D Balder MD, PLLC

Primary specialty

SpecialistTaxonomy code 174400000X

License

21885 Issued in MS

Legal business name

D BALDER MD, PLLC

Practice address

15190 Community Rd
Gulfport, MS 39503-3485

Phone

(228) 265-5945

NPI assigned

Mar 28, 2016

Last updated

Apr 7, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Susan Nussell

Title

Billing Manager

Phone

(972) 387-5800

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• D Balder MD PLLC

  • Specialist
  • Gulfport, MS
  • NPI 1366993321

  O20160407001802

  Same enrollment

Locations

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

{
    "created_epoch": "1459123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459987200000",
    "number": "1396107330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15190 COMMUNITY RD",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395033485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15190 COMMUNITY RD",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395033485",
            "telephone_number": "228-265-5945"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "D BALDER MD, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-28",
        "last_updated": "2016-04-07",
        "status": "A",
        "authorized_official_last_name": "NUSSELL",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "972-387-5800",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "MS",
            "license": "21885",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Grant Curtis-Bell
• Pamela Sue Cutrer, PH.D.
• Cyril VK Bethala, MD, PA
• Michael Czaska
• D Balder MD PLLC
• Donielle A Daigle, M.D.
• Jared Walter Daley, PHARMD
• Breanne Dalton, M.S.,SLP
• Terry Dalton
• Stephanie M Damitio, C.R.N.A

• Specialist in Gulfport, MS
• Providers in Gulfport, MS by specialty
• Specialist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2016; 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.