Active NPI
Bali Surgical Practice PLLC
- Surgery Physician
- Charleston, WV
National Provider Identifier
1659419653
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- 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
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | Primary | ||
| Vascular Surgery Physician | 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 001834802 | Other | WV | BLUE CROSS |
| 3810009656 | Medicaid | WV | |
| 1689670069 | Other | WV | INDIVIUAL NPI |
Other names 1
- Charleston Surgical Arts
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WV
Enrollment records 1
National Provider Directory
National Provider DirectoryLocations
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.
-
- Surgery Physician
- Charleston, WV
- NPI 1689670069
-
- Surgery Physician
- Newark, DE
- NPI 1215066048
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.