland, OR 97212-1111

Phone

(503) 288-8066

NPI assigned

Sep 4, 2007

Last updated

Nov 1, 2012By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Jennifer Ballin Former name

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Oregon Health Sciences University School of Medicine, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Larsen Sanchez Psychology LLCGroup PAC ID 6608138383, 17 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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.

• Larsen Sanchez Psychology, LLC

  dba Portland Mental Health & Wellness

  • Clinical Psychologist
  • Portland, OR
  • NPI 1588041388

  Psychiatric/Mental Health

  Medicare reassignment Care Compare group NPD
• Lifeworks NW

  • Mental Health Counselor
  • Portland, OR
  • NPI 1467408013
  NPD (past)

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

{
    "created_epoch": "1188864000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1351728000000",
    "number": "1184818080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5516 NE 45TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972181422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3716 NE MLK BLVD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972121111",
            "telephone_number": "503-288-8066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BALINKY",
        "first_name": "JACOB",
        "credential": "PMHNP-BC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-09-04",
        "last_updated": "2012-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "OR",
            "license": "200750104NP",
            "primary": true
        },
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "OR",
            "license": "200542475RN",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "BALLIN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Laura Ann Bales, BS, CADCI
• Rick Balestra, M.D.
• Kellie Balfe, BCBA
• Sandeep Bali
• Kimberly Baling
• Martin J Balish, MD
• Michael Eric Balkovich, MD
• Chaz Chavon Balkum
• Alexis Ball
• Amanda C Ball, MS

• Psychiatric/Mental Health Nurse Practitioner in Portland, OR
• Providers in Portland, OR by specialty
• Psychiatric/Mental Health Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2012; 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.