| Dr Samuel James Ballentine, MD | |
|
1290 Silas Deane Hwy Ste 101, Wethersfield, CT 06109-4337 | |
| (860) 859-9061 | |
| (860) 889-6200 |
| Full Name | Dr Samuel James Ballentine |
|---|---|
| Gender | Male |
| Speciality | Pathology |
| Experience | 13 Years |
| Location | 1290 Silas Deane Hwy Ste 101, Wethersfield, Connecticut |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881038735 | NPI | - | NPPES |
| 200071078 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207ZP0102X | Pathology - Anatomic Pathology & Clinical Pathology | 2019024601 (Missouri) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Barnes Jewish Hospital | Saint louis, MO | Hospital |
| Barnes-jewish West County Hospital | Creve coeur, MO | Hospital |
| Memorial Hospital | Belleville, IL | Hospital |
| Missouri Baptist Medical Center | Town and country, MO | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Washington University | 9830008770 | 3047 |
| Connecticut Gi Pllc | 9830110758 | 240 |
| Eastern Connecticut Pathology Consultants, Pc | 3173511581 | 19 |
| Entity Name | Washington University |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1316987746 PECOS PAC ID: 9830008770 Enrollment ID: O20040406001038 |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Samuel James Ballentine, MD Po Box 7412011, Chicago, IL 60674-2011 Ph: (314) 362-5641 | Dr Samuel James Ballentine, MD 1290 Silas Deane Hwy Ste 101, Wethersfield, CT 06109-4337 Ph: (860) 859-9061 |
Dr. William Robert Gesztes, MD, MSC Pathology Medicare: Accepting Medicare Assignments Practice Location: 1290 Silas Deane Hwy Ste 101, Wethersfield, CT 06109 Phone: 860-859-9061 Fax: 860-889-6200 |