Active NPI
Jacob E Ballard, ATC
- Athletic Trainer
- Montgomery, AL
National Provider Identifier
1558645713
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 1049
- Practice address
- 464 Saint Lukes Dr
Montgomery, AL 36117-7104 - Phone
- (334) 272-0853
- Fax
- (334) 272-0871
- NPI assigned
- Oct 6, 2011
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 1049 | AL | Primary |
Addresses
Primary practice location
464 Saint Lukes Dr
Montgomery, AL 36117-7104
Mailing address
464 Saint Lukes Dr
Montgomery, AL 36117-7104
Phone (334) 272-0853
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1049 | AL | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1317859200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1317859200000",
"number": "1558645713",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "464 SAINT LUKES DR",
"city": "MONTGOMERY",
"state": "AL",
"postal_code": "361177104",
"telephone_number": "334-272-0853",
"fax_number": "334-272-0871"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "464 SAINT LUKES DR",
"city": "MONTGOMERY",
"state": "AL",
"postal_code": "361177104",
"telephone_number": "334-272-0853",
"fax_number": "334-272-0871"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BALLARD",
"first_name": "JACOB",
"middle_name": "E",
"credential": "ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-10-06",
"last_updated": "2011-10-06",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "AL",
"license": "1049",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Montgomery, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.