DR. JOHN MICHAEL BALINTONA MD
NPI 1104813583
Obstetrics & Gynecology in Fargo, ND
NPI Status: Active since September 30, 2005
Contact Information
3000 32ND AVE S
FARGO, ND
ZIP 58103
Phone: (701) 364-8000
Fax: (701) 364-8078
- Individual
- Male
- Years of Experience 30
- Obstetrics & Gynecology
- Accepts Insurance
- Accepts Medicare Approved Payment
- PECOS Enrolled
- Medicare Quality Reporting
About JOHN BALINTONA
This page provides the complete NPI Profile along with additional information for John Balintona, a women's health care provider established in Fargo, North Dakota with a medical specialization in Obstetrics & Gynecology and more than 30 years of experience. He graduated from Uniformed Services Uhs Fe Hebert School Of Med in 1996. The healthcare provider is registered in the NPI registry with number 1104813583 assigned on September 2005. The practitioner's primary taxonomy code is 207V00000X with license number PT16256 (ND). The provider is registered as an individual and his NPI record was last updated 6 years ago.
- NPI
- 1104813583
- Provider Name
- DR. JOHN MICHAEL BALINTONA MD
- Gender
- Male
- Entity Type
- Individual
- Location Address
- 3000 32ND AVE S FARGO, ND 58103
- Location Phone
- (701) 364-8000
- Location Fax
- (701) 364-8078
- Mailing Address
- 1702 UNIVERSITY DR S FARGO, ND 58103
- Medical School Name
- UNIFORMED SERVICES UHS FE HEBERT SCHOOL OF MED
- Graduation Year
- 1996
- Is Sole Proprietor?
- No
- Enumeration Date
- 09-30-2005
- Last Update Date
- 02-18-2020
- Code Navigator
Women's health care providers like John Balintona treat and diagnose diseases and conditions that affect a woman's physical and emotional health. Women's health professionals come from a variety of different specialties, including obstetrician/gynecologists, general surgeons, perinatologists, physician assistants, nurse practitioners or nurse midwives. A women's health provider might help you with family planning, breast care, pregnancy and child birth, osteoporosis, menopause, heart disease, etc.
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
Obstetrics & Gynecology
- Taxonomy Code
- 207V00000X
- Type
- Allopathic & Osteopathic Physicians
- License No.
- PT16256
- License State
- ND
- Taxonomy Description
- An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women.
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 | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 40227 (MN) |
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- BlueCare Bronze HSA Eligible $50 PCP Copay ($5 Value Based Drug List) - PPO
- BlueCare Gold $10 PCP Copay ($5 Value Based Drug List) - PPO
- BlueCare Silver $20 PCP Copay ($5 Value Based Drug List) - PPO
- BlueDirect Bronze 100 HSA Eligible ($8000 Deductible / $5 Preventive Drug List) - PPO
- BlueDirect Gold 90 HSA Eligible ($2600 Deductible / $5 Preventive Drug List) - PPO
- BlueDirect Silver 80 HSA Eligible ($3500 Deductible / $5 Preventive Drug List) - PPO
- BlueEssential Catastrophic 100 HSA Eligible $10600 Deductible - PPO
- BlueValue Bronze HSA Eligible $50 PCP Copay (Standardized plan) - PPO
- BlueValue Gold $30 PCP Copay (Standardized plan) - PPO
- BlueValue Silver $40 PCP Copay (Standardized plan) - PPO
- DakotaBlue Altru Gold ($5 Value Based Drug List) - PPO
- DakotaBlue Altru Silver ($5 Value Based Drug List) - PPO
- DakotaBlue Trinity Gold ($5 Value Based Drug List) - PPO
- DakotaBlue Trinity Silver ($5 Value Based Drug List) - PPO
- Essentia Choice Care with Medica Bronze $0 Copay PCP Visits - HMO
- Essentia Choice Care with Medica Bronze HSA - EPO
- Essentia Choice Care with Medica Bronze Share - EPO
- Essentia Choice Care with Medica Bronze Share - HMO
- Essentia Choice Care with Medica Expanded Bronze Standard - EPO
- Essentia Choice Care with Medica Expanded Bronze Standard - HMO
- Essentia Choice Care with Medica Gold $0 Copay PCP Visits - EPO
- Essentia Choice Care with Medica Gold $0 Copay PCP Visits - HMO
- Essentia Choice Care with Medica Gold Share - EPO
- Essentia Choice Care with Medica Gold Share - HMO
- Essentia Choice Care with Medica Gold Standard - EPO
- Essentia Choice Care with Medica Gold Standard - HMO
- Essentia Choice Care with Medica Silver $0 Copay PCP Visits - EPO
- Essentia Choice Care with Medica Silver $0 Copay PCP Visits - HMO
- Essentia Choice Care with Medica Silver Share - EPO
- Essentia Choice Care with Medica Silver Share - HMO
- Essentia Choice Care with Medica Silver Standard - EPO
