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DR. LEORA BETH BALSAM M.D.
NPI 1083800585
Thoracic Surgery (Cardiothoracic Vascular Surgery) in Worcester, MA

Active since September 18, 2007PECOS EnrolledAccepts Medicare Assignment
97.02/100
CMS Quality Rating
55 LAKE AVENUE NORTH, DEPARTMENT OF SURGERY, WORCESTER, MA 01655(508) 334-2577(508) 334-7284 Get Directions Write a Review

NPPES record last updated: November 2, 2020. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Nov 2, 2020, Dec 20, 2017, Sep 19, 2017 (3 updates tracked since 2017).

About Dr. Leora Beth Balsam M.d. NPPES

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

DR. LEORA BETH BALSAM M.D. (NPI 1083800585) is an individual thoracic surgery (cardiothoracic vascular surgery) provider in Worcester, Massachusetts, licensed in Massachusetts (273202) and active in the NPI registry since September 2007. She is enrolled in Medicare PECOS, is affiliated with Umass Memorial Healthalliance Hospitals, and is a graduate of Harvard Medical School (1998).

NPPES Registry Identity

NPI1083800585
Entity TypeIndividualFemale
Primary Taxonomy208G00000X
Provider Legal NameDR. LEORA BETH BALSAMCredential: M.D.
Location Address55 LAKE AVENUE NORTH, DEPARTMENT OF SURGERYWorcester, MA 01655-0001
Mailing AddressPo Box 415348Boston, MA 02241-5348
Phone(508) 334-2577
Fax(508) 334-7284
Sole ProprietorNo
Medical School CMSHarvard Medical SchoolGraduated 1998
Enumeration DateSeptember 18, 2007
Last NPPES UpdateNovember 2, 20203 updates tracked since enumeration
NPPES CertifiedNovember 2, 2020
✔ NPI 1083800585 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyThoracic Surgery (Cardiothoracic Vascular Surgery)Allopathic & Osteopathic Physicians
Taxonomy Code208G00000X
Licenses✔ Licensed in MA · 273202✔ Licensed in CA · A69615✔ Licensed in NY · 248717-1
Definition
A thoracic surgeon provides the operative, perioperative and critical care of patients with pathologic conditions within the chest. Included is the surgical care of coronary artery disease, cancers of the lung, esophagus and chest wall, abnormalities of the trachea, abnormalities of the great vessels and heart valves, congenital anomalies, tumors of the mediastinum and diseases of the diaphragm. The management of the airway and injuries of the chest is within the scope of the specialty.
55 LAKE AVENUE NORTH, Worcester, MA 01655
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Other Identifiers 1

Medicaid00A869820CA

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield.Insurance ›

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

Dr. Leora Beth Balsam M.d. 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 ID345300026
PECOS Enrollment IDI20180202000426
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 11

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.

Coronary artery bypass using artery graft, 1 graft 33533
A coronary artery bypass with one artery graft is a surgical procedure to improve blood flow to your heart. An artery from another part of your body is used to bypass a blocked or narrowed coronary artery. This can help reduce chest pain and risk of heart attack.
50 services50 patients
New patient office or other outpatient visit with a high level of medical decision making, if using time, 60 minutes or more 99205
This is a first-time patient visit where a healthcare professional spends 60-74 minutes with you. It involves a comprehensive evaluation, including your medical history and current health condition. They'll also advise on preventive health measures and formulate a treatment plan if needed.
50 services50 patients
Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes 99223
Initial hospital inpatient care per day, typically 70 minutes, refers to the daily medical service provided to patients admitted to the hospital. This includes a comprehensive evaluation, diagnosis, treatment plan, and monitoring of your health condition. It ensures your well-being during your hospital stay.
45 services45 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.
38 services38 patients
Coronary artery bypass using vein or artery graft, 2 grafts 33518
A coronary artery bypass with 2 grafts is a surgery to improve blood flow to your heart. A surgeon takes a healthy vein or artery from your body and attaches it to the blocked coronary artery. This creates a new path for blood to flow, bypassing the blockage.
30 services30 patients
Replacement of aortic valve through the skin and femoral artery 33361
This procedure, known as Transcatheter Aortic Valve Replacement (TAVR), involves replacing a damaged aortic valve through a small incision in the leg. A catheter is inserted into the femoral artery and guided up to the heart. The new valve is then positioned and deployed, restoring normal blood flow.
27 services27 patients

