DR. AJAY K BALARAM MD
NPI 1013171636
Orthopaedic Surgery - Hand Surgery in Arlington Heights, IL
NPI Status: Active since July 13, 2008
Contact Information
515 W ALGONQUIN RD
ARLINGTON HEIGHTS, IL
ZIP 60005
Phone: (847) 956-0099
Fax: (847) 956-0099
- Individual
- Male
- Years of Experience 20
- Orthopaedic Surgery
- Hand Surgery
- Accepts Medicare Approved Payment
- PECOS Enrolled
- Medicare Quality Reporting
About AJAY BALARAM
This page provides the complete NPI Profile along with additional information for Ajay Balaram, a provider established in Arlington Heights, Illinois with a medical specialization in Orthopaedic Surgery, focusing in hand surgery and more than 20 years of experience. He graduated from Creighton University School Of Medicine in 2006. The healthcare provider is registered in the NPI registry with number 1013171636 assigned on July 2008. The practitioner's primary taxonomy code is 207XS0106X with license number 036.123743 (IL). The provider is registered as an individual and his NPI record was last updated 14 years ago.
- NPI
- 1013171636
- Provider Name
- DR. AJAY K BALARAM MD
- Gender
- Male
- Entity Type
- Individual
- Location Address
- 515 W ALGONQUIN RD ARLINGTON HEIGHTS, IL 60005
- Location Phone
- (847) 956-0099
- Location Fax
- (847) 956-0099
- Mailing Address
- 515 W ALGONQUIN RD ARLINGTON HEIGHTS, IL 60005
- Mailing Phone
- (847) 956-0099
- Mailing Fax
- (847) 956-0099
- Medical School Name
- CREIGHTON UNIVERSITY SCHOOL OF MEDICINE
- Graduation Year
- 2006
- Is Sole Proprietor?
- No
- Enumeration Date
- 07-13-2008
- Last Update Date
- 11-11-2012
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Orthopaedic Surgery Hand Surgery
- Taxonomy Code
- 207XS0106X
- Type
- Allopathic & Osteopathic Physicians
- License No.
- 036.123743
- License State
- IL
- Taxonomy Description
- An orthopaedic surgeon trained in the investigation, preservation and restoration by medical, surgical and rehabilitative means of all structures of the upper extremity directly affecting the form and function of the hand and wrist.
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 125051809 (IL) |
| 2 | 390200000X | Student, Health Care | Student in an Organized Health Care Education/Training Program | 261302 (NY) |
Medicare Participation & PECOS Enrollment Status
Ajay Balaram is registered with Medicare and accepts claims assignment, this means the provider accepts the approved amount for the cost of rendered services as full payment. Participating providers may not charge beneficiaries more than the approved amount for their services. Please keep in mind that beneficiaries still have to pay a coinsurance or copayment amount for a visit or service.
Ajay Balaram is enrolled in PECOS and is eligible to order or refer health care services for Medicare patients. The provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.
What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.
Is the provider registered in PECOS? Yes
PECOS PAC ID: 1658517529
What is the PECOS Associate Control ID?
A PAC ID is a unique 10-digit number assigned to an individual or organization healthcare provider in PECOS. The PAC ID is used to link together all the provider information, like tax identification numbers and organizational names. A PAC ID can be connected to multiple Enrollment IDs if an individual or organization has enrolled in PECOS more than once.PECOS Enrollment ID: I20130419000085
What is the Provider Enrollment ID?
The Enrollment ID is a unique alphanumeric 15-digit code assigned to each new provider's PECOS enrollment application. The Enrollment ID is used to link together all the provider enrollment information like enrollment type, state, provider specialty, and reassignment of benefits.Accepts Medicare Assignment? Yes
What does it mean "accepts medicare assignment"?
When a provider accepts Medicare assignment, the provider agrees to be paid directly by Medicare and to accept the payment amount approved by Medicare. Additionally, the provider agrees to not bill patients for more than the Medicare deductible and coinsurance amounts.
