NPIMap

Individual provider Active NPI

Jamal Abdul Yasser Balouch, DO

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Great Falls, MT
National Provider Identifier
1922254705
Registry record updated Mar 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081P2900X
License
34171 Issued in MT
Practice address
500 15TH Ave S
Great Falls, MT 59405-4324
Phone
(406) 455-5000
Fax
(406) 731-8318
NPI assigned
Aug 13, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 29, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Physical Medicine & Rehabilitation) Physician 2081P2900X 34171 MT Primary

Addresses

Primary practice location

500 15TH Ave S
Great Falls, MT 59405-4324

Mailing address

500 15TH Ave S
Great Falls, MT 59405-4324
Phone (406) 455-5000

Other identifiers 2

IdentifierTypeStateIssuer
NC1545MedicaidSC
5919902MedicaidNC

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jamal.balouch.p1@direct.benefisbmg.nextgenshare.com Direct Benefis Hospitals, Inc.

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220128000198 AZ Practitioner - Physical Medicine and Rehabilitation 6901065341 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Medicine and Rehabilitation
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1851 N Gemini Dr
Suite a
Flagstaff, AZ 86001-1607
Phone 4808219339105

Hospital & facility affiliations

  • Flagstaff Medical Center Hospital, Flagstaff, AZ, CCN 030023
  • Verde Valley Medical Center Hospital, Cottonwood, AZ, CCN 030007
  • Yavapai Regional Medical Center Hospital, Prescott, AZ, CCN 030012
  • Kingman Regional Medical Center Hospital, Kingman, AZ, CCN 030055
  • Tuba City Regional Health Care Corporation Hospital, Tuba City, AZ, CCN 030073
  • Rehabilitation Hospital of Northern Arizona Inpatient rehabilitation facility, Flagstaff, AZ, CCN 033041
  • Mountain Valley Regional Rehabilitation Hospital Inpatient rehabilitation facility, Prescott Valley, AZ, CCN 033036

Merit-based Incentive Payment System (MIPS)

Final score
56.84 of 100Reported as individual
Quality
72.06
Improvement activities
0
Cost
72.92

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
34171MTMDPain Medicine (Physical Medicine & Rehabilitation) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Aspen Rehab PLLC Pain Medicine CurrentSince Dec 28, 2021 Accepting new patients
Mountain Valley Regional Rehabilitation Hospital Inc Past Accepting new patients
Frances Mahon Deaconess Hospital Past Accepting new patients
Rehabilitation Hospital of Northern Arizona LLC Past Accepting new patients

Locations

1851 N Gemini Dr
Flagstaff, AZ 86001
Phone (928) 266-0118

1521 N Pine Cliff Dr
Flagstaff, AZ 86001
Phone (928) 440-2350

1851 N Gemini Dr
Ste A
Flagstaff, AZ 86001
Phone (480) 821-9339

902 N Beaver St
Flagstaff, AZ 86001

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/AIBGDD/Endpoint/AIBGDD

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 11

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1218585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616976000000",
    "number": "1922254705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 15TH AVE S",
            "city": "GREAT FALLS",
            "state": "MT",
            "postal_code": "594054324",
            "telephone_number": "406-455-5000",
            "fax_number": "406-731-8318"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 15TH AVE S",
            "city": "GREAT FALLS",
            "state": "MT",
            "postal_code": "594054324",
            "telephone_number": "406-455-5000",
            "fax_number": "406-731-8318"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BALOUCH",
        "first_name": "JAMAL",
        "middle_name": "ABDUL YASSER",
        "name_prefix": "Mr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-08-13",
        "last_updated": "2021-03-29",
        "certification_date": "2021-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2081P2900X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "MT",
            "license": "34171",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NC1545",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5919902",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jamal.balouch.p1@direct.benefisbmg.nextgenshare.com",
            "affiliation": "Y",
            "affiliationName": "Benefis Hospitals, Inc.",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "500 15th Ave S",
            "city": "Great Falls",
            "state": "MT",
            "country_code": "US",
            "postal_code": "594054324",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Great Falls, MT

Sources for this page

Verify at the official NPI Registry.