NPIMap

Organization Active NPI

Blue Balloon MD LLC

  • Psychologist
  • Owings Mills, MD
National Provider Identifier
1386212157
Registry record updated Jun 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Legal business name
BLUE BALLOON MD LLC
Practice address
500 Redland CT Ste 102
Owings Mills, MD 21117-3265
Phone
(201) 216-9500
NPI assigned
Jun 16, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2021

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

Authorized official

Name
David Sussman
Title
Coo
Phone
(201) 216-9500

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103T00000X Primary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X

Addresses

Primary practice location

500 Redland CT Ste 102
Owings Mills, MD 21117-3265

Mailing address

500 Redland CT Ste 102
Owings Mills, MD 21117-3265

National Provider Directory

National Provider Directory
Tax ID family
Blue Balloon MD LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1623801600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623974400000",
    "number": "1386212157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 REDLAND CT STE 102",
            "city": "OWINGS MILLS",
            "state": "MD",
            "postal_code": "211173265"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 REDLAND CT STE 102",
            "city": "OWINGS MILLS",
            "state": "MD",
            "postal_code": "211173265",
            "telephone_number": "201-216-9500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE BALLOON MD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-16",
        "last_updated": "2021-06-18",
        "certification_date": "2021-06-18",
        "status": "A",
        "authorized_official_last_name": "SUSSMAN",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "201-216-9500"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Owings Mills, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2021; 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.