Jacqueline Balon, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

4704100757 Issued in MI

Practice address

30055 Northwestern Hwy
Ste L50
Farmington Hills, MI 48334-3230

Phone

(248) 626-8200

Fax

(248) 737-9287

NPI assigned

Apr 12, 2006

Sex

Female

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 5

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner, Nurse Practitioner

Practice roles

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/EJDADD

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Great Lakes Pain Consult PLLC

  • Pain Medicine (Anesthesiology) Physician
  • Bay City, MI
  • NPI 1255370094
  NPD (past)
• Michigan Pain Consultants PC

  • Pain Medicine (Anesthesiology) Physician
  • Grand Rapids, MI
  • NPI 1467418574
  NPD (past)
• Tri-County Pain Consultants PC

  • Pain Medicine (Anesthesiology) Physician
  • Novi, MI
  • NPI 1578529681

  Nurse Practitioner

  NPD (past)

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

{
    "created_epoch": "1144800000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1189555200000",
    "number": "1306800933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 120070",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495280102",
            "telephone_number": "616-940-0660",
            "fax_number": "616-940-1965"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30055 NORTHWESTERN HWY",
            "address_2": "STE L50",
            "city": "FARMINGTON HILLS",
            "state": "MI",
            "postal_code": "483343230",
            "telephone_number": "248-626-8200",
            "fax_number": "248-737-9287"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BALON",
        "first_name": "JACQUELINE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-12",
        "last_updated": "2007-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": "4704100757",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4362714",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MCARE",
            "identifier": "13834",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4790050",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM",
            "identifier": "0866685",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ALLIANCE PLAN",
            "identifier": "P30273",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jaime Balli
• Balmoral Living LLC.
• Mike Balogun
• Alice Balole
• Heather Dawn Balon, AU.D.
• Elia Baltazar
• Kaylee Baltierrez
• Tylea Baltz
• Chelsie Baltzell
• Yomara Balvastro

• Nurse Practitioner in Farmington Hills, MI
• Providers in Farmington Hills, MI by specialty
• Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2007; 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.