SHAILESH BALASUBRAMANIAN
NPI 1164748562
Internal Medicine - Pulmonary Disease in Santa Monica, CA

Active since April 12, 2010PECOS EnrolledAccepts Medicare Assignment
86.15/100
CMS Quality Rating
1223 16TH ST STE 3400, SANTA MONICA, CA 90404(310) 449-0939(424) 259-7790 Get Directions Write a Review

NPPES record last updated: November 20, 2020. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Shailesh Balasubramanian NPPES

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

SHAILESH BALASUBRAMANIAN (NPI 1164748562) is an individual pulmonary disease provider in Santa Monica, California, licensed in California (A168744) and active in the NPI registry since April 2010. He is enrolled in Medicare PECOS and is a graduate of Other (2010).

NPPES Registry Identity

NPI1164748562
Entity TypeIndividualMale
Primary Taxonomy207RP1001X
Provider Legal NameSHAILESH BALASUBRAMANIAN
Location Address1223 16TH ST STE 3400Santa Monica, CA 90404-1279
Mailing Address5767 W Century Blvd Ste 400Los Angeles, CA 90045-5631 · (310) 301-8771 · Fax (310) 301-8771
Fax(424) 259-7790
Sole ProprietorYes
Medical School CMSOtherGraduated 2010
Enumeration DateApril 12, 2010
Last NPPES UpdateNovember 20, 2020
NPPES CertifiedNovember 20, 2020
NPI 1164748562 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

Primary SpecialtyInternal Medicine · Pulmonary DiseaseAllopathic & Osteopathic Physicians
Taxonomy Code207RP1001X
License Licensed in CA · A168744
Definition

An internist who treats diseases of the lungs and airways. The pulmonologist diagnoses and treats cancer, pneumonia, pleurisy, asthma, occupational and environmental diseases, bronchitis, sleep disorders, emphysema and other complex disorders of the lungs.

Also ListedInternal MedicineTaxonomy 207R00000X · License 274282 (NY)
1223 16TH ST STE 3400, Santa Monica, CA 90404

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

Shailesh Balasubramanian 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 ID3173749306
PECOS Enrollment IDI20200710001079
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 18

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.

Test to measure expiratory airflow and volume 94010
This test, known as spirometry, assesses how well your lungs work. It measures how much air you can inhale, how much you can exhale and how quickly you can exhale. It's non-invasive and helps diagnose conditions like asthma or COPD.
312 services292 patients
Test to examine how well the lungs exchange gases 94729
This is a test called a pulmonary function test, which helps understand the efficiency of your lungs. It measures how much air your lungs can hold, how quickly you can move air in and out of your lungs, and how well your lungs put oxygen into and remove carbon dioxide from your blood.
273 services265 patients
Test to determine lung volumes using sensors 94726
This test, called spirometry, measures lung capacity using sensors. You breathe into a mouthpiece attached to a device that records the amount and rate of air you inhale and exhale. It helps diagnose and monitor lung conditions.
211 services207 patients
Critical care, first 30-74 minutes 99291
Critical care involves immediate and constant attention by a team of specially-trained health professionals. It's for patients with life-threatening conditions, requiring first 30-74 minutes of intense monitoring and treatment.
188 services79 patients
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes 99233
Follow-up hospital inpatient care per day typically involves a 35-minute check-up by your healthcare provider. This service includes monitoring your health progress, adjusting your treatment plan if needed, and answering any questions you may have about your condition or care.
129 services61 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.
98 services64 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 90404 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
$142.39 typical visit price
range $62.96 – $187.60
Typical copayment $35.59 (range $15.74 – $46.90)
Most-billed visit code 99204
Established Patient
$109.96 typical visit price
range $20.84 – $153.61
Typical copayment $27.49 (range $5.21 – $38.40)
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.

86.15/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Individually scored
Quality95.72
Improvement Activities0
Cost81.58

Referred Medical Equipment & Supplies CMS DME claims 2

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) E0466
DME-Other DME · category DE005N
1 supplier11 claims11 services$781.83 avg. paid by Medicare
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate E1390
DME-Oxygen and Supplies · category DC002N
3 suppliers15 claims15 services$67.58 avg. paid by Medicare
Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

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.

Internal Medicine (Pulmonary Disease)
1223 16TH ST STE 3400
SANTA MONICA, CA 90404
Internal Medicine (Sleep Medicine)
1223 16TH ST STE 3400
SANTA MONICA, CA 90404
Internal Medicine (Pulmonary Disease)
1223 16TH ST STE 3400
SANTA MONICA, CA 90404
Internal Medicine (Pulmonary Disease)
1223 16TH ST STE 3400
SANTA MONICA, CA 90404
Dietitian, Registered
1223 16TH ST STE 3400
SANTA MONICA, CA 90404
Internal Medicine (Pulmonary Disease)
1223 16TH ST STE 3400
SANTA MONICA, CA 90404
Internal Medicine (Pulmonary Disease)
1223 16TH ST STE 3400
SANTA MONICA, CA 90404
Surgery
1223 16TH ST STE 3400
SANTA MONICA, CA 90404

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 Shailesh Balasubramanian's NPI number?

The NPI number for Shailesh Balasubramanian is 1164748562. It was assigned to this individual provider in the NPPES registry on April 12, 2010.

Where is Shailesh Balasubramanian located?

Shailesh Balasubramanian practices at 1223 16th St Ste 3400, Santa Monica, CA 90404. The listed phone number is (310) 449-0939.

What is Shailesh Balasubramanian's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Pulmonary Disease, with taxonomy code 207RP1001X.

Is Shailesh Balasubramanian enrolled in Medicare?

Yes. Shailesh Balasubramanian 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.

When was this NPI record last updated?

The NPPES record for Shailesh Balasubramanian was last updated on November 20, 2020. NPI Profile syncs with the weekly NPPES data releases published by CMS.