Charles Douglas Balcome, ACNP

Primary specialty

Acute Care Nurse PractitionerTaxonomy code 363LA2100X

License

AP11604 Issued in AZ

Practice address

16601 N 40TH St Ste 204
Phoenix, AZ 85032-3356

Phone

(602) 633-3721

Fax

(602) 595-1127

NPI assigned

Sep 24, 2018

Last updated

Oct 20, 2021By the provider in NPPES

Sex

Male

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 1

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Acute Care Surgical Specialists LLCGroup PAC ID 7315106416, 17 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Honorhealth Deer Valley Medical Center Hospital, Phoenix, AZ, CCN 030092

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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.

• Acute Care Surgical Specialists, LLC

  • Emergency Medical Services (Emergency Medicine) Physician
  • Phoenix, AZ
  • NPI 1225311871
  Medicare reassignment Care Compare group NPD
• Honorhealth

  dba HonorHealth Contract Providers

  • Surgery Physician
  • Scottsdale, AZ
  • NPI 1801092564
  Medicare reassignment NPD
• Honorhealth Ambulatory

  dba HonorHealth Research Institute

  • Hematology & Oncology Physician
  • Scottsdale, AZ
  • NPI 1407050917
  Medicare reassignment NPD
• Honorhealth

  dba HonorHealth Tina's Treasures

  • Prosthetic/Orthotic Supplier
  • Peoria, AZ
  • NPI 1386456762
  NPD
• Honorhealth Ambulatory

  • Emergency Medicine Physician
  • Mesa, AZ
  • NPI 1891518130
  NPD
• Scottsdale Healthcare Corp

  • Family Medicine Physician
  • Scottsdale, AZ
  • NPI 1609150010
  NPD

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

• Honorhealth

  dba HonorHealth Deer Valley Medical Center

  • General Acute Care Hospital
  • Phoenix, AZ
  • NPI 1528169125
  Care Compare affiliation

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

{
    "created_epoch": "1537747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634688000000",
    "number": "1376027557",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22331 N 79TH DR",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853832157",
            "telephone_number": "602-335-9374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16601 N 40TH ST STE 204",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850323356",
            "telephone_number": "602-633-3721",
            "fax_number": "602-595-1127"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BALCOME",
        "first_name": "CHARLES",
        "middle_name": "DOUGLAS",
        "name_prefix": "Mr.",
        "credential": "ACNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-09-24",
        "last_updated": "2021-10-20",
        "certification_date": "2021-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "AZ",
            "license": "AP11604",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "443489",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Balanced Health Medical Center
• Balanced Life Psychiatry
• Kristina G Balangue, MD
• Jennifer K Balbarin, P.T.
• Nicolas Balbi Caruso
• Sarah Bald, PSYD
• Jake Baldasare, MD
• Marlaine Baldelli, FNP
• Candelario Balderas
• Leslie Balderas

• Acute Care Nurse Practitioner in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Acute Care Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2021; 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.