A provider who doesn't accept assignment may charge you up to 15% over the Medicare-approved amount. This is known as the limiting charge. You may have to pay this amount, or it may be covered by another insurer.Eligible to Order or Refer Part B Clinical Laboratory and Imaging: Yes
Eligible to Order or Refer Durable Medical Equipment (DMEPOS): Yes
Eligible to Order or Refer a Home Health Agency (HHA): Yes
Eligible to Order or Refer Power Mobility Devices: Yes
Provider Referred Orders for Durable Medical Equipment, Devices & Supplies
The following list reflects the services, supplies or durable medical equipment ordered by this provider to a DME supplier on behalf of patients. The information below is derived from Medicare claims data and reflects the BETOS category, HCPCS code information and the number times each service was submitted under the Medicare fee-for-service program.
Orthotic Devices
DME-Orthotic Devices (DF000N)
Hand finger orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment (HCPCS:L3913)
1 DME suppliers used 11 Medicare Claims 11 Services Paid
Areas of Expertise
The following services and procedures, recently provided to Medicare patients, illustrate the range of care this provider offers. This list reflects the variety of services available to all patients visiting the practice and is based on 2022 Medicare dataset. In general, the more frequently a provider treats specific conditions or performs particular procedures, the more experienced they become in addressing similar patient needs. The provider has delivered many of the services listed below to Medicare patients. Please note that this list does not include services provided to patients who are not covered by Medicare.
Established patient office or other outpatient visit, 30-39 minutes
Initial hospital inpatient care per day, typically 50 minutes
Injection, dexamethasone sodium phosphate, 1 mg
New patient office or other outpatient visit, 45-59 minutes
X-ray of finger, minimum of 2 views
X-ray of hand, minimum of 3 views
X-ray of shoulder, minimum of 2 views
X-ray of wrist, minimum of 3 views
This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
This service was performed 175 times for 96 patientsInitial hospital inpatient care is a service where a healthcare provider spends about 50 minutes per day overseeing your care while you're admitted in the hospital. This includes reviewing your health status, planning your treatment, and ensuring your safety and comfort.
This service was performed 12 times for 12 patientsDexamethasone sodium phosphate is a medication given via injection. It is a type of steroid that helps reduce inflammation and immune responses. It can be used to treat a variety of conditions, such as allergies, skin conditions, arthritis, and more.
This service was performed 120 times for 18 patientsThis is a first-time office or outpatient visit lasting between 45-59 minutes. The healthcare provider evaluates your health, discusses your medical history, and may suggest further tests or treatments. It's an opportunity to ask questions and understand your health better.
This service was performed 75 times for 75 patientsAn X-ray of the finger involves capturing images of your finger from at least two different angles. This non-invasive procedure helps in visualizing the bones and joints, aiding in the diagnosis of fractures, infections, or other abnormalities. Minimal discomfort may be experienced.
This service was performed 49 times for 27 patientsAn X-ray of the hand, minimum of 3 views, is a non-invasive imaging test. It uses a small amount of radiation to produce images of the bones in your hand from different angles. This helps in diagnosing fractures, infections, arthritis, or other abnormalities. It's quick and painless.
This service was performed 45 times for 34 patientsAn X-ray of the shoulder, with a minimum of 2 views, is a non-invasive imaging test. It uses a small amount of radiation to produce images of your shoulder bones. This helps in diagnosing conditions like fractures, arthritis, or other abnormalities. The procedure is quick and painless.
This service was performed 30 times for 22 patientsAn X-ray of the wrist, minimum of 3 views, is a diagnostic procedure that uses radiation to create images of your wrist from different angles. This helps detect fractures, infections, or other abnormalities for accurate diagnosis and treatment planning.
