Sally J Ballard, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

Practice address

200 S Broadway
Goreville, IL 62939

Phone

(618) 995-2396

Fax

(618) 995-2947

NPI assigned

Jul 18, 2007

Last updated

Nov 12, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

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.

• CLS Medical Inc.

  dba Goreville Family Practice

  • Primary Care Clinic/Center
  • Goreville, IL
  • NPI 1790980985
  NPD (past)
• Norris City Health Clinic

  • Rural Health Clinic/Center
  • Norris City, IL
  • NPI 1326274325
  NPD (past)

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

{
    "created_epoch": "1184716800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1194825600000",
    "number": "1720288756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 S BROADWAY",
            "address_2": "PO BOX 40",
            "city": "GOREVILLE",
            "state": "IL",
            "postal_code": "62939",
            "telephone_number": "618-995-2396",
            "fax_number": "618-995-2947"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 S BROADWAY",
            "city": "GOREVILLE",
            "state": "IL",
            "postal_code": "62939",
            "telephone_number": "618-995-2396",
            "fax_number": "618-995-2947"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BALLARD",
        "first_name": "SALLY",
        "middle_name": "J",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-07-18",
        "last_updated": "2007-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP NUMBER",
            "identifier": "215389",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Douglas Eugene Atkins
• Tricia Ann Bailey
• William J Banz
• Blue Note Therapy PLLC
• Blake William Cain, MD, MS
• Camarato Drug Inc (Goreville Professional Pharmacy)
• Matthew Camarato, RPH

• Medical Physician Assistant in Goreville, IL
• Providers in Goreville, IL by specialty
• Medical Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.