NPIMap

Individual provider Active NPI

Wesam Ballouk, MD

  • Nephrology Physician
  • Memphis, TN
National Provider Identifier
1841291762
Registry record updated Feb 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
MD37027 Issued in TN
Practice address
2225 Union Ave
Ste 100
Memphis, TN 38104-4316
Phone
(901) 726-1161
Fax
(901) 726-0161
NPI assigned
Aug 2, 2005
Last updated
Feb 28, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X MD37027 TN Primary

Addresses

Primary practice location

2225 Union Ave
Ste 100
Memphis, TN 38104-4316

Mailing address

2225 Union Ave
Ste 100
Memphis, TN 38104-4316
Phone (901) 726-1161

Other identifiers 1

IdentifierTypeStateIssuer
3326941MedicaidTN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050125000633 TN Practitioner - Emergency MedicinePractitioner - Internal Medicine 4981654217 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency MedicineAlso: Internal Medicine
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Kidney Group of Memphis, PLLCGroup PAC ID 5991711483, 4 clinicians

Practice addresses (Care Compare)

1533 Bonnie LN
Suite 1
Cordova, TN 38016-1564
Phone (901) 726-1161

2225 Union Ave
Suite 100
Memphis, TN 38104-4391
Phone (901) 726-1161

7640 Wolf River Cir
Germantown, TN 38138-1713
Phone (901) 726-1161

7840 Church St
Millington, TN 38053-2403
Phone (901) 726-1161

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD37027TNMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Kidney Group of Memphis, PLLC Specialist CurrentSince Jan 1, 2006 Accepting new patients

Locations

2225 Union Ave
Ste 100
Memphis, TN 38104
Phone (901) 726-1161

Organizations & group practices 1

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.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1122940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740700800000",
    "number": "1841291762",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2225 UNION AVE",
            "address_2": "STE 100",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381044316",
            "telephone_number": "901-726-1161",
            "fax_number": "901-726-0161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2225 UNION AVE",
            "address_2": "STE 100",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381044316",
            "telephone_number": "901-726-1161",
            "fax_number": "901-726-0161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BALLOUK",
        "first_name": "WESAM",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-02",
        "last_updated": "2025-02-28",
        "certification_date": "2025-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "TN",
            "license": "MD37027",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3326941",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Memphis, TN

Sources for this page

Verify at the official NPI Registry.