NPIMap

Organization Active NPI

Balanced

  • Clinical Social Worker
  • Eureka, IL
National Provider Identifier
1225332273
Registry record updated Jan 5, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
149011988 Issued in IL
Legal business name
BALANCED
Practice address
607 W Burton Ave
Eureka, IL 61530-1356
Phone
(309) 251-1900
NPI assigned
Jan 5, 2011
Last updated
Jan 5, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2011

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

Authorized official

Name
Amy BramanNPI 1417256975
Title
Licensed Clinical Social Worker
Phone
(309) 251-1900

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 149011988 IL Primary
Clinical Social Worker 1041C0700X 149008793 IL

Addresses

Primary practice location

607 W Burton Ave
Eureka, IL 61530-1356

Mailing address

607 W Burton Ave
Eureka, IL 61530-1356

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120525000595 IL Part B Supplier - Clinic/Group Practice 9830352020 Receives reassigned benefits from 14 practitioners
Practice locations: Washington, IL

National Provider Directory

National Provider Directory

Locations

100 Hillcrest Dr
Ste C
Washington, IL 61571
Phone (309) 444-2800

Practitioners & affiliated clinicians

Practitioners 16

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.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1294185600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1294185600000",
    "number": "1225332273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "607 W BURTON AVE",
            "city": "EUREKA",
            "state": "IL",
            "postal_code": "615301356"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "607 W BURTON AVE",
            "city": "EUREKA",
            "state": "IL",
            "postal_code": "615301356",
            "telephone_number": "309-251-1900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BALANCED",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-05",
        "last_updated": "2011-01-05",
        "status": "A",
        "authorized_official_last_name": "BRAMAN",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "LICENSED CLINICAL SOCIAL WORKER",
        "authorized_official_telephone_number": "309-251-1900"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149011988",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149008793",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eureka, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 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.