Balanced Wellness Primary Care, LLC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

004797 Issued in CT

Legal business name

BALANCED WELLNESS PRIMARY CARE, LLC

Practice address

620 Norwich New London Tpke
Uncasville, CT 06382

Phone

(860) 892-8012

Fax

(860) 892-8027

NPI assigned

Mar 18, 2013

Last updated

Jun 17, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kristin Marie MahanNPI 1750663860

Title

Owner

Phone

(860) 892-8012

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kristin Marie Mahan

  • Family Nurse Practitioner
  • Uncasville, CT
  • NPI 1750663860
  Medicare reassignment Care Compare group NPD Authorized official
• Joseph F O'Keefe, M.D.

  • Physical Medicine & Rehabilitation Physician
  • Farmington, CT
  • NPI 1538104583
  Medicare reassignment Care Compare group NPD
• Kathleen Eagle, MSN, APRN, FNP-C

  • Family Nurse Practitioner
  • Uncasville, CT
  • NPI 1275202087
  Medicare reassignment NPD
• Tracy Michele Jullarine, APRN

  • Family Nurse Practitioner
  • Uncasville, CT
  • NPI 1831857143
  Medicare reassignment NPD
• Lynda Mary Lombardi, NP-C

  • Family Nurse Practitioner
  • Groton, CT
  • NPI 1992128128
  Medicare reassignment NPD
• Danielle Lee Mallory, APRN FNP-BC

  • Family Nurse Practitioner
  • Uncasville, CT
  • NPI 1003478686
  Medicare reassignment NPD

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

{
    "created_epoch": "1363564800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1655424000000",
    "number": "1780926774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "620 NORWICH NEW LONDON TPKE",
            "city": "UNCASVILLE",
            "state": "CT",
            "postal_code": "06382",
            "telephone_number": "860-892-8012",
            "fax_number": "860-892-8027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 NORWICH NEW LONDON TPKE",
            "city": "UNCASVILLE",
            "state": "CT",
            "postal_code": "06382",
            "telephone_number": "860-892-8012",
            "fax_number": "860-892-8027"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BALANCED WELLNESS PRIMARY CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-18",
        "last_updated": "2022-06-17",
        "certification_date": "2022-06-16",
        "status": "A",
        "authorized_official_last_name": "MAHAN",
        "authorized_official_first_name": "KRISTIN",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "860-892-8012"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "CT",
            "license": "004797",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Judith Olson Applegate, APRN
• Bethany Grace Arabic
• Michel-Ange Aurelus-Joseph
• Cassie Babcock, OTR/L
• Bruce E Bailey, M.D.
• Richard Bennink, LCSW
• Amber Brooks, PTA
• Tammy Brown
• Stephen Gerard Burke, PTA
• Sydney Byrd

• Family Nurse Practitioner in Uncasville, CT
• Providers in Uncasville, CT by specialty
• Family Nurse Practitioner in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.