Physician Compare National (NPI:1295093052)

HEALTHCARE PROVIDER: NICHOLAS BALLAY MD

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1295093052
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	4385881804
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20190108001320
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	BALLAY
	Individual professional last name
Provider First Name	NICHOLAS
	Individual professional first name
Provider Middle Name	P
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2012
	Individual professional's medical school graduation year
Primary Specialty	GENERAL SURGERY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	304 WRIGHT ST
	Group Practice or individual's line 1 address
City	SWEETWATER
	Group Practice or individual's city
State	TN
	Group Practice or individual's state
Zip Code	378741181
	Group Practice or individual's zip code (9 digits when available)
Phone Number	8652138544
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	440068
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	STARR REGIONAL MEDICAL CENTER ATHENS
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	440084
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	SWEETWATER HOSPITAL ASSOCIATION
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	M