Active NPI
John R Balfanz, MD
- Pediatrics Physician
- Saint Paul, MN
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 20262
- Practice address
- 233 Grand Ave
St Paul, MN 55102 - Phone
- (651) 227-7806
- Fax
- (651) 256-6707
- NPI assigned
- Jan 18, 2006
- Last updated
- Oct 11, 2016
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 20262 | MN | Primary |
Addresses
Primary practice location
233 Grand Ave
St Paul, MN 55102
Mailing address
Essentia Health Duluth Clinic - McL2Cred
400 East Third Street
Duluth, MN 55805-1951
Phone (218) 786-8319
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 048087800 | Medicaid | MN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ND
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Innovis Health LLC | Current | Accepting new patients | |
| Innovis Health, LLC | Current | Accepting new patients |
Locations
400 E 3rd St
Duluth, MN 55805
Phone (218) 722-8364
1702 University Dr S
Fargo, ND 58103
Phone (701) 364-4222
3000 32nd Ave S
Fargo, ND 58103
Phone (701) 364-3000
Organizations & group practices 2
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.
-
dba Essentia Health-Osgood Clinic
- Multi-Specialty Clinic/Center
- Fargo, ND
- NPI 1144776576
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137542400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1476144000000",
"number": "1669452561",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "ESSENTIA HEALTH DULUTH CLINIC - MCL2CRED",
"address_2": "400 EAST THIRD STREET",
"city": "DULUTH",
"state": "MN",
"postal_code": "558051951",
"telephone_number": "218-786-8319"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "233 GRAND AVE",
"city": "ST PAUL",
"state": "MN",
"postal_code": "55102",
"telephone_number": "651-227-7806",
"fax_number": "651-256-6707"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BALFANZ",
"first_name": "JOHN",
"middle_name": "R",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-01-18",
"last_updated": "2016-10-11",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MN",
"license": "20262",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "048087800",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Saint Paul, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2016; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.