Carlos Eduardo Ballesteros, M.D.
Individual provider Active NPI Obstetrics & Gynecology Physician · San Juan, TX
NPI 1912384686 · NPPES record last updated Dec 17, 2021
Key facts
- NPI
- 1912384686
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Obstetrics & Gynecology Physician 207V00000X
- License
- S4097 (TX)
- Practice address
- 1211 N Raul Longoria Rd Ste C
San Juan, TX 78589-3714 - Phone
- (956) 782-7878
- Fax
- (956) 782-7877
- NPI assigned
- May 1, 2015
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 8
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Obstetrics/Gynecology
- Education
- Other, 2015
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Presbyterian Healthcare Services
Practice addresses (Care Compare)
2200 W 21St St
Clovis, NM 88101-2011
Phone (505) 769-7577
Hospital & facility affiliations
- Plains Regional Medical Center
Merit-based Incentive Payment System (MIPS)
- Final score
- 88.68 of 100
- Quality
- 82.35
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 76.6
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TX, NM
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20211118000338 | TX | Practitioner - Obstetrics/Gynecology | 0143516179 | Reassigns benefits to 2 organizations |
| I20231116001248 | NM | Practitioner - Obstetrics/Gynecology | 0143516179 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Alberto D Duran M.D P.a. | Obstetrics & Gynecology | Current |
Accepting new patients |
| Obhg Texas Holdings, P.a. | Obstetrics & Gynecology | Current |
Accepting new patients |
| Edgar a Rodriguez MD PA | Obstetrics & Gynecology | Current |
Accepting new patients |
| Presbyterian Healthcare Services | Obstetrics & Gynecology | Current |
Accepting new patients |
| Presbyterian Healthcare Services | Current |
Accepting new patients | |
| Doctors Hospital at Renaissance, LTD | Past | Accepting new patients | |
| Presbyterian Healthcare Services | Past | Accepting new patients | |
| Columbia Rio Grande Healthcare, L.P. | Past | Accepting new patients |
Locations
2100 N Mlk Blvd
Clovis, NM 88101
Phone (505) 769-2141
2200 W 21st St
Clovis, NM 88101
Phone (505) 769-7577
1600 Wallace Blvd
Amarillo, TX 79106
Phone (806) 212-2000
12221 N Mopac Expy
Austin, TX 78758
Phone (512) 901-2530
2830 Calder St
Beaumont, TX 77702
Phone (409) 899-7000
5950 Saratoga Blvd
Corpus Christi, TX 78414
Phone (321) 917-9263
9440 Poppy Dr
Dallas, TX 75218
Phone (214) 324-6100
1400 8th Ave
Ft Worth, TX 76104
Phone (817) 922-1559
7600 Beechnut St
Houston, TX 77074
Phone (713) 456-5000
3011 W Loop 1604 N
San Antonio, TX 78251
Phone (726) 266-7081
1211 N Raul Longoria Rd
Ste C
San Juan, TX 78589
Phone (956) 782-4002
Interoperability endpoints
- cballesteros240701@direct.phs.org
- https://fhir-myrecord.cerner.com/r4/3fe59471-3589-4f65-b447-b92822bfc057/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | S4097 | TX | Yes |
Addresses
Primary practice location
1211 N Raul Longoria Rd Ste C
San Juan, TX 78589-3714
Mailing address
1211 N Raul Longoria Rd Ste C
San Juan, TX 78589-3714
Phone (956) 782-7878
Other providers in San Juan, TX
- Chukwunonso Jideofor Azikiwe
- Azuart DME LLC
- Baca Family Practice PLLC
- Americo M Baca
- Thomas Boake Ball
- Jaqueline Aide Barrera
- Basiouni Basiouni
- Behavioral and Consultant Nurses of South Texas LLC
- Bella Vida DME , LLC.
- Diana Marilyn Beltran
All providers in San Juan, TX · Obstetrics & Gynecology Physician in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 17, 2021. 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).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.