Beatric E Balsamo, PA
Individual provider Active NPI Medical Physician Assistant · Taos, NM
NPI 1871638403 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1871638403
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- License
- 83PA001 (NM)
- Practice address
- 1399 Weimer Rd Ste 200
Ndcbu Box 5775
Taos, NM 87571-6349 - Phone
- (505) 758-2224
- Fax
- (505) 758-4903
- NPI assigned
- Feb 21, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NM
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20131115000735 | NM | Practitioner - Physician Assistant | 4981830221 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 83PA001 | NM | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Taos Health Systems Inc Holy Cross Hospital | Current |
Accepting new patients |
Locations
1399 Weimer Rd
Ste 200
Taos, NM 87571
Phone (505) 758-2224
1397 Weimer Rd
Taos, NM 87571
Phone (575) 751-5746
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 83PA001 | NM | Yes |
Addresses
Primary practice location
1399 Weimer Rd Ste 200
Ndcbu Box 5775
Taos, NM 87571-6349
Mailing address
PO Box 933
Ranchos de Taos, NM 87557-0933
Phone (505) 758-0137
Other providers in Taos, NM
- Samantha Baca
- Jana Bailey
- Justin Bailey
- Lauren Bailey
- Stephen James Balise
- Franklin Dennis Bardin
- Stephanie Lynn Barnes
- Kristen Bartels
- Bertrand Bassett
- Heather Marie Bates
All providers in Taos, NM · Medical Physician Assistant in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.