Willie Benjamin Ballou, NP-C
Individual provider Active NPI Nurse Practitioner · Tempe, AZ
NPI 1548657802 · NPPES record last updated Jul 7, 2021
Key facts
- NPI
- 1548657802
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 229136 (AZ)
- Practice address
- 4041 S McClintock Dr
Tempe, AZ 85282-5879 - Phone
- (520) 233-7111
- NPI assigned
- Apr 23, 2015
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 10
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2014
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
7500 N Dreamy Draw Dr
Phoenix, AZ 85020-4638
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (7 enrollments) in TX, AZ, LA, NM, OR, NV, CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180504001120 | TX | Practitioner - Nurse Practitioner | 4385908086 | Reassigns benefits to 3 organizations |
| I20210728000362 | AZ | Practitioner - Nurse Practitioner | 4385908086 | Reassigns benefits to 2 organizations |
| I20221108003122 | LA | Practitioner - Nurse Practitioner | 4385908086 | Reassigns benefits to 1 organization |
| I20231123000069 | NM | Practitioner - Nurse Practitioner | 4385908086 | Reassigns benefits to 2 organizations |
| I20240322003989 | OR | Practitioner - Nurse Practitioner | 4385908086 | Reassigns benefits to 2 organizations |
| I20240325001676 | NV | Practitioner - Nurse Practitioner | 4385908086 | Reassigns benefits to 2 organizations |
| I20260204004529 | CA | Practitioner - Nurse Practitioner | 4385908086 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Adobe PH Ca Medical Group, P.C. | Current |
Accepting new patients | |
| Signify Health, LLC | Nurse Practitioner | Current |
Accepting new patients |
| Community Care Health Network LLC | Nurse Practitioner | Current |
Accepting new patients |
| Great Health Aftx PC | Current |
Accepting new patients | |
| Adobe Provider Group | Nurse Practitioner | Current |
Accepting new patients |
| Vpa of Texas PLLC | Current |
Accepting new patients | |
| Vpa of Texas PLLC | Current | Accepting new patients | |
| Adobe PH PC | Current |
Accepting new patients | |
| Signify Health Medical Associates, PLLC | Nurse Practitioner | Current |
Accepting new patients |
| Adobe Care and Wellness LLC | Past | Accepting new patients |
Locations
2705 S Alma School Rd
Chandler, AZ 85286
Phone (480) 820-7246
7500 N Dreamy Draw Dr
Ste 100B
Phoenix, AZ 85020
Phone (520) 233-7111
7500 N Dreamy Draw Dr
Ste 100
Phoenix, AZ 85020
Phone (520) 233-7111
9201 E Mountain View Rd
Ste 220
Scottsdale, AZ 85258
Phone (480) 862-1883
4041 S McClintock Dr
Ste 311
Tempe, AZ 85282
Phone 5202337111377
135 S State College Blvd
#228
Brea, CA 92821
2900 Westfork Dr
Ste 401
Baton Rouge, LA 70827
Phone (225) 953-0895
100 Sun Ave NE
Ste 650
Albuquerque, NM 87109
Phone (505) 260-4300
500 Marquette Ave NW
Ste 1200
Albuquerque, NM 87102
Phone (505) 295-6685
701 S Carson St
Ste 200
Carson City, NV 89701
Phone (617) 586-0958
7251 W Lake Mead Blvd
Ste 300
Las Vegas, NV 89128
Phone (702) 562-4096
407 Willoughby Ave
Brooklyn, NY 11205
Phone (212) 201-1252
780 Commercial St SE
Ste 100
Salem, OR 97301
Phone (469) 466-7037
8215 SW Tualatin Sherwood Rd
Ste 200
Tualatin, OR 97062
Phone (503) 899-3793
4055 Valley View Ln
Ste 400
Dallas, TX 75244
Phone (469) 466-7037
4545 Fuller Dr
Ste 325
Irving, TX 75038
Phone (972) 870-5511
1003 Columbia St
Stamford, TX 79553
Phone (325) 773-3671
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Health Nurse Practitioner | 363LA2200X | AP127755 | TX | |
| Nurse Practitioner | 363L00000X | 229136 | AZ | Yes |
Addresses
Primary practice location
4041 S McClintock Dr
Tempe, AZ 85282-5879
Mailing address
4041 S McClintock Dr
Ste 311
Tempe, AZ 85282-5879
Phone (520) 233-7111
Other practice location 1
2718 Skyview Point Dr
None
Houston, TX 77047-8122
Phone (281) 908-6346
Other providers in Tempe, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 7, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.