This service was performed 64 times for 36 patientsPhysician Visit Costs
The typical physician office visit costs for Medicare beneficiaries in this area are: $23.51 for a new patient copayment and $18.7 for an established patient copayment.
The pricing information below displays the copayment minimum, maximum and average amount that patients under Medicare are charged when visiting this provider as a new or established patient. Please keep in mind that these prices are just for reference purposes, and the actual prices charged by the provider might be different.
For patients covered under private health plans the prices below are also useful as healthcare pricing for private insurance is usually established as a function of Medicare prices. Private insurance covered patients should check their individual plans to determine the exact pricing.
The prices below reflect the costs for new and established patients in the 60005 ZIP code area.
New Patients Visit Costs *
The most utilized procedure code for new patients office visits is 99203
- Average New Patient Price $94.06
- Minimum New Patient Price $60.08
- Maximum New Patient Price $183.39
- Average New Patient Copayment $23.51
- Minimum New Patient Copayment $15.02
- Maximum New Patient Copayment $45.84
Established Patients Visit Costs *
The most utilized procedure code for established patients office visits is 99213
- Average Established Patient Price $74.8
- Minimum Established Patient Price $18.97
- Maximum Established Patient Price $148.12
- Average Established Patient Copayment $18.7
- Minimum Established Patient Copayment $4.74
- Maximum Established Patient Copayment $37.03
* The physician office visit costs information is generated by statistical analysis of similar providers in the same geographical area. The pricing information above IS NOT the amount charged by this provider.
Quality Reporting
The provider participated in CMS Quality Payment Program. The Quality Payment Program aims to improve population health, reduce costs and improve the care received by Medicare beneficiaries. The following quality measures meet Medicare's statistical reporting standards. Not all providers report the same information, because not all providers give the same services to patients. The quality information is just a snapshot of some the care providers give to their patients. Reporting more or less information is not a reflection of quality.
| Quality Measure | Performance | Number of Patients |
|---|---|---|
| Documentation of Current Medications in the Medical Record | 79% | 2967 |
| Percentage of visits for patients aged 18 years and older for which the eligible professional or eligible clinician attests to documenting a list of current medications using all immediate resources available on the date of the encounter. This list must include ALL known prescriptions, over-the-counters, herbals, and vitamin/mineral/dietary (nutritional) supplements AND must contain the medications' name, dosage, frequency and route of administration | ||
| e-Prescribing | 99% | 171 |
| At least one permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using certified EHR technology. | ||
| Medication Reconciliation | 42% | 550 |
| The MIPS eligible clinician performs medication reconciliation for at least one transition of care in which the patient is transitioned into the care of the MIPS eligible clinician. | ||
| Patient-Specific Education | 63% | 976 |
| The MIPS eligible clinician must use clinically relevant information from CEHRT to identify patient-specific educational resources and provide access to those materials to at least one unique patient seen by the MIPS eligible clinician. | ||
| Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan | 25% | 896 |
| Percentage of patients aged 18 years and older with a BMI documented during the current encounter or during the previous twelve months AND with a BMI outside of normal parameters, a follow-up plan is documented during the encounter or during the previous twelve months of the current encounter Normal Parameters: Age 18 years and older BMI >= 18.5 and < 25 kg/m2 | ||
| Provide 24/7 Access to MIPS Eligible Clinicians or Groups Who Have Real-Time Access to Patient's Medical Record | Yes | N/A |
