MEDICARE: HUSSIEN A BALLOUT M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	ME131941	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	JA255Y	OTHER	FL	MEDICARE PTAN
3	P02091198	OTHER	FL	RRMEDICARE PTAN
4	JA255Z	OTHER	FL	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376955682
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HUSSIEN A BALLOUT M.D.

Provider Business Mailing Address
First Line	:	1931 19TH PL
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32960-3555
Country	:	US
Telephone Number	:	321-387-9451
Fax Number	:

Provider Business Practice Location Address
First Line	:	1931 19TH PL
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32960-3555
Country	:	US
Telephone Number	:	321-387-9451
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2014
Last Update Date	:	01/28/2025

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Directions to “ HUSSIEN A BALLOUT M.D.” Practice Location

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