NPIMap

Individual provider Active NPI

Nathan Shane Balusik

  • Family Medicine Physician
  • Waterville, OH
National Provider Identifier
1407174576
Registry record updated Jun 21, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
35.120628 Issued in OH
Practice address
900 Waterville Monclova Rd
Suite a
Waterville, OH 43566-1099
Phone
(419) 878-3010
Fax
(419) 878-3236
NPI assigned
May 13, 2010
Last updated
Jun 21, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 35.120628 OH Primary

Addresses

Primary practice location

900 Waterville Monclova Rd
Suite a
Waterville, OH 43566-1099

Mailing address

900 Waterville Monclova Rd
Suite a
Waterville, OH 43566-1099
Phone (419) 878-3010

Other identifiers 1

IdentifierTypeStateIssuer
35 120628OtherOHSTATE LICENSE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130829000913 OH Practitioner - Family Practice 6002055423 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Toledo College of Medicine, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Health Physicians-North LLCGroup PAC ID 2668522400, 131 clinicians

Practice addresses (Care Compare)

2213 Cherry St
Toledo, OH 43608-2603

2222 Cherry St
Toledo, OH 43608-2675

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Anne Grady Corporation CurrentSince Aug 20, 2013 Accepting new patients
Mercy Health Physicians-North LLC Family Medicine CurrentSince May 31, 2023 Accepting new patients
Anne Grady Corporation CurrentSince Aug 20, 2013 Accepting new patients
Mercy Health Physicians - North, LLC CurrentSince May 31, 2023 Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients

Locations

1525 Eber Rd
Holland, OH 43528
Phone (419) 866-6500

5901 Monclova Rd
Maumee, OH 43537
Phone (419) 893-5911

2222 Cherry St
Ste 2300
Toledo, OH 43608
Phone (419) 251-8013

Interoperability endpoints

  • Direct secure messaging: nbalusik111252@direct.bsmhealth.org

Organizations & group practices 5

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 7

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": "1273708800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1371772800000",
    "number": "1407174576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 WATERVILLE MONCLOVA RD",
            "address_2": "SUITE A",
            "city": "WATERVILLE",
            "state": "OH",
            "postal_code": "435661099",
            "telephone_number": "419-878-3010",
            "fax_number": "419-878-3236"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 WATERVILLE MONCLOVA RD",
            "address_2": "SUITE A",
            "city": "WATERVILLE",
            "state": "OH",
            "postal_code": "435661099",
            "telephone_number": "419-878-3010",
            "fax_number": "419-878-3236"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BALUSIK",
        "first_name": "NATHAN",
        "middle_name": "SHANE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-05-13",
        "last_updated": "2013-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35.120628",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "35 120628",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterville, OH

Sources for this page

Verify at the official NPI Registry.