NPIMap

Individual provider Active NPI

Praveen Chandar Balraj, MD

  • Vascular Surgery Physician
  • Queen Creek, AZ
National Provider Identifier
1447562640
Registry record updated Jul 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
55078 Issued in AZ
Practice address
21321 E Ocotillo Rd Ste 125
Queen Creek, AZ 85142-5995
Phone
(480) 936-7722
Fax
(480) 936-7723
NPI assigned
Jul 6, 2010
Last updated
Jul 22, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X MT191085 PA
Vascular Surgery Physician 2086S0129X 4301103519 MI
Vascular Surgery Physician 2086S0129X 55078 AZ Primary

Addresses

Primary practice location

21321 E Ocotillo Rd Ste 125
Queen Creek, AZ 85142-5995

Mailing address

2040 S Alma School Rd Ste 1
Chandler, AZ 85286-7076
Phone (480) 936-7722

Other identifiers 1

IdentifierTypeStateIssuer
316871MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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
I20171121002534 AZ Practitioner - Vascular Surgery 6305159062 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Vascular Surgery
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

21321 E Ocotillo Rd
Suite 125
Queen Creek, AZ 85142-5995
Phone (480) 936-7722

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Varicose vein removal81
Leg revascularization (restoring blood flow)71
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MT191085PAMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Vascular Institute of Arizona PLLC Vascular Surgery CurrentSince Jun 8, 2021 Accepting new patients
Henry Ford Health System Current Accepting new patients

Locations

2040 S Alma School Rd
Ste 1
Chandler, AZ 85286
Phone (602) 323-0894

8405 E Baseline Rd
Ste 107
Mesa, AZ 85209
Phone (480) 936-7722

21321 E Ocotillo Rd
Ste 125
Queen Creek, AZ 85142
Phone (480) 677-4800

2799 W Grand Blvd
Detroit, MI 48202
Phone (313) 876-2062

2799 W Grand Blvd
#K8
Detroit, MI 48202
Phone (313) 916-1755

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/DIJFCD
  • FHIR API: https://fhir4.healow.com/fhir/r4/DIJFCD/Endpoint/DIJFCD
  • FHIR API: https://fhir4.healow.com/fhir/r4/IFFCCD

Organizations & group practices 2

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": "1278374400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626912000000",
    "number": "1447562640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2040 S ALMA SCHOOL RD STE 1",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852867076",
            "telephone_number": "480-936-7722",
            "fax_number": "480-936-7723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21321 E OCOTILLO RD STE 125",
            "city": "QUEEN CREEK",
            "state": "AZ",
            "postal_code": "851425995",
            "telephone_number": "480-936-7722",
            "fax_number": "480-936-7723"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BALRAJ",
        "first_name": "PRAVEEN CHANDAR",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-07-06",
        "last_updated": "2021-07-22",
        "certification_date": "2021-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "PA",
            "license": "MT191085",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "MI",
            "license": "4301103519",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "AZ",
            "license": "55078",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "316871",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Queen Creek, AZ

Sources for this page

Verify at the official NPI Registry.