Kenneth H Ballentine, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

6863T Issued in CA

Practice address

5275 Prospect Rd
San Jose, CA 95129-5031

Phone

(408) 255-0576

Fax

(408) 255-0577

NPI assigned

Jan 26, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Kenneth H. Ballentine OD Inc.

  • Eyewear Supplier
  • San Jose, CA
  • NPI 1649448507

  Optometrist

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1138233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1265155200000",
    "number": "1548230071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5275 PROSPECT RD",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951295031",
            "telephone_number": "408-255-0576",
            "fax_number": "408-255-0577"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5275 PROSPECT RD",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951295031",
            "telephone_number": "408-255-0576",
            "fax_number": "408-255-0577"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BALLENTINE",
        "first_name": "KENNETH",
        "middle_name": "H",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-26",
        "last_updated": "2010-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "6863T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEDERAL TAXPAYER ID",
            "identifier": "94-2710370",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SD0068630",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Steven Ball
• Rosario Ballantyne
• Virginia Ballantyne
• Aisa Ballard-Dosty
• Marissa Ballard, BCBA
• Julius Ballesil
• Vixchel Ballesteros Estrada, AMFT
• Brandon Ballesteros
• Clarise Ballesteros, LCSW
• Faith Nazareno Ballesteros

• Optometrist in San Jose, CA
• Providers in San Jose, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2010; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.