- Essentia Choice Care with Medica Silver Standard - HMO
- Medica Individual Choice Bronze $0 Copay PCP Visits - HMO
- Medica Individual Choice Bronze HSA - EPO
- Sanford Individual Simplicity $1,750 - PPO
- Sanford Individual Simplicity $10,600 - PPO
- Sanford Individual Simplicity $3,500 - PPO
- Sanford Individual Simplicity $4,750 - PPO
- Sanford Individual Simplicity $6,500 - PPO
- Sanford Individual Simplicity $7,200 HSA Qualified - PPO
- Sanford Individual Simplicity Standardized $2,000 - PPO
- Sanford Individual Simplicity Standardized $6,000 - PPO
- Sanford Individual Simplicity Standardized $7,500 - PPO
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
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 |
|---|---|---|---|
| 03153827 | MEDICAID (05) | NM | |
| 707193 | MEDICAID (05) | AZ | |
| 91659558 | MEDICAID (05) | CO |
Medicare Participation & PECOS Enrollment Status
John Balintona 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.
John Balintona 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: 9537232764
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: I20080722000493, I20200305001785, I20210208001460
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
Physician Visit Costs
The typical physician office visit costs for Medicare beneficiaries in this area are: $31.86 for a new patient copayment and $17.37 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 58103 ZIP code area.
New Patients Visit Costs *
The most utilized procedure code for new patients office visits is 99204
- Average New Patient Price $127.45
- Minimum New Patient Price $55.75
- Maximum New Patient Price $168.12
- Average New Patient Copayment $31.86
- Minimum New Patient Copayment $13.93
- Maximum New Patient Copayment $42.03
Established Patients Visit Costs *
The most utilized procedure code for established patients office visits is 99213
- Average Established Patient Price $69.48
- Minimum Established Patient Price $18.11
- Maximum Established Patient Price $137.65
- Average Established Patient Copayment $17.37
- Minimum Established Patient Copayment $4.52
- Maximum Established Patient Copayment $34.41
* 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 |
|---|---|---|
| Measurement and Improvement at the Practice and Panel Level | Yes | N/A |
| Measure and improve quality at the practice and panel level, such as the American Board of Orthopaedic Surgery (ABOS) Physician Scorecards, that could include one or more of the following: • Regularly review measures of quality, utilization, patient satisfaction and other measures that may be useful at the practice level and at the level of the care team or MIPS eligible clinician or group (panel); and/or • Use relevant data sources to create benchmarks and goals for performance at the practice level and panel level. | ||
| Use of decision support and standardized treatment protocols | Yes | N/A |
| Use decision support and standardized treatment protocols to manage workflow in the team to meet patient needs. | ||
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. John Balintona is affiliated with the following medical facilities:
| Hospital Name | Address | Phone | Hospital Type | Overall Rating |
|---|---|---|---|---|
| ESSENTIA HEALTH ST MARYS - DETROIT LAKES | 1027 WASHINGTON AVE DETROIT LAKES, MN 56501 | (218) 847-0888 | Acute Care Hospitals | |
| ESSENTIA HEALTH FOSSTON | 900 HILLIGOSS BOULEVARD SE FOSSTON, MN 56542 | (218) 435-1133 | Critical Access 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 1104813583, we treat the final digit (3) 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 57. The final step is to find the difference between that total and the next multiple of ten (60 - 57 = 3).
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 57 is 60. The difference is the calculated check digit.
Other Providers at the Same Location
The following 20 providers are registered at the same or a nearby location.
FARGO, ND 58103
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1104813583, enumerated as an "individual" on September 30, 2005.
The provider is located at 3000 32ND AVE S FARGO, ND 58103 and the phone number is (701) 364-8000.
Obstetrics & Gynecology with taxonomy code 207V00000X.
The provider might be accepting Accepts: Blue Cross Blue Shield of North Dakota, Medica,. Please consult your insurance carrier or call the provider to verify.
John Balintona is affiliated with: ESSENTIA HEALTH ST MARYS - DETROIT LAKES and ESSENTIA HEALTH FOSSTON.
