DR. PHILIP JOHN BANEY IV M.D.
NPI 1245253723
Family Medicine in Hamburg, PA

Active since July 25, 2006PECOS EnrolledAccepts Medicare Assignment
81.19/100
CMS Quality Rating
31 INDUSTRIAL DR, HAMBURG, PA 19526(610) 816-2170(610) 562-9814 Get Directions Write a Review

NPPES record last updated: February 22, 2016. Verified against the NPPES registry weekly; last sync: July 19, 2026.

About Dr. Philip John Baney Iv M.d. NPPES

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

DR. PHILIP JOHN BANEY IV M.D. (NPI 1245253723) is an individual family medicine provider in Hamburg, Pennsylvania, licensed in Pennsylvania (MD069454L) and active in the NPI registry since July 2006. He is enrolled in Medicare PECOS, is affiliated with Reading Hospital, and is a graduate of Temple University School Of Medicine (1997).

NPPES Registry Identity

NPI1245253723
Entity TypeIndividualMale
Primary Taxonomy207Q00000X
Provider Legal NameDR. PHILIP JOHN BANEY IVCredential: M.D.
Location Address31 INDUSTRIAL DRHamburg, PA 19526-8778
Mailing AddressPo Box 13579Reading, PA 19612-3579 · (484) 628-0796 · Fax (484) 334-7026
Fax(610) 562-9814
Sole ProprietorNo
Medical School CMSTemple University School Of MedicineGraduated 1997
Enumeration DateJuly 25, 2006
Last NPPES UpdateFebruary 22, 2016
NPI 1245253723 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License Licensed in PA · MD069454L
Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

31 INDUSTRIAL DR, Hamburg, PA 19526

Other Identifiers 2

Medicare PIN040818PA
Medicaid102325198PA

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. Philip John Baney Iv 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 ID2163319799
PECOS Enrollment IDI20040301000078
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 5

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.

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.
650 services348 patients
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit G0439
An annual wellness visit is a yearly appointment with your primary care provider to create or update a personalized prevention plan. This plan helps prevent illness based on your current health and risk factors. It's a subsequent visit, meaning it follows an initial assessment.
160 services160 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.
134 services108 patients
Administration of influenza virus vaccine G0008
The administration of the influenza virus vaccine, also known as the flu shot, is a simple procedure to protect against the flu. A healthcare provider injects a small dose of the vaccine into your arm. This stimulates your immune system to produce antibodies, which will help your body fight off the flu if exposed.
87 services87 patients
Transitional care management services for problem of at least moderate complexity 99495
Transitional care management services focus on coordinating and managing your care after you leave the hospital. For moderate complexity problems, this involves managing your medications, arranging further treatments, and ensuring you have the necessary follow-ups.
33 services29 patients

Hospital Affiliations CMS Care Compare 5

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

Reading Hospital

Acute Care Hospitals · West Reading, PA
3/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number390044
Location420 S 5th AvenueWest Reading, PA 19611 · Berks County
Emergency services Birthing friendly

St Luke's Hospital Bethlehem

Acute Care Hospitals · Bethlehem, PA
5/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number390049
Location801 Ostrum StreetBethlehem, PA 18015 · Northampton County
Emergency services Birthing friendly

Penn State Health St. Joseph

Acute Care Hospitals · Reading, PA
4/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number390096
Location2500 Bernville RoadReading, PA 19605 · Berks County
Emergency services Birthing friendly

St Luke's Miners Memorial Hospital

Acute Care Hospitals · Coaldale, PA
5/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number390183
Location360 W Ruddle StreetCoaldale, PA 18218 · Schuylkill County
Emergency services

Geisinger St. Luke's Hospital

Acute Care Hospitals · Orwigsburg, PA
5/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number390332
Location100 Paramount BoulevardOrwigsburg, PA 17961 · Schuylkill County

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 19526 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
$84.88 typical visit price
range $54.64 – $166.87
Typical copayment $21.22 (range $13.66 – $41.71)
Most-billed visit code 99203
Established Patient
$96.82 typical visit price
range $17.33 – $135.84
Typical copayment $24.20 (range $4.33 – $33.96)
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.

81.19/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice
Quality74.56
Promoting Interoperability97
Improvement Activities40
Cost65.23

Reported Quality Measures

Care Plan
Percentage of patients aged 65 years and older who have an advance care plan or surrogate decision maker documented in the medical record that an advance care plan was discussed but the patient did not wish or was not able to name a surrogate decision maker…
21%335 patients1/55-star benchmark: 100%
Diabetes: Eye Exam
Percentage of patients 18-75 years of age with diabetes who had a retinal or dilated eye exam by an eye care professional during the measurement period or a negative retinal exam (no evidence of retinopathy) in the 12 months prior to the measurement period
14%72 patients1/55-star benchmark: 100%
Medication Reconciliation Post-Discharge
The percentage of discharges from any inpatient facility (e.g. hospital, skilled nursing facility, or rehabilitation facility) for patients 18 years and older of age seen within 30 days following discharge in the office by the physician, prescribing…
Patients 65+: 100% · 57 patients
100%76 patients
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.

Referred Medical Equipment & Supplies CMS DME claims 3

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

Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips A4253
DME-Other DME · category DE017N
10 suppliers49 claims114 services$5.56 avg. paid by Medicare
Lancets, per box of 100 A4259
DME-Medical/Surgical Supplies · category DA000N
7 suppliers21 claims26 services$1.15 avg. paid by Medicare
Lightweight wheelchair K0003
DME-Wheelchairs · category DD000N
2 suppliers14 claims14 services$34.12 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 3

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

Family Medicine
31 INDUSTRIAL DR
HAMBURG, PA 19526
Durable Medical Equipment & Medical Supplies
31 INDUSTRIAL DR, SUITE 150
HAMBURG, PA 19526
Physical Therapist (Orthopedic)
31 INDUSTRIAL DR, SUITE 129
HAMBURG, PA 19526

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 Philip Baney's NPI number?

The NPI number for Philip Baney is 1245253723. It was assigned to this individual provider in the NPPES registry on July 25, 2006.

Where is Philip Baney located?

Philip Baney practices at 31 Industrial Dr, Hamburg, PA 19526. The listed phone number is (610) 816-2170.

What is Philip Baney's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Philip Baney enrolled in Medicare?

Yes. Philip Baney 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.

Is Philip Baney affiliated with any hospitals?

According to CMS data, Philip Baney is affiliated with Reading Hospital, St Luke's Hospital Bethlehem, Penn State Health St. Joseph, St Luke's Miners Memorial Hospital and Geisinger St. Luke's Hospital.

When was this NPI record last updated?

The NPPES record for Philip Baney was last updated on February 22, 2016. NPI Profile syncs with the weekly NPPES data releases published by CMS.