NADER H BALBA MD
NPI 1013949254
Internal Medicine - Gastroenterology in Fairfax, VA

Q: What is Nader Balba's NPI number?

The NPI number for Nader Balba is 1013949254. It was assigned to this individual provider in the NPPES registry on July 7, 2006.

Q: What is Nader Balba's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Gastroenterology, with taxonomy code 207RG0100X.

Q: When was this NPI record last updated?

The NPPES record for Nader Balba was last updated on May 7, 2019. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since July 07, 2006PECOS EnrolledAccepts Medicare Assignment

80.82/100

CMS Quality Rating

3028 JAVIER RD STE 500, FAIRFAX, VA 22031(703) 698-8960(571) 494-5794 Get Directions Write a Review

NPPES record last updated: May 7, 2019. Verified against the NPPES registry weekly; last sync: July 26, 2026.

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About Nader H Balba Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

NADER H BALBA MD (NPI 1013949254) is an individual gastroenterology provider in Fairfax, Virginia, licensed in Virginia (0101058922) and active in the NPI registry since July 2006. He is enrolled in Medicare PECOS, is affiliated with Virginia Hospital Center, and maintains 2 additional practice locations.

NPPES Registry Identity

NPI1013949254

Entity TypeIndividualMale

Primary Taxonomy207RG0100X

Provider Legal NameNADER H BALBACredential: MD

Location Address3028 JAVIER RD STE 500Fairfax, VA 22031-4622

Mailing Address3700 Joseph Siewick Dr, Suite 308Fairfax, VA 22033 · (703) 698-8960 · Fax (703) 716-8703

Phone(703) 698-8960

Fax(571) 494-5794

Sole ProprietorNo

Medical School CMSOtherGraduated 1997

Enumeration DateJuly 7, 2006

Last NPPES UpdateMay 7, 2019

✔ NPI 1013949254 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal Medicine · GastroenterologyAllopathic & Osteopathic Physicians

Taxonomy Code207RG0100X

License✔ Licensed in VA · 0101058922

Definition

An internist who specializes in diagnosis and treatment of diseases of the digestive organs including the stomach, bowels, liver and gallbladder. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer and jaundice and performs complex diagnostic and therapeutic procedures using endoscopes to visualize internal organs.

3028 JAVIER RD STE 500, Fairfax, VA 22031

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Secondary Practice Locations 2

Location 13700 Joseph Siewick Dr Ste 308Fairfax, VA 22033-1739 · Phone (703) 698-8960 · Fax (647) 646-4744

Location 23914 Centreville Rd Ste 350Chantilly, VA 20151-3289 · Phone (703) 716-8700

Other Identifiers 8

Other339058Anthem Bcbs

Other339057Anthem Bcbs

Other342328Anthem Bcbs

Other346671Anthem Bcbs

Other79160017Carefirst Bcbs

Other339052Anthem Bcbs

Other339055Anthem Bcbs

Medicaid5885515VA

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Nader H Balba Md is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID2062402308

PECOS Enrollment IDI20040517001452

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims 17

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Chronic care management services, first 20 minutes of clinical staff time directed by health care professional, per calendar month 99490

Chronic care management services involve a healthcare professional directing clinical staff in managing your chronic conditions. This includes the first 20 minutes per month of services like medication management, care coordination, and health monitoring to help improve your health and quality of life.

274 services94 patients

Chronic care management services for two or more chronic conditions, additional 20 minutes of clinical staff time directed by health care professional, per calendar month 99439

Chronic Care Management services involve regular check-ins with healthcare professionals to manage two or more chronic conditions. It includes an additional 20 minutes of clinical staff time per month, directed by a healthcare professional, to ensure optimal health management.

269 services91 patients

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214

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.

167 services143 patients

Biopsy of large bowel using a flexible endoscope 45380

A biopsy of the large bowel using a flexible endoscope is a procedure where a thin, flexible tube with a camera is inserted through the rectum to examine the bowel. If abnormal tissue is found, a small sample is taken for further examination. This helps in diagnosing conditions like inflammation, polyps, or cancer.

98 services98 patients

Biopsy of esophagus, stomach, and/or upper small bowel using a flexible endoscope 43239

This procedure involves using a thin, flexible tube with a light and camera, known as an endoscope, to examine the esophagus, stomach, and upper part of the small intestine. Small tissue samples are taken for further examination to help diagnose various conditions.