| • Provide 24/7 access to MIPS eligible clinicians, groups, or care teams for advice about urgent and emergent care (e.g., MIPS eligible clinician and care team access to medical record, cross-coverage with access to medical record, or protocol-driven nurse line with access to medical record) that could include one or more of the following: • Expanded hours in evenings and weekends with access to the patient medical record (e.g., coordinate with small practices to provide alternate hour office visits and urgent care); • Use of alternatives to increase access to care team by MIPS eligible clinicians and groups, such as e-visits, phone visits, group visits, home visits and alternate locations (e.g., senior centers and assisted living centers); and/or Provision of same-day or next-day access to a consistent MIPS eligible clinician, group or care team when needed for urgent care or transition management. | ||
| Provide Patient Access | 85% | 976 |
| At least one patient seen by the MIPS eligible clinician during the performance period is provided timely access to view online, download, and transmit to a third party their health information subject to the MIPS eligible clinician's discretion to withhold certain information. | ||
| Secure Messaging | 0% | 976 |
| For at least one unique patient seen by the MIPS eligible clinician during the performance period, a secure message was sent using the electronic messaging function of CEHRT to the patient (or the patient-authorized representative), or in response to a secure message sent by the patient (or the patient-authorized representative) during the performance period. | ||
| Security Risk Analysis | Yes | N/A |
| Conduct or review a security risk analysis in accordance with the requirements in 45 CFR 164.308(a)(1), including addressing the security (to include encryption) of ePHI data created or maintained by certified EHR technology in accordance with requirements in 45 CFR164.312(a)(2)(iv) and 45 CFR 164.306(d)(3), and implement security updates as necessary and correct identified security deficiencies as part of the MIPS eligible clinician's risk management process. | ||
| Use of High-Risk Medications in the Elderly | 0% "Inverse Quality Measure" This is an inverse quality measure, a lower rate means the provider is rated better. | 225 |
| Percentage of patients 65 years of age and older who were ordered high-risk medications. Two rates are submitted. 1) Percentage of patients who were ordered at least one high-risk medication. 2) Percentage of patients who were ordered at least two of the same high-risk medication | ||
Find Provider Hospital Affiliations - Privileges
Doctors and physicians must apply for hospital privileges to treat patients at hospitals. Find out if your doctor has privileges to practice at your preferred hospital by using the hospital affiliation information below based on recent medical claims.
Hospital affiliation is identified through self-reporting data, inpatient, outpatient, physician and ancillary service claims linked by the medical claims NPI number and place of service code. Additionally, to further determine provider hospital affiliation the clinician must have provided services to at least three patients on three different dates in the last 12 months. Ajay Balaram is affiliated with the following medical facilities:
| Hospital Name | Address | Phone | Hospital Type | Overall Rating |
|---|---|---|---|---|
| NORTHWEST COMMUNITY HOSPITAL 1 | 800 W CENTRAL ROAD ARLINGTON HEIGHTS, IL 60005 | (847) 618-1000 | Acute Care Hospitals | |
| ALEXIAN BROTHERS MEDICAL CENTER 1 | 800 BIESTERFIELD RD ELK GROVE VILLAGE, IL 60007 | (847) 437-5500 | Acute Care Hospitals |
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1013171636, we treat the final digit (6) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 54. The final step is to find the difference between that total and the next multiple of ten (60 - 54 = 6).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 54 is 60. The difference is the calculated check digit.
Other Providers at the Same Location
The following 11 providers are registered at the same or a nearby location.
ARLINGTON HEIGHTS, IL 60005
ARLINGTON HEIGHTS, IL 60005
ARLINGTON HEIGHTS, IL 60005
ARLINGTON HEIGHTS, IL 60005
ARLINGTON HTS, IL 60005
ARLINGTON HTS, IL 60005
ARLINGTON HEIGHTS, IL 60005
ARLINGTON HEIGHTS, IL 60005
ARLINGTON HEIGHTS, IL 60005
ARLINGTON HEIGHTS, IL 60005
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1013171636, enumerated as an "individual" on July 13, 2008.
The provider is located at 515 W ALGONQUIN RD ARLINGTON HEIGHTS, IL 60005 and the phone number is (847) 956-0099.
Orthopaedic Surgery with taxonomy code 207XS0106X and a focus in Hand Surgery.
Ajay Balaram is affiliated with: NORTHWEST COMMUNITY HOSPITAL 1 and ALEXIAN BROTHERS MEDICAL CENTER 1.
