NPIMap

Individual provider Active NPI

Richard Dane Ballard, M.D.

  • Interventional Cardiology Physician
  • Tupelo, MS
National Provider Identifier
1366739054
Registry record updated Sep 18, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Cardiology PhysicianTaxonomy code 207RI0011X
License
22430 Issued in MS
Practice address
499 Gloster Creek VLG Ste A2
Tupelo, MS 38801
Phone
(662) 620-6800
Fax
(662) 620-6950
NPI assigned
Jul 1, 2011
Last updated
Sep 18, 2018By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 18, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Interventional Cardiology Physician 207RI0011X 22430 MS Primary

Addresses

Primary practice location

499 Gloster Creek VLG Ste A2
Tupelo, MS 38801

Mailing address

499 Gloster Creek VLG Ste A2
Tupelo, MS 38801-4749
Phone (662) 620-6800

Other practice location 1

499 Gloster Creek Vlg Ste A2
Tupelo, MS 38801
Phone (662) 620-6800

Other identifiers 2

IdentifierTypeStateIssuer
05300066MedicaidMS
T-2401OtherMSTEMPORARY MS MEDICAL LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS, AL2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20180627003171 MS Practitioner - Interventional CardiologyPractitioner - Cardiovascular Disease (Cardiology) 8628324076 Reassigns benefits to 4 organizations
I20260611002105 AL Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Interventional Cardiology 8628324076 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)Also: Interventional Cardiology
Education
University of Mississippi School of Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Mississippi Clinics LLCGroup PAC ID 3870773914, 21 clinicians

Practice addresses (Care Compare)

255 Medical Dr
Suite 4
Winfield, AL 35594-5005
Phone (662) 620-6800

499 Gloster Creek VLG
Suite A2
Tupelo, MS 38801-4749
Phone (662) 620-6800

830 S Gloster St
Tupelo, MS 38801-4934
Phone (662) 377-3000

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting67
Leg revascularization (restoring blood flow)19

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
North Mississippi Medical Center Services LLC Single Specialty Current Accepting new patients
North Mississippi Clinics LLC Single Specialty Current Accepting new patients
North Mississippi Medical Center Current Accepting new patients
North Mississippi Clinics LLC Single Specialty CurrentSince Mar 21, 2023 Accepting new patients
North Mississippi Clinics LLC Single Specialty CurrentSince Mar 21, 2023 Accepting new patients
Cardiology Associates of North Ms PA Single Specialty CurrentSince Aug 1, 2018 Accepting new patients
North Mississippi Medical Center Services LLC Single Specialty CurrentSince Nov 29, 2018 Accepting new patients
Webster Health Services, Inc. Past Accepting new patients
North Mississippi Medical Center, Inc. Past Accepting new patients

Locations

801 Stark Rd
Starkville, MS 39759
Phone (662) 324-1475

499 Gloster Creek Vlg
Ste A2
Tupelo, MS 38801
Phone (662) 620-6800

830 S Gloster St
Tupelo, MS 38801
Phone (662) 377-3136

Interoperability endpoints

  • Direct secure messaging: richardballard@nmhs.medalliesdirect.net

Organizations & group practices 11

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.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1309478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537228800000",
    "number": "1366739054",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "499 GLOSTER CREEK VLG STE A2",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388014749",
            "telephone_number": "662-620-6800",
            "fax_number": "662-620-6950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "499 GLOSTER CREEK VLG STE A2",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "38801",
            "telephone_number": "662-620-6800",
            "fax_number": "662-620-6950"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "499 Gloster Creek Vlg Ste A2",
            "address_purpose": "LOCATION",
            "city": "Tupelo",
            "state": "MS",
            "postal_code": "38801",
            "country_code": "US",
            "telephone_number": "662-620-6800",
            "fax_number": "662-620-6950",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BALLARD",
        "first_name": "RICHARD",
        "middle_name": "DANE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-07-01",
        "last_updated": "2018-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "MS",
            "license": "22430",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05300066",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TEMPORARY MS MEDICAL LICENSE",
            "identifier": "T-2401",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tupelo, MS

Sources for this page

Verify at the official NPI Registry.