Organization Active NPI

Bali Surgical Practice PLLC

  • Surgery Physician
  • Charleston, WV
National Provider Identifier
1659419653
Registry record updated Sep 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
BALI SURGICAL PRACTICE PLLC
Doing business as
Charleston Surgical Arts
Practice address
400 Court St Ste 203
Charleston, WV 25301-1653
Phone
(304) 346-2254
Fax
(304) 346-3184
NPI assigned
Feb 2, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2024

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

Authorized official

Name
Veda Amber Evans
Title
Billing Manager
Phone
(304) 346-2254

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X Primary
Vascular Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2086S0129X

Addresses

Primary practice location

400 Court St Ste 203
Charleston, WV 25301-1653

Mailing address

400 Court St Ste 203
Charleston, WV 25301-1653
Phone (304) 346-2254

Other identifiers 3

IdentifierTypeStateIssuer
001834802OtherWVBLUE CROSS
3810009656MedicaidWV
1689670069OtherWVINDIVIUAL NPI

Other names 1

  • Charleston Surgical Arts Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241012000236 WV Part B Supplier - Clinic/Group Practice 3678582251 Receives reassigned benefits from 1 practitioner
Practice locations: Charleston, WV

National Provider Directory

National Provider Directory

Locations

400 Court St
Ste 203
Charleston, WV 25301
Phone (304) 343-4900

400 Court St
Ste 302
Charleston, WV 25301
Phone 3043469400121

400 S Ruffner Rd
Ste 2
Charleston, WV 25314
Phone (304) 346-2254

401 Division St
Ste 202
South Charleston, WV 25309
Phone (304) 766-4300

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1170374400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725408000000",
    "number": "1659419653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 COURT ST STE 203",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253011653",
            "telephone_number": "304-346-2254",
            "fax_number": "304-346-3184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 COURT ST STE 203",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253011653",
            "telephone_number": "304-346-2254",
            "fax_number": "304-346-3184"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BALI SURGICAL PRACTICE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-02",
        "last_updated": "2024-09-04",
        "certification_date": "2024-09-04",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "VEDA",
        "authorized_official_middle_name": "AMBER",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "304-346-2254"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "001834802",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810009656",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIUAL NPI",
            "identifier": "1689670069",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Charleston Surgical Arts",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Charleston, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.