| Entity Name: | BALLOUT INTERNATIONAL PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 16 Jul 2018 (7 years ago) |
| Last Event: | LC NAME CHANGE |
| Event Date Filed: | 01 Nov 2024 (3 months ago) |
| Document Number: | L18000171124 |
| FEI/EIN Number | 83-1243016 |
| Address: | 1941 FLORIDA A1A, APT 202, INDIAN HARBOUR BEACH, FL, 32937, US |
| Mail Address: | 1941 FLORIDA A1A, APT 202, INDIAN HARBOUR BEACH, FL, 32937, US |
| ZIP code: | 32937 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1629554225 | 2018-07-17 | 2024-09-18 | 1931 19TH PL, VERO BEACH, FL, 329603555, US | 1931 19TH PL, VERO BEACH, FL, 329603555, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 313-574-2965 |
| Fax | 7024412580 |
Authorized person
| Name | HUSSIEN BALLOUT |
| Role | OWNER |
| Phone | 3135742965 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICARE PTAN |
| Number | JL435A |
| State | FL |
| Issuer | MEDICAID |
| Number | 100849400 |
| State | FL |
| Issuer | RRMEDICARE PTAN |
| Number | DY5252 |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BALLOUT INTERNATIONAL DEFINED BENEFIT PLAN | 2023 | 831243016 | 2024-04-15 | BALLOUT INTERNATIONAL LLC | 4 | |||||||||||||
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| BALLOUT INTERNATIONAL 401(K) PLAN | 2023 | 831243016 | 2024-04-15 | BALLOUT INTERNATIONAL LLC | 4 | |||||||||||||
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| Name | Role | Address |
|---|---|---|
| BALLOUT HUSSIEN | Agent | 1941 Florida A1A, Indian Harbour Beach, FL, 32937 |
| Name | Role | Address |
|---|---|---|
| a ballout hussien | memb | 1941 Florida A1A, Indian Harbour Beach, FL, 32937 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G19000099275 | EVOLUTIONARY HEALTHCARE | ACTIVE | 2019-09-10 | 2029-12-31 | No data | 1941 HIGHWAY A1A, APT 202, INDIAN HARBOUR BEACH, FL, 32937 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC NAME CHANGE | 2024-11-01 | BALLOUT INTERNATIONAL PLLC | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-04-29 | 1941 Florida A1A, apt 202, Indian Harbour Beach, FL 32937 | No data |
| REGISTERED AGENT NAME CHANGED | 2020-02-11 | BALLOUT, HUSSIEN | No data |
| Name | Date |
|---|---|
| LC Name Change | 2024-11-01 |
| ANNUAL REPORT | 2024-04-29 |
| ANNUAL REPORT | 2023-01-19 |
| ANNUAL REPORT | 2022-04-11 |
| ANNUAL REPORT | 2021-02-01 |
| ANNUAL REPORT | 2020-02-11 |
| ANNUAL REPORT | 2019-03-20 |
| Florida Limited Liability | 2018-07-16 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
