Ballard Glenn Blair, D.P.M

Primary specialty

Primary Podiatric Medicine PodiatristTaxonomy code 213EP1101X

License

00419 Issued in CT

Practice address

375 Bridgeport Ave
Shelton, CT 06484

Phone

(203) 929-5559

Fax

(203) 929-5277

NPI assigned

Aug 7, 2006

Last updated

Sep 4, 2013By 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 4

Addresses

Other identifiers 1

Other names 1

• B. Glenn Blair Professional name

Medicare fee-for-service enrollment

Enrolled in CT

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Podiatry

Education

College of Podiatric Med and Surgery, Des Moines University, 1986

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

0 of 100Reported as individual

Quality

0

Improvement activities

0

Cost

0

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• B .Glenn Blair DPM P.C.

  • Primary Podiatric Medicine Podiatrist
  • Shelton, CT
  • NPI 1306020938
  Medicare reassignment NPD
• Physical Therapy of Southern Connecticut, P.C.

  • Specialist
  • Derby, CT
  • NPI 1164585451
  NPD (past)

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

{
    "created_epoch": "1154908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1378252800000",
    "number": "1356350201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "375 BRIDGEPORT AVE",
            "city": "SHELTON",
            "state": "CT",
            "postal_code": "06484",
            "telephone_number": "203-929-5559",
            "fax_number": "203-929-5277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "375 BRIDGEPORT AVE",
            "city": "SHELTON",
            "state": "CT",
            "postal_code": "06484",
            "telephone_number": "203-929-5559",
            "fax_number": "203-929-5277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAIR",
        "first_name": "BALLARD",
        "middle_name": "GLENN",
        "credential": "D.P.M",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-07",
        "last_updated": "2013-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "CT",
            "license": "CT000419",
            "primary": false
        },
        {
            "code": "213EP1101X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Primary Podiatric Medicine",
            "state": "CT",
            "license": "00419",
            "primary": true
        },
        {
            "code": "213ER0200X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Radiology",
            "state": "CT",
            "license": "00419",
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "CT",
            "license": "00419",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004070918",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "B.",
            "last_name": "BLAIR",
            "middle_name": "GLENN",
            "credential": "D.P.M",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Primary Podiatric Medicine Podiatrist in Shelton, CT
• Providers in Shelton, CT by specialty
• Primary Podiatric Medicine Podiatrist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2013; 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.