NPIMap

Individual provider Active NPI

Robert Ballough, P.A.

  • Medical Physician Assistant
  • East Hartford, CT
National Provider Identifier
1851551972
Registry record updated Apr 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
002079 Issued in CT
Practice address
94 Connecticut Blvd
East Hartford, CT 06108-3013
Phone
(860) 528-1359
NPI assigned
Jun 12, 2008
Last updated
Apr 30, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 002079 CT Primary

Addresses

Primary practice location

94 Connecticut Blvd
East Hartford, CT 06108-3013

Mailing address

4 Farm CT
Wallingford, CT 06492-3251
Phone (203) 376-1863

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
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
I20131129000004 CT Practitioner - Physician Assistant 3476789181 Reassigns benefits to 8 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Hartford Healthcare Urgent Care Centers LLCGroup PAC ID 7618242777, 201 clinicians
Northeast Medical Group IncGroup PAC ID 1254233836, 1,357 clinicians

Practice addresses (Care Compare)

1061 W Main St
Branford, CT 06405-3430
Phone (860) 207-8942

35 Talcottville Rd
Vernon, CT 06066-5261
Phone (860) 787-5774

385 W Main St
Avon, CT 06001-4357
Phone (860) 777-6977

7 Mill Pond Dr
Suite a
Granby, CT 06035-2637
Phone (860) 323-3164

95 Armory Rd
Stratford, CT 06614-1702
Phone (203) 384-3388

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
2079CTMDPsychologist
002079CTMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Northeast Medical Group, Inc. CurrentSince Sep 9, 2024 Accepting new patients
First Choice Health Centers, Inc. CurrentSince Dec 12, 2015 Accepting new patients
Mill Hill Medical Consultants Inc CurrentSince Sep 9, 2024 Accepting new patients
First Choice Health Centers, Inc. CurrentSince Dec 12, 2015 Accepting new patients
Southington Urgent Care Past Accepting new patients
Masonicare Primary Care Physicians PastSince Oct 1, 2001 Accepting new patients
Masonicare Behavioral Health, LLC PastSince Dec 17, 2007 Accepting new patients

Locations

94 Connecticut Blvd
Hartford, CT 06108
Phone (860) 610-6191

95 Armory Rd
Stratford, CT 06614
Phone (203) 384-3388

67 Masonic Ave
Fl 1
Wallingford, CT 06492
Phone (203) 265-0355

67 Masonic Ave
Fl 3
Wallingford, CT 06492

Interoperability endpoints

  • Direct secure messaging: rballough681598@direct.ynhh.org
  • Direct secure messaging: robert.ballough@xdr.hhchealthdirect.org

Organizations & group practices 14

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.

View all 14

Hospital & facility affiliations 3

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": "1213228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714435200000",
    "number": "1851551972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 FARM CT",
            "city": "WALLINGFORD",
            "state": "CT",
            "postal_code": "064923251",
            "telephone_number": "203-376-1863"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "94 CONNECTICUT BLVD",
            "city": "EAST HARTFORD",
            "state": "CT",
            "postal_code": "061083013",
            "telephone_number": "860-528-1359"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BALLOUGH",
        "first_name": "ROBERT",
        "name_prefix": "Mr.",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-12",
        "last_updated": "2024-04-30",
        "certification_date": "2024-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CT",
            "license": "002079",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in East Hartford, CT

Sources for this page

Verify at the official NPI Registry.