Robert Lee Ballou, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

3989 Issued in KY

Practice address

109 N Main St
Corbin, KY 40701

Phone

(606) 528-2350

Fax

(606) 528-5507

NPI assigned

Sep 14, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in KY

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1158192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1205107200000",
    "number": "1891890679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 N MAIN ST",
            "city": "CORBIN",
            "state": "KY",
            "postal_code": "40701",
            "telephone_number": "606-528-2350",
            "fax_number": "606-528-5507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 N MAIN ST",
            "city": "CORBIN",
            "state": "KY",
            "postal_code": "40701",
            "telephone_number": "606-528-2350",
            "fax_number": "606-528-5507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BALLOU",
        "first_name": "ROBERT",
        "middle_name": "LEE",
        "name_prefix": "Mr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-14",
        "last_updated": "2008-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "KY",
            "license": "3989",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "KY",
            "license": "3989",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "60039898",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TENN CARE",
            "identifier": "4240857",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Linda Pauline Baker
• Mary Aileen Baker, BA
• Rita Nicole Baker
• Linda Bales
• Heather Ball
• Banfield Diagnostic Imaging, LLC (Banfield Diagnostic Imaging)
• Jeffery Jacob Banfield, R.T.(R)
• Aaron Israel Banks, BS
• Baptist Health Medical Group Inc
• Baptist Health Medical Group Inc

• General Practice Dentistry in Corbin, KY
• Providers in Corbin, KY by specialty
• General Practice Dentistry in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2008; 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.