67 services65 patients

Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213

This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.

41 services40 patients

New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more 99204

This 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.

39 services39 patients

Removal of polyps or growths of large bowel using an endoscope with mechanical snare 45385

This procedure involves using a thin, flexible tube called an endoscope to examine the large bowel. If any abnormal growths or polyps are found, a tool called a mechanical snare is used to remove them. This is a common method to prevent potential health issues.

32 services32 patients

Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more 99215

This service involves a follow-up appointment for existing patients, lasting between 40 to 54 minutes. During this time, your healthcare provider will assess your current health status, discuss any changes or concerns, review your treatment plan, and answer any questions you may have.

30 services26 patients

Biopsy of large bowel using a flexible endoscope 45380

27 services27 patients

Biopsy of esophagus, stomach, and/or upper small bowel using a flexible endoscope 43239

23 services23 patients

Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more 99212

This is a routine check-up for patients who have previously seen the doctor. During this 10-19 minute visit, the doctor will review your health status, discuss any concerns, and manage ongoing treatments or medications. It's a chance to ensure your health is on track.

19 services19 patients

Removal of polyps or growths of large bowel using an endoscope with mechanical snare 45385

13 services13 patients

New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more 99203

This service involves an initial office or outpatient visit for a new patient. The healthcare professional will spend 30-44 minutes understanding your health history, current issues, and discussing possible treatment plans. It's a comprehensive evaluation to start your healthcare journey.

12 services12 patients

Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes 99222

Initial 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.

12 services12 patients

Colorectal cancer screening; colonoscopy on individual at high risk G0105

Colorectal cancer screening, specifically a colonoscopy, is a preventive measure for those at high risk. A thin, flexible tube with a camera inspects the colon to spot any abnormal growths. This test helps detect potential issues early, enhancing the effectiveness of treatment.

12 services12 patients

Colorectal cancer screening; colonoscopy on individual at high risk G0105

11 services11 patients

Hospital Affiliations CMS Care Compare 2

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Virginia Hospital Center

Acute Care Hospitals · Arlington, VA

5/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number490050

Location1701 North George Mason DriveArlington, VA 22205 · Arlington County

Emergency services Birthing friendly

Inova Fair Oaks Hospital

Acute Care Hospitals · Fairfax, VA

5/5 CMS rating

OwnershipVoluntary non-profit - Other

CMS Certification Number490101

Location3600 Joseph Siewick DriveFairfax, VA 22033 · Fairfax County

Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 22031 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$147.85 typical visit price

range $65.18 – $194.86

Typical copayment $36.96 (range $16.29 – $48.71)

Most-billed visit code 99204

Established Patient

$113.72 typical visit price

range $21.40 – $158.88

Typical copayment $28.43 (range $5.35 – $39.72)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

80.82/100

MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program

Scored as part of a group practice

Quality

61.63

Promoting Interoperability

100

Improvement Activities

Cost

74.45

Reported Quality Measures

Colorectal Cancer Screening

Percentage of adults 50-75 years of age who had appropriate screening for colorectal cancer

84%493 patients4/55-star benchmark: 85%

Documentation of Current Medications in the Medical Record

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.

84%1,356 patients3/55-star benchmark: 100%

e-Prescribing

At least one permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using certified EHR technology.

94%546 patients4/55-star benchmark: 100%

Medication Reconciliation

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.

89%131 patients4/55-star benchmark: 100%

Patient-Specific Education

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.

25%365 patients2/55-star benchmark: 99%

Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan

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…

87%1,104 patients4/55-star benchmark: 97%

Provide Patient Access

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…

76%447 patients4/55-star benchmark: 100%

Secure Messaging

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…

32%447 patients3/55-star benchmark: 59%

Use of High-Risk Medications in the Elderly

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.

Lower rates are better for this measure.

Patients 2+: 0% · 343 patients

1%343 patients4/55-star benchmark: 100%

Providers report different measures because they deliver different services; reporting more or less information is not a reflection of quality. Star ratings appear only where CMS assigned them.

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Other Providers at the Same Location NPPES 9

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

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Internal Medicine (Gastroenterology)