NPIMap

Organization Active NPI

Bala Family Practice

  • Primary Care Clinic/Center
  • Bel Air, MD
National Provider Identifier
1386898443
Registry record updated Jun 1, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
D52279 Issued in MD
Legal business name
BALA FAMILY PRACTICE
Practice address
2021B Emmorton Rd
Suite 210
Bel Air, MD 21015-8980
Phone
(410) 569-1001
Fax
(410) 569-1569
NPI assigned
Nov 14, 2008
Last updated
Jun 1, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2010

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

Authorized official

Name
Dr. Sriram H Balasubramanian, M.DNPI 1952366056
Title
Owner
Phone
(410) 569-1001

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X D52279 MD Primary

Addresses

Primary practice location

2021B Emmorton Rd
Suite 210
Bel Air, MD 21015-8980

Mailing address

2021B Emmorton Rd
Suite 210
Bel Air, MD 21015-8980
Phone (410) 569-1001

Other identifiers 1

IdentifierTypeStateIssuer
793302900MedicaidMD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090123000197 MD Part B Supplier - Clinic/Group Practice 2860556628 Receives reassigned benefits from 4 practitioners
Practice locations: Bel Air, MD

National Provider Directory

National Provider Directory

Locations

2021B Emmorton Rd
Ste 21015
Bel Air, MD 21015

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1226620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1275350400000",
    "number": "1386898443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2021B EMMORTON RD",
            "address_2": "SUITE 210",
            "city": "BEL AIR",
            "state": "MD",
            "postal_code": "210158980",
            "telephone_number": "410-569-1001",
            "fax_number": "141-056-9156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2021B EMMORTON RD",
            "address_2": "SUITE 210",
            "city": "BEL AIR",
            "state": "MD",
            "postal_code": "210158980",
            "telephone_number": "410-569-1001",
            "fax_number": "410-569-1569"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BALA FAMILY PRACTICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-14",
        "last_updated": "2010-06-01",
        "status": "A",
        "authorized_official_last_name": "BALASUBRAMANIAN",
        "authorized_official_first_name": "SRIRAM",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "410-569-1001",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "MD",
            "license": "D52279",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "793302900",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bel Air, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.