Active NPI
Alissa Ballard, DO
- Family Medicine Physician
- O'Fallon, MO
National Provider Identifier
1508359100
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 2021017793
- Practice address
- 2630 State Highway K
Ste 100
O'Fallon, MO 63368 - Phone
- (636) 240-5454
- NPI assigned
- Jun 8, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 2021017793 | MO | Primary |
Addresses
Primary practice location
2630 State Highway K
Ste 100
O'Fallon, MO 63368
Mailing address
2630 State Highway K
Ste 100
O'Fallon, MO 63368
Phone (636) 240-5454
Other practice location 1
1505 W Sherman Ave
Vineland, NJ 08360-7059
Phone (856) 641-8000
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| FHIR URL | https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ | Health Information Exchange (HIE) |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- Other, 2018
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
1110 Highlands Plaza Dr E
Saint Louis, MO 63110-1351
Phone (314) 273-0195
2630 Hwy K
O Fallon, MO 63368-6624
Phone (636) 240-5454
7212 Balson Ave
Saint Louis, MO 63130-3001
Hospital & facility affiliations
- BJC Home Care Services
- Aw Health Care
- Missouri Baptist Medical Center
- Progress West Hospital
- Barnes-Jewish St Peters Hospital
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of skin lesions | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Physician Groups LC | Family Medicine | Current | Accepting new patients |
| Physician Groups LC | Current | Accepting new patients |
Locations
2630 Highway K
O Fallon, MO 63368
Phone (636) 240-5454
2630 Highway K
Ste 100
O Fallon, MO 63368
Phone (636) 240-5454
Organizations & group practices 3
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.
-
- Home Health Agency
- Saint Louis, MO
- NPI 1215936588
-
- Multi-Specialty Clinic/Center
- Farmington, MO
- NPI 1427114990
Hospital & facility affiliations 5
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Home Health Agency
- Saint Louis, MO
- NPI 1215936588
-
- General Acute Care Hospital
- Saint Peters, MO
- NPI 1144238908
-
- Home Health Agency
- Saint Louis, MO
- NPI 1326077199
-
- General Acute Care Hospital
- Saint Louis, MO
- NPI 1487663506
-
- General Acute Care Hospital
- O Fallon, MO
- NPI 1508938044
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1528416000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1626739200000",
"number": "1508359100",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2630 STATE HIGHWAY K",
"address_2": "STE 100",
"city": "O'FALLON",
"state": "MO",
"postal_code": "63368",
"telephone_number": "636-240-5454"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2630 STATE HIGHWAY K",
"address_2": "STE 100",
"city": "O'FALLON",
"state": "MO",
"postal_code": "63368",
"telephone_number": "636-240-5454"
}
],
"practiceLocations": [
{
"address_1": "1505 W Sherman Ave",
"address_purpose": "LOCATION",
"city": "Vineland",
"state": "NJ",
"postal_code": "083607059",
"country_code": "US",
"telephone_number": "856-641-8000",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BALLARD",
"first_name": "ALISSA",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-06-08",
"last_updated": "2021-07-20",
"certification_date": "2021-06-11",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MO",
"license": "2021017793",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "FHIR",
"endpointTypeDescription": "FHIR URL",
"endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
"affiliation": "N",
"endpointDescription": "BJC",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "2630 State Highway K",
"address_2": "Ste 100",
"city": "O'Fallon",
"state": "MO",
"country_code": "US",
"postal_code": "63368",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in O'Fallon, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.