DR. SARMISTHA BHALLA M.D
NPI 1083791792
Psychiatry & Neurology - Psychiatry in Mexico, MO

NPI Status: Active since November 01, 2006

Contact Information

321 W PROMENADE ST
MEXICO, MO
ZIP 65265
Phone: (573) 582-1234
Fax: (573) 582-1212

NPI Profile Information
Primary Taxonomy
Insurance Plans Accepted
Medicare Participation & PECOS Status
Areas of Expertise
Physician Visit Costs
Quality Reporting
Hospital Affiliations - Privileges
NPI Validation
Other Providers Same Location
Frequently Asked Questions

Individual
Female
Years of Experience 17
Psychiatry & Neurology
Psychiatry
Accepts Insurance
Accepts Medicare Approved Payment
PECOS Enrolled
Medicare Quality Reporting

About SARMISTHA BHALLA

This page provides the complete NPI Profile along with additional information for Sarmistha Bhalla, a provider established in Mexico, Missouri with a medical specialization in Psychiatry & Neurology, focusing in psychiatry and more than 17 years of experience. The healthcare provider is registered in the NPI registry with number 1083791792 assigned on November 2006. The practitioner's primary taxonomy code is 2084P0800X with license number 2009003220 (MO). The provider is registered as an individual and her NPI record was last updated 15 years ago.

NPI: 1083791792
Provider Name: DR. SARMISTHA BHALLA M.D
Gender: Female
Entity Type: Individual
Location Address: 321 W PROMENADE ST MEXICO, MO 65265
Location Phone: (573) 582-1234
Location Fax: (573) 582-1212
Mailing Address: 321 W PROMENADE ST MEXICO, MO 65265
Mailing Phone: (573) 582-1234
Mailing Fax: (573) 582-1212
Medical School Name: OTHER
Graduation Year: 2009
Is Sole Proprietor?: Yes
Enumeration Date: 11-01-2006
Last Update Date: 08-24-2011
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A psychiatrist like Sarmistha Bhalla are primary mental health physicians diagnose and treat mental illnesses through psychotherapy, psychoanalysis, hospitalization and medication. Psychiatrist help patients find solutions through changes in their behavioral patterns, explorations of experiences, group and family therapy.

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: Psychiatry & Neurology Psychiatry
Taxonomy Code: 2084P0800X
Type: Allopathic & Osteopathic Physicians
License No.: 2009003220
License State: MO
Taxonomy Description: A Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, anxiety disorders, substance-related disorders, sexual and gender identity disorders and adjustment disorders. Biologic, psychological, and social components of illnesses are explored and understood in treatment of the whole person. Tools used may include diagnostic laboratory tests, prescribed medications, evaluation and treatment of psychological and interpersonal problems with individuals and families, and intervention for coping with stress, crises, and other problems.

Insurance Plans Accepted

According to publicly available information the provider might be accepting the following health plans from these health insurance companies:

Medica

Balance by Medica Bronze $0 Copay PCP Visits - EPO
Balance by Medica Bronze Premier - EPO
Balance by Medica Expanded Bronze Standard - EPO
Balance by Medica Gold $0 Copay PCP Visits - EPO
Balance by Medica Gold Share - EPO
Balance by Medica Gold Standard - EPO
Balance by Medica Silver $0 Copay PCP Visits - EPO
Balance by Medica Silver Share - EPO
Balance by Medica Silver Standard - EPO
Medica with MU Health Care Bronze $0 Copay PCP Visits - EPO

Oscar Insurance Company

Bronze Classic 4700 - EPO
Bronze Classic Standard - EPO
Bronze Elite + PCP Saver - EPO
Bronze Elite + PCP Saver Plus - EPO
Bronze Simple Diabetes - EPO
Gold Classic Standard - EPO
Gold Simple - EPO
Silver Classic Standard - EPO
Silver Elite Saver Plus - EPO
Silver Simple Diabetes - EPO

Providence Health Plan

Connect 1500 Gold - EPO
Connect 6000 Silver - EPO
Connect 9800 Bronze - EPO
HSA Qualified 7500 Bronze - Choice Network - EPO
HSA-E Qualified 7500 Bronze - Signature Network - EPO
Providence Oregon Standard Bronze Plan - Choice Network - EPO
Providence Oregon Standard Bronze Plan - Signature Network - EPO
Providence Oregon Standard Gold Plan - Choice Network - EPO
Providence Oregon Standard Gold Plan - Signature Network - EPO
Providence Oregon Standard Silver Plan - Choice Network - EPO

UnitedHealthcare

UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) - EPO
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) - HMO
UHC Bronze Essential (No Referrals) - EPO
UHC Bronze Standard (No Referrals) - EPO
UHC Bronze Standard (No Referrals) - HMO
UHC Bronze Standard+ (Dental + Vision, No Referrals) - EPO
UHC Bronze Value ($0 Virtual Urgent Care, No Referrals) - HMO
UHC Bronze Value+ ($0 Virtual Urgent Care, Dental + Vision, No Referrals) - HMO
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, No Referrals) - HMO
UHC Gold Advantage ($0 Virtual Urgent Care, No Referrals) - EPO

Medicare

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

Medicaid

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

*Please verify directly with this provider to make sure your insurance plan is currently accepted.

