Jose Balboa Blanco, SURGICAL ASSISTANT

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

238.000547 Issued in IL

Practice address

18761 Chestnut CT
Mokena, IL 60448-9501

Phone

(786) 296-5425

NPI assigned

May 6, 2016

Last updated

Jun 7, 2025By the provider in NPPES

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 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Proassisting, Inc

  • Surgical Physician Assistant
  • Mokena, IL
  • NPI 1679229611

  Surgical Assistant

  NPD
• Proassisting Services LLC

  • Surgical Physician Assistant
  • Mokena, IL
  • NPI 1841107745
  NPD (past)

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

{
    "created_epoch": "1462492800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1749254400000",
    "number": "1902252125",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18761 CHESTNUT CT",
            "city": "MOKENA",
            "state": "IL",
            "postal_code": "604489501",
            "telephone_number": "786-296-5425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18761 CHESTNUT CT",
            "city": "MOKENA",
            "state": "IL",
            "postal_code": "604489501",
            "telephone_number": "786-296-5425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BALBOA BLANCO",
        "first_name": "JOSE",
        "credential": "SURGICAL ASSISTANT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-05-06",
        "last_updated": "2025-06-07",
        "certification_date": "2025-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246ZC0007X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Surgical Assistant",
            "state": "CO",
            "license": "15-483",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "IL",
            "license": "238.000547",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DRIVER LICENCE",
            "identifier": "B411427823290",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Melissa J Atieh, DAC, PHARMD
• Autumn Dental of Mokena LLC
• B.E.L.a. Charities, Inc. (B.E.L.A. Recovery)
• Annmarie Bach, CRNA
• Balance Health PLLC
• Melissa Jayne Banevich-Glaros, OTR/L
• Jessica Bara, APRN, CNP
• Jessica C Barnes
• Lauren Barnes
• Ruby Barraza, RBT

• Surgical Physician Assistant in Mokena, IL
• Providers in Mokena, IL by specialty
• Surgical Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.