James Joseph Balza, LCSW
Individual provider Active NPI Clinical Social Worker · Green Bay, WI
NPI 1720242555 · NPPES record last updated Feb 25, 2021
Key facts
- NPI
- 1720242555
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 998-123 (WI)
- Practice address
- 1499 6TH St
Green Bay, WI 54304-2252 - Phone
- (920) 497-6161
- Fax
- (920) 498-0476
- NPI assigned
- Jul 10, 2008
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Clinical Social Worker
- Education
- Other, 1984
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Innovative Counseling Inc
Practice addresses (Care Compare)
1499 6TH St
Green Bay, WI 54304-2252
Phone (920) 497-6161
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
- 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 |
|---|---|---|---|---|
| I20091012000216 | WI | Practitioner - Clinical Social Worker | 1658417373 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 998-123 | WI | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Innovative Counseling Inc | Current |
Accepting new patients |
Locations
1499 6th St
Green Bay, WI 54304
Phone (920) 497-6161
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 998-123 | WI | Yes |
Addresses
Primary practice location
1499 6TH St
Green Bay, WI 54304-2252
Mailing address
1160 Kepler Dr
Green Bay, WI 54311-8321
Phone (920) 288-5500
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 43739400 | Medicaid | WI |
Other providers in Green Bay, WI
- Elisabeth V Ballard
- Bela R. Ballo
- Frances Stahl Ballo
- Jennifer Lynn Balthazor
- Al Baltrusaitis
- Kyla S Balzar
- Denise M Balzola
- Stephanie Banaszynski
- Lauren Louise Bancroft
- Pradeep Bangalore Prakash
All providers in Green Bay, WI · Clinical Social Worker in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 25, 2021. 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).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.