Additional Identifiers

The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier	Type / Code	Identifier State	Identifier Issuer
1083791792	MEDICAID (05)	MO

Medicare Participation & PECOS Enrollment Status

Sarmistha Bhalla 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.

Sarmistha Bhalla 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: 4183770589
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: I20090928000319
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

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.

Follow-up hospital inpatient care per day, typically 15 minutes
Follow-up hospital inpatient care per day, typically 25 minutes
Follow-up hospital inpatient care per day, typically 35 minutes
Follow-up nursing facility visit per day, typically 15 minutes
Initial hospital inpatient care per day, typically 70 minutes

Physician Visit Costs

The typical physician office visit costs for Medicare beneficiaries in this area are: $40.31 for a new patient copayment and $16.42 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 65265 ZIP code area.

New Patients Visit Costs *

The most utilized procedure code for new patients office visits is 99205

Average New Patient Price $161.24
Minimum New Patient Price $52.28
Maximum New Patient Price $161.24

Average New Patient Copayment $40.31
Minimum New Patient Copayment $13.07
Maximum New Patient Copayment $40.31

Established Patients Visit Costs *

The most utilized procedure code for established patients office visits is 99213

Average Established Patient Price $65.71
Minimum Established Patient Price $16.3
Maximum Established Patient Price $131.05

Average Established Patient Copayment $16.42
Minimum Established Patient Copayment $4.07
Maximum Established Patient Copayment $32.76

* 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
Dementia: Cognitive Assessment	81%	95
Percentage of patients, regardless of age, with a diagnosis of dementia for whom an assessment of cognition is performed and the results reviewed at least once within a 12-month period
Electronic Health Record Enhancements for BH data capture	Yes	N/A
Enhancements to an electronic health record to capture additional data on behavioral health (BH) populations and use that data for additional decision-making purposes (e.g., capture of additional BH data results in additional depression screening for at-risk patient not previously identified).
Falls: Screening for Future Fall Risk	77%	82
Percentage of patients 65 years of age and older who were screened for future fall risk during the measurement period
Implementation of medication management practice improvements	Yes	N/A
Manage medications to maximize efficiency, effectiveness and safety that could include one or more of the following: Reconcile and coordinate medications and provide medication management across transitions of care settings and eligible clinicians or groups; Integrate a pharmacist into the care team; and/or Conduct periodic, structured medication reviews.
Pneumococcal Vaccination Status for Older Adults	51%	82
Percentage of patients 65 years of age and older who have ever received a pneumococcal vaccine
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.
Tobacco use	Yes	N/A
Tobacco use: Regular engagement of MIPS eligible clinicians or groups in integrated prevention and treatment interventions, including tobacco use screening and cessation interventions (refer to NQF #0028) for patients with co-occurring conditions of behavioral or mental health and at risk factors for tobacco dependence.
Use of certified EHR to capture patient reported outcomes	Yes	N/A
In support of improving patient access, performing additional activities that enable capture of patient reported outcomes (e.g., home blood pressure, blood glucose logs, food diaries, at-risk health factors such as tobacco or alcohol use, etc.) or patient activation measures through use of certified EHR technology, containing this data in a separate queue for clinician recognition and review.

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. Sarmistha Bhalla is affiliated with the following medical facilities:

Hospital Name	Address	Phone	Hospital Type	Overall Rating
UNIVERSITY OF MISSOURI HEALTH CARE	ONE HOSPITAL DRIVE COLUMBIA, MO 65212	(573) 882-4141	Acute Care Hospitals

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 1083791792, we treat the final digit (2) 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 68. The final step is to find the difference between that total and the next multiple of ten (70 - 68 = 2).

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.

Pos 1

Doubled → 2

Pos 2

Unchanged

Pos 3

Doubled → 16 → 1 + 6

Pos 4

Unchanged

Pos 5

Doubled → 14 → 1 + 4

Pos 6

Unchanged

Pos 7

Doubled → 2

Pos 8

Unchanged

Pos 9

Doubled → 18 → 1 + 8

Check

Target digit

Regular digit Doubled digit Check digit

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.

1 → 2 8 → 16 → 7 7 → 14 → 5 1 → 2 9 → 18 → 9

Step 2: Add all digits plus the NPI constant

Add the transformed values, the unchanged digits, and the constant 24.

2 + 0 + 1 + 6 + 3 + 1 + 4 + 9 + 2 + 7 + 1 + 8 + 24 = 68

Step 3: Find the amount needed to reach the next multiple of 10

The next multiple of ten after 68 is 70. The difference is the calculated check digit.

70 - 68 = 2

This NPI is valid

The calculated check digit is 2, which matches the last digit of 1083791792.