| Mark Richard Baller, CRNA | |
|
10102 Bluffmont Ln, Lone Tree, CO 80124-5570 | |
| (303) 799-6859 | |
| Not Available |
| Full Name | Mark Richard Baller |
|---|---|
| Gender | Male |
| Speciality | Nurse Anesthetist, Certified Registered |
| Location | 10102 Bluffmont Ln, Lone Tree, Colorado |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083671986 | NPI | - | NPPES |
| 77228219 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 367500000X | Nurse Anesthetist, Certified Registered | 541986 (Texas) | Secondary |
| 367500000X | Nurse Anesthetist, Certified Registered | 175201 (Colorado) | Primary |
| Entity Name | Kremmling Memorial Hospital District |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1619962321 PECOS PAC ID: 7517871544 Enrollment ID: O20040312001110 |
| Entity Name | Guardian Anesthesia Services, Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1013946797 PECOS PAC ID: 8820030455 Enrollment ID: O20050524001161 |
| Entity Name | Southern Colorado Crna Associates Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1043538382 PECOS PAC ID: 3072785559 Enrollment ID: O20111005000146 |
| Entity Name | Optumcare Colorado Medical Group Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1407252828 PECOS PAC ID: 2769706431 Enrollment ID: O20150129000413 |
| Mailing Address | Practice Location Address |
|---|---|
| Mark Richard Baller, CRNA 10102 Bluffmont Ln, Lone Tree, CO 80124-5570 Ph: (303) 799-6859 | Mark Richard Baller, CRNA 10102 Bluffmont Ln, Lone Tree, CO 80124-5570 Ph: (303) 799-6859 |
Mr. Jeffery Zimmerman, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 9101 Kimmer Dr Ste 1000, Lone Tree, CO 80124 Phone: 303-388-4461 Fax: 720-639-8946 | |
Dawn Denise Fangrow, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 10103 Ridgegate Pkwy Ste 312, Lone Tree, CO 80124 Phone: 303-788-8888 Fax: 866-456-4594 |