Active NPI
Shawn Everett Ballard, DDS
- Dentist
- Logan, WV
National Provider Identifier
1891280426
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 4344
- Practice address
- 127 Prosperity LN
Logan, WV 25601-3488 - Phone
- (304) 752-4801
- NPI assigned
- Jun 26, 2018
- Last updated
- Jun 26, 2018
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 4344 | WV | Primary |
Addresses
Primary practice location
127 Prosperity LN
Logan, WV 25601-3488
Mailing address
127 Prosperity LN
Logan, WV 25601-3488
Phone (304) 752-4801
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4344 | WV | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jeffrey S. McCoy Susan Fowler Goodwin D.D.S. Inc. | Past | Accepting new patients |
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.
-
- General Practice Dentistry
- Logan, WV
- NPI 1245447200
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1529971200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1529971200000",
"number": "1891280426",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "127 PROSPERITY LN",
"city": "LOGAN",
"state": "WV",
"postal_code": "256013488",
"telephone_number": "304-752-4801"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "127 PROSPERITY LN",
"city": "LOGAN",
"state": "WV",
"postal_code": "256013488",
"telephone_number": "304-752-4801"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BALLARD",
"first_name": "SHAWN",
"middle_name": "EVERETT",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-06-26",
"last_updated": "2018-06-26",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WV",
"license": "4344",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Logan, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.