Willie Benjamin Ballou, NP-C

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

229136 Issued in AZ

Practice address

4041 S McClintock Dr
Tempe, AZ 85282-5879

Phone

(520) 233-7111

NPI assigned

Apr 23, 2015

Last updated

Jul 7, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TX, AZ, LA, NM, OR, NV, CA7 enrollments

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 7

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)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Adobe PH PC

  • Family Medicine Physician
  • Phoenix, AZ
  • NPI 1891535142

  NM, NV, OR

  Medicare reassignment NPD
• Adobe Provider Group

  • Nurse Practitioner
  • Tempe, AZ
  • NPI 1659850279
  Medicare reassignment NPD
• Adobe PH Ca Medical Group, P.C.

  • Family Medicine Physician
  • Brea, CA
  • NPI 1427889195
  Medicare reassignment NPD
• Community Care Health Network LLC

  dba Matrix Medical Network

  • Nurse Practitioner
  • Nashville, TN
  • NPI 1619368842

  LA

  Medicare reassignment NPD
• Great Health Aftx PC

  • Family Medicine Physician
  • Stamford, TX
  • NPI 1174384259
  Medicare reassignment NPD
• Signify Health Medical Associates, PLLC

  • General Practice Physician
  • Dallas, TX
  • NPI 1750845863

  Nurse Practitioner, NV, OR

  Medicare reassignment NPD
• Signify Health, LLC

  • General Practice Physician
  • Dallas, TX
  • NPI 1689158487

  AZ, NM, Nurse Practitioner

  Medicare reassignment NPD
• Vpa of Texas PLLC

  dba HarmonyCares Medical Group

  • Family Medicine Physician
  • Irving, TX
  • NPI 1679510499
  Medicare reassignment NPD
• Vpa of Texas PLLC

  dba HarmonyCares Medical Group

  • Family Medicine Physician
  • Irving, TX
  • NPI 1326667536
  NPD
• Adobe Care and Wellness LLC

  • Case Management Agency
  • Mesa, AZ
  • NPI 1346678935
  NPD (past)

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

{
    "created_epoch": "1429747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625616000000",
    "number": "1548657802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4041 S MCCLINTOCK DR",
            "address_2": "STE 311",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852825879",
            "telephone_number": "520-233-7111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4041 S MCCLINTOCK DR",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852825879",
            "telephone_number": "520-233-7111"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2718 Skyview Point Dr",
            "address_2": "None",
            "address_purpose": "LOCATION",
            "city": "Houston",
            "state": "TX",
            "postal_code": "770478122",
            "country_code": "US",
            "telephone_number": "281-908-6346",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BALLOU",
        "first_name": "WILLIE",
        "middle_name": "BENJAMIN",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-04-23",
        "last_updated": "2021-07-07",
        "certification_date": "2021-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "TX",
            "license": "AP127755",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "AZ",
            "license": "229136",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dana Renee Balagot Mort, LPN
• Rachel Baldwin, DTR
• Steven Alex Baldwin, MD
• Jordan Ball
• John Balles, PH.D.
• Blythe Bankenbush, PA-C
• Carrie Susanne Bann, PMHNP-BC
• Banner Enticare Tempe Surgery Center LLC (Banner Tempe Surgery Center)
• Banner Health (Banner Health Clinic- Tempe)
• Banner Occupational Health - Onsite, LLC

• Nurse Practitioner in Tempe, AZ
• Providers in Tempe, AZ by specialty
• Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 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.

Verify at the official NPI Registry.