Active NPI
Jacob Daniel Bal, SLP
- Speech-Language Pathologist
- Frederick, MD
National Provider Identifier
1497197016
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 07324
- Practice address
- 626 Trail Ave
Frederick, MD 21701-4934 - Phone
- (301) 662-1997
- Fax
- (301) 668-2202
- NPI assigned
- Jul 24, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 2202006812 | VA | |
| Speech-Language Pathologist | 235Z00000X | SLP-1452 | WV | |
| Speech-Language Pathologist | 235Z00000X | 07324 | MD | Primary |
Addresses
Primary practice location
626 Trail Ave
Frederick, MD 21701-4934
Mailing address
626 Trail Ave
Frederick, MD 21701-4934
Phone (301) 662-1997
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 07324 | Other | MD | STATE OF MARYLAND |
| SLP-1452 | Other | WV | WEST VIRGINIA BOARDNOF EXAMINERS |
| 2202006812 | Other | VA | COMMONWEALTH OF VIRGINIA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 07324 | MD | MD | Speech-Language Pathologist |
| 2202006812 | VA | MD | Speech-Language Pathologist |
| SLP-1452 | WV | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Homecare Rehab, LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Speech/Language/Hearing Specialist/Technologist
- Frederick, MD
- NPI 1336254192
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1374624000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1374624000000",
"number": "1497197016",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "626 TRAIL AVE",
"city": "FREDERICK",
"state": "MD",
"postal_code": "217014934",
"telephone_number": "301-662-1997",
"fax_number": "301-668-2202"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "626 TRAIL AVE",
"city": "FREDERICK",
"state": "MD",
"postal_code": "217014934",
"telephone_number": "301-662-1997",
"fax_number": "301-668-2202"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BAL",
"first_name": "JACOB",
"middle_name": "DANIEL",
"credential": "SLP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-07-24",
"last_updated": "2013-07-24",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "VA",
"license": "2202006812",
"primary": false
},
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "WV",
"license": "SLP-1452",
"primary": false
},
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "MD",
"license": "07324",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE OF MARYLAND",
"identifier": "07324",
"state": "MD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WEST VIRGINIA BOARDNOF EXAMINERS",
"identifier": "SLP-1452",
"state": "WV"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COMMONWEALTH OF VIRGINIA",
"identifier": "2202006812",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Frederick, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.