R S Balboa MDPC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

RB028997 Issued in MI

Legal business name

R S BALBOA MDPC

Practice address

1201 Stone St Ste 5
Port Huron, MI 48060-3563

Phone

(810) 966-9556

Fax

(810) 966-4898

NPI assigned

Jun 29, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Ronaldo S Balboa, MDNPI 1417941055

Title

Owner

Phone

(810) 966-9556

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ronaldo S Balboa, M.D.

  • Internal Medicine Physician
  • Port Huron, MI
  • NPI 1417941055
  Medicare reassignment NPD Authorized official
• Riad Robert Hajjar, M.D.

  • Internal Medicine Physician
  • Port Huron, MI
  • NPI 1538153176
  NPD
• Jaclyn Kamidoi

  • Nurse Practitioner
  • Port Huron, MI
  • NPI 1992202998
  NPD

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

{
    "created_epoch": "1246233600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1260835200000",
    "number": "1801024807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 STONE ST STE 5",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480603563",
            "telephone_number": "810-966-9556",
            "fax_number": "810-966-4898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 STONE ST STE 5",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480603563",
            "telephone_number": "810-966-9556",
            "fax_number": "810-966-4898"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "R S BALBOA MDPC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-29",
        "last_updated": "2009-12-15",
        "status": "A",
        "authorized_official_last_name": "BALBOA",
        "authorized_official_first_name": "RONALDO",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "810-966-9556",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "RB028997",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "110094613",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1006297",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM",
            "identifier": "0740374",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amalia Pytleski
• Carly Quain
• Mellisa Lyn Quandt
• Ausanae Quarles, LMSW
• Patrina Quinn, CRNA
• Elizabeth Rabine
• Amy Racz
• Rafia Khalil Arthritis & Rheumatology Center PC
• Rafia Khalil Arthritis & Rheumatology Center PC
• Haider Rahbar, MD

• Internal Medicine Physician in Port Huron, MI
• Providers in Port Huron, MI by specialty
• Internal Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2009; 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.

Verify at the official NPI Registry.