James Moses Ballard II, PHD
Individual provider Active NPI Clinical Psychologist · Washington, DC
NPI 1619081973 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1619081973
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- PSY354 (DC)
- Practice address
- 650 Pennsylvania Ave SE
Suite 440
Washington, DC 20003-4318 - Phone
- (202) 544-5440
- Fax
- (202) 544-3004
- NPI assigned
- Aug 17, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in DC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20111128000162 | DC | Practitioner - Clinical Psychologist | 7012181266 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY354 | DC | MD | Clinical Psychologist |
| 04420 | MD | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Capitolhill Consortium for Counseling & Consultation, LLC | Current |
Accepting new patients | |
| Interdynamics, Inc. | Past |
Accepting new patients |
Locations
650 Pennsylvania Ave SE
Ste 240
Washington, DC 20003
Phone (202) 544-1751
650 Pennsylvania Ave SE
Ste 440
Washington, DC 20003
Phone (202) 422-1802
12150 Annapolis Rd
Ste 309
Glenn Dale, MD 20769
Phone (301) 754-2222
1400 Mercantile Ln
Ste 252
Upper Marlboro, MD 20774
Phone (240) 324-8968
1235 S Clark St
Ste 510
Arlington, VA 22202
Phone (703) 413-3028
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY354 | DC | Yes |
Addresses
Primary practice location
650 Pennsylvania Ave SE
Suite 440
Washington, DC 20003-4318
Mailing address
650 Pennsylvania Ave SE
Suite 440
Washington, DC 20003-4318
Phone (202) 544-5440
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PSY354 | Other | DC | STATE LICENSE |
Other providers in Washington, DC
- Richie Balla
- Demetria Ballard Ballard Bey
- April Kavanagh Ballard
- Elizabeth Day Ballard
- Frances Hall Ballard
- Nitai Ballard
- Pamela Ballard
- Ricca Ballard
- Stacy Ballard
- Victoria Lachais Ballard
All providers in Washington, DC · Clinical Psychologist in District of Columbia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. 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).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.