Samuel Edward Balla, LISW-S

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

I1500113SUPV Issued in OH

Practice address

88 N. Sandusky St
Delaware, OH 43015

Phone

(740) 203-3800

Fax

(740) 203-3799

NPI assigned

Jul 19, 2016

Last updated

Jul 19, 2016By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Sondermind Provider Network LLC

  • Clinical Social Worker
  • Denver, CO
  • NPI 1760854442

  OH

  Medicare reassignment NPD
• Wellqor Psychological Services of California, PC

  • Clinical Psychologist
  • Murrieta, CA
  • NPI 1093173742

  OH

  Medicare reassignment NPD
• Wellqor Psychological Services, PC

  • Clinical Psychologist
  • Melville, NY
  • NPI 1063920841

  OH

  Medicare reassignment NPD
• Maryhaven Inc

  • Addiction (Substance Use Disorder) Registered Nurse
  • Delaware, OH
  • NPI 1538676317
  NPD (past)

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

{
    "created_epoch": "1468886400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1468886400000",
    "number": "1851744403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1791 ALUM CREEK DR",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432071708",
            "telephone_number": "614-445-8131",
            "fax_number": "614-827-8380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "88 N. SANDUSKY ST",
            "city": "DELAWARE",
            "state": "OH",
            "postal_code": "43015",
            "telephone_number": "740-203-3800",
            "fax_number": "740-203-3799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BALLA",
        "first_name": "SAMUEL",
        "middle_name": "EDWARD",
        "name_prefix": "Mr.",
        "credential": "LISW-S",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-07-19",
        "last_updated": "2016-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I1500113SUPV",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Backcare Chiropractic LLC
• Backcare Family Chiropractic, LLC
• Danielle Baker, BCBA, COBA, LPC, NCC
• Susan Paige Baker
• Sylwia Bal
• Courtney Amanda Rene' Bargar, LMT
• Bruce Barker, MD
• Gwynn Susan Barnes, PT
• Jessica M Barnett, MD
• Christina Marie Barone, CNP

• Clinical Social Worker in Delaware, OH
• Providers in Delaware, OH by specialty
• Clinical Social Worker in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.