Hospital Affiliations CMS Care Compare 3

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

Umass Memorial Healthalliance Hospitals

Acute Care Hospitals · Leominster, MA
2/5 CMS rating
OwnershipVoluntary non-profit - Other
CMS Certification Number220001
Location60 Hospital RoadLeominster, MA 01453 · Worcester County
Emergency services

Umass Memorial Health - Harrington Hospital

Acute Care Hospitals · Southbridge, MA
3/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number220019
Location100 South StreetSouthbridge, MA 01550 · Worcester County
Emergency services

Umass Memorial Medical Center/University Campus

Acute Care Hospitals · Worcester, MA
4/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number220163
Location55 Lake Avenue NorthWorcester, MA 01655 · Worcester County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 01655 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
$177.36 typical visit price
range $58.86 – $177.36
Typical copayment $44.34 (range $14.71 – $44.34)
Most-billed visit code 99205
Established Patient
$73.22 typical visit price
range $19.11 – $144.84
Typical copayment $18.30 (range $4.77 – $36.21)
Most-billed visit code 99213
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.

97.02/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored through an Alternative Payment Model
Quality78.09
Promoting Interoperability100
Improvement Activities40

Reported Quality Measures

Patient Centered Surgical Risk Assessment and Communication for Cardiac Surgery
Percentage of patients age 18 and older undergoing a non-emergency risk modeled cardiac surgery procedure that had personalized risk assessment using the STS risk calculator and discussed those risks with the surgeon.
100%123 patients5/55-star benchmark: 100%
Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention
Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months AND who received tobacco cessation intervention if identified as a tobacco user
99%137 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.

Other Providers at the Same Location NPPES 20

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

MAI-PHUONG THI TRAN PHARMD
Pharmacist
55 LAKE AVENUE NORTH
WORCESTER, MA 01655
Worcester County (508) 421-1900
NEIL J. KLUGER MD
Internal Medicine (Hematology & Oncology)
55 LAKE AVENUE NORTH
WORCESTER, MA 01655
Worcester County (508) 334-6276
SUMA CHANDRA KANNABIRAN MD
Radiology (Diagnostic Radiology)
55 LAKE AVENUE NORTH, DEPARTMENT OF RADIOLOGY
WORCESTER, MA 01655
Worcester County (508) 334-1000
DISHA DALELA MD
Student in an Organized Health Care Education/Training Program
55 LAKE AVENUE NORTH
WORCESTER, MA 01655
Worcester County (508) 334-1000
DR. KATHERINE HENDREN ROSE MD
Student in an Organized Health Care Education/Training Program
55 LAKE AVENUE NORTH
WORCESTER, MA 01655
Worcester County (508) 856-3590
MARLENE DENISE JACOBO MD
Student in an Organized Health Care Education/Training Program
55 LAKE AVENUE NORTH
WORCESTER, MA 01655
Worcester County (508) 334-1000
KIMBERLY MAI ZAYHOWSKI MS
Genetic Counselor, MS
55 LAKE AVENUE NORTH, DEPARTMENT OF GENETICS; BENEDICT BUILDING 3RD FLOOR
WORCESTER, MA 01655
Worcester County (774) 442-6660
DR. NATASHA LYNN BRZOSKA DNP
Nurse Practitioner
55 LAKE AVENUE NORTH
WORCESTER, MA 01655
Worcester County (508) 334-1975

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Leora Balsam's NPI number?

The NPI number for Leora Balsam is 1083800585. It was assigned to this individual provider in the NPPES registry on September 18, 2007.

Where is Leora Balsam located?

Leora Balsam practices at 55 Lake Avenue North Department Of Surgery, Worcester, MA 01655. The listed phone number is (508) 334-2577.

What is Leora Balsam's specialty?

The primary specialty registered for this NPI is Thoracic Surgery (Cardiothoracic Vascular Surgery) with taxonomy code 208G00000X.

Is Leora Balsam enrolled in Medicare?

Yes. Leora Balsam is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Leora Balsam accept?

Health plans from Anthem Blue Cross and Blue Shield list Leora Balsam as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is Leora Balsam affiliated with any hospitals?

According to CMS data, Leora Balsam is affiliated with Umass Memorial Healthalliance Hospitals, Umass Memorial Health - Harrington Hospital and Umass Memorial Medical Center/University Campus.

When was this NPI record last updated?

The NPPES record for Leora Balsam was last updated on November 2, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.