Individual provider Active NPI

Conrado Ballecer, M.D.

  • Anesthesiology Physician
  • Phoenix, AZ
National Provider Identifier
1235165648
Registry record updated Aug 16, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
6473 Issued in AZ
Practice address
7600 N 16TH St
Phoenix, AZ 85020-4431
Phone
(602) 395-0718
Fax
(602) 277-8146
NPI assigned
Jun 25, 2006
Last updated
Aug 16, 2010By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 16, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 6473 AZ Primary

Addresses

Primary practice location

7600 N 16TH St
Phoenix, AZ 85020-4431

Mailing address

PO Box 39179
Phoenix, AZ 85069-9179
Phone (602) 395-0718

Other identifiers 1

IdentifierTypeStateIssuer
223636MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050929000905 AZ Practitioner - Anesthesiology 3678559697 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
6473AZMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Ophthalmic Anesthesiology Consultants of Arizona PLLC Anesthesiology CurrentSince Jan 1, 2018 Accepting new patients

Locations

300 E Osborn Rd
Ste 102
Phoenix, AZ 85012
Phone (602) 234-8478

7878 N 16th St
Ste 250
Phoenix, AZ 85020
Phone (602) 234-1803

10541 W Thunderbird Blvd
Sun City, AZ 85351
Phone (623) 748-7810

9849 W Thunderbird Blvd
Sun City, AZ 85351
Phone (623) 583-2020

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1151193600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1281916800000",
    "number": "1235165648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 39179",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850699179",
            "telephone_number": "602-395-0718",
            "fax_number": "602-277-8146"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7600 N 16TH ST",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850204431",
            "telephone_number": "602-395-0718",
            "fax_number": "602-277-8146"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BALLECER",
        "first_name": "CONRADO",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-25",
        "last_updated": "2010-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "AZ",
            "license": "6473",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "223636",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.