ELIZABETH ANNE BALLE, certified social wor — NPI 1497290555 (Licensed & Credentialed Behavioral Health & Social Service Providers

CMS-1500 Box 24J / 33a • NPI

1497290555

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

1041C0700X (CMS 80)

Licensed & Credentialed Behavioral Health & Social Service Providers — Social Worker, Clinical

Box 32 Service Location & ZIP+4

589 S STATE ST, PROVO, UT, 84606-5056

✓ 9-Digit EDI 837 ZIP+4 (84606-5056)

Practice Phone & Referral Fax

(801) 429-2000

Fax: (801) 429-2001

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1497290555 (ELIZABETH ANNE BALLE, certified social wor) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

This practitioner does not currently appear in the CMS individual Order & Referring PECOS file (may practice in pediatrics, commercial-only networks, or hospital-employed settings).

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1497290555` (NPI-1 Individual Practitioner)
Provider / Legal Name	ELIZABETH ANNE BALLE, certified social wor
Plain-English Specialty	Licensed & Credentialed Behavioral Health & Social Service Providers — Social Worker, Clinical NUCC Code: `1041C0700X` (Social Worker, Clinical)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	589 S STATE ST, PROVO, UT, 84606-5056
Practice Telephone / Fax	Tel: (801) 429-2000 \| Fax: (801) 429-2001
Administrative Mailing Address	589 S STATE ST, PROVO, UT, 84606-5056
Enumeration & Last Sync	Enumerated: 2016-12-28 \| CMS Record Updated: 2024-05-20

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

589 S STATE ST, PROVO, UT, 84606-5056

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Plain-English Taxonomy & CMS Crosswalk (1041C0700X)

What Does Taxonomy Code 1041C0700X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 1041C0700X translates to:
"Licensed & Credentialed Behavioral Health & Social Service Providers — Social Worker, Clinical"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 80 (Licensed Clinical Social Worker)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Social Worker, Clinical for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (ELIZABETH ANNE BALLE, certified social wor)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`1041C0700X` — Social Worker, Clinical Plain English: Licensed & Credentialed Behavioral Health & Social Service Providers — Social Worker, Clinical	State: N/A \| License: `Verified` \| Primary: Secondary
`1041C0700X` — Social Worker, Clinical Plain English: Licensed & Credentialed Behavioral Health & Social Service Providers — Social Worker, Clinical	State: UT \| License: `8579993-3502` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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ELIZABETH ANNE BALLE, certified social wor (NPI #1497290555)