Emil Antonine Balasandiran, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

01029899 Issued in IN

Practice address

1406 W Bella Dr
Marion, IN 46953-5229

Phone

(765) 660-7720

Fax

(765) 662-4493

NPI assigned

Sep 21, 2006

Last updated

Oct 20, 2020By 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 1

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Interoperability endpoints

• Direct secure messaging: emil.balasandiran@mgh.eclinicaldirectplus.com

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

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603152000000",
    "number": "1205935731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 N WABASH",
            "address_2": "STE G20",
            "city": "MARION",
            "state": "IN",
            "postal_code": "469522600",
            "telephone_number": "765-660-7600",
            "fax_number": "765-651-7313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1406 W BELLA DR",
            "city": "MARION",
            "state": "IN",
            "postal_code": "469535229",
            "telephone_number": "765-660-7720",
            "fax_number": "765-662-4493"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BALASANDIRAN",
        "first_name": "EMIL",
        "middle_name": "ANTONINE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-21",
        "last_updated": "2020-10-20",
        "certification_date": "2020-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01029899",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000742788",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100124430",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "emil.balasandiran@mgh.eclinicaldirectplus.com",
            "affiliation": "N",
            "address_1": "1406 W Bella Dr",
            "city": "Marion",
            "state": "IN",
            "country_code": "US",
            "postal_code": "469535229",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jacqueline Bakehorn
• Baker Foot Solutions Corp (Marion Foot Center)
• Alexis Baker
• Isabella Baker, RBT
• Whitney Baker
• Baldwin Surgical Associates, P.C.
• Anne Bales
• Cynthia Jane Ball, R.D., C.D.
• Delayne Blayre Ball, CCC-SLP
• Nika T. Ball, OTR/L

• Family Medicine Physician in Marion, IN
• Providers in Marion, IN by specialty
• Family Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2020; 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.