Thomas Benjamin Bales, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA58355 Issued in CA

Practice address

345 Blackstone Blvd
Providence, RI 02906-4800

Phone

(401) 455-6200

NPI assigned

Jul 7, 2018

Last updated

Sep 25, 2020By 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 CA

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 1

Specialty

Physician Assistant

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Grace Kwon CorporationGroup PAC ID 4688160476, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts, Physician Assistant

State licenses

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.

• Grace Kwon Corporation

  • Psychiatry Physician
  • Tustin, CA
  • NPI 1255898706
  Medicare reassignment Care Compare group
• Harbor Psychiatry & Mental Health, Professional Corporation

  • Psychiatry Physician
  • Newport Beach, CA
  • NPI 1780050054
  Medicare reassignment

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

{
    "created_epoch": "1530921600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600992000000",
    "number": "1649766114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4631 TELLER AVE",
            "address_2": "STE 100",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926608105",
            "telephone_number": "949-887-7187",
            "fax_number": "949-476-3080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "345 BLACKSTONE BLVD",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029064800",
            "telephone_number": "401-455-6200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BALES",
        "first_name": "THOMAS",
        "middle_name": "BENJAMIN",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-07-07",
        "last_updated": "2020-09-25",
        "certification_date": "2020-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA58355",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "RI",
            "license": "PA01031",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Heather Y Baldassi, PT
• Abigail Baldwin-Leclair, MD
• Ashley Mary Baldwin, RNP
• Margaret Sedell Baldwin
• Rachel K Baldwin, PHD
• Stefan Santo Balestra, PA-C
• Jennifer Lynn Balfour, MAOM, PHD
• Sujata Balgobin, CRNA
• Audrey Ballard, MD
• Samantha Ballas

• Physician Assistant in Providence, RI
• Providers in Providence, RI by specialty
• Physician Assistant in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2020; 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.