Active NPI
Julio Ballestas, M.D
- Psychiatry Physician
- Hollywood, FL
National Provider Identifier
1841521069
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- ME142436
- Practice address
- 200 S Park Rd Ste 140
Hollywood, FL 33021-8351 - Phone
- (631) 260-7360
- NPI assigned
- Jan 28, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | ME142436 | FL | Primary |
| Psychiatry Physician | 2084P0800X | 0101283790 | VA | |
| Psychiatry Physician | 2084P0800X | 274923 | NY |
Addresses
Primary practice location
200 S Park Rd Ste 140
Hollywood, FL 33021-8351
Mailing address
200 S Park Rd Ste 140
Hollywood, FL 33021-8351
Phone (631) 260-7360
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 28, 2025 through Jan 28, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME142436 | FL | MD | Psychiatry Physician |
| 274923 | NY | MD | Psychiatry Physician |
| 0101283790 | VA | MD | Psychiatry Physician |
Interoperability endpoints
- fbh.julioballestas@141363.advancedmd-direct.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1264636800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1733097600000",
"number": "1841521069",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 S PARK RD STE 140",
"city": "HOLLYWOOD",
"state": "FL",
"postal_code": "330218351",
"telephone_number": "631-260-7360"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 S PARK RD STE 140",
"city": "HOLLYWOOD",
"state": "FL",
"postal_code": "330218351",
"telephone_number": "631-260-7360"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BALLESTAS",
"first_name": "JULIO",
"name_prefix": "Dr.",
"credential": "M.D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-01-28",
"last_updated": "2024-12-02",
"certification_date": "2024-12-02",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "FL",
"license": "ME142436",
"primary": true
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "VA",
"license": "0101283790",
"primary": false
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "NY",
"license": "274923",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hollywood, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.