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ANDREW PETER BALBAUGH M.D.
NPI 1265640411
Internal Medicine in Georgetown, KY

Active since May 20, 2007PECOS EnrolledAccepts Medicare Assignment
196 BEVINS LN, SUITE F, GEORGETOWN, KY 40324(502) 863-2818(502) 863-2764 Get Directions Write a Review

NPPES record last updated: February 11, 2017. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Feb 11, 2017, Oct 2, 2015 (2 updates tracked since 2015).

About Andrew Peter Balbaugh M.d. NPPES

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

ANDREW PETER BALBAUGH M.D. (NPI 1265640411) is an individual internal medicine provider in Georgetown, Kentucky, licensed in Kentucky (41057) and active in the NPI registry since May 2007. He is enrolled in Medicare PECOS, is affiliated with Georgetown Community Hospital, and is a graduate of Northeastern Ohio University College Of Medicine (2003).

NPPES Registry Identity

NPI1265640411
Entity TypeIndividualMale
Primary Taxonomy207R00000X
Provider Legal NameANDREW PETER BALBAUGHCredential: M.D.
Location Address196 BEVINS LN, SUITE FGeorgetown, KY 40324-8534
Mailing Address330 Seven Springs WayBrentwood, TN 37027-5098 · (615) 920-7906 · Fax (615) 920-8775
Phone(502) 863-2818
Fax(502) 863-2764
Sole ProprietorNo
Medical School CMSNortheastern Ohio University College Of MedicineGraduated 2003
Enumeration DateMay 20, 2007
Last NPPES UpdateFebruary 11, 20172 updates tracked since enumeration
✔ NPI 1265640411 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
License✔ Licensed in KY · 41057
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
Also ListedPediatricsTaxonomy 208000000X · License 41057 (KY)
196 BEVINS LN, Georgetown, KY 40324
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Other Identifiers 2

Medicaid7100011650KY
Medicare PIN00664002KY

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

Andrew Peter Balbaugh 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 ID4880789841
PECOS Enrollment IDI20071005000097
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 3

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 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.
85 services44 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.
25 services25 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.
18 services13 patients

Hospital Affiliations CMS Care Compare

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

Georgetown Community Hospital

Acute Care Hospitals · Georgetown, KY
OwnershipProprietary
CMS Certification Number180101
Location1140 Lexington RoadGeorgetown, KY 40324 · Scott County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 40324 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
$122.77 typical visit price
range $52.76 – $162.27
Typical copayment $30.69 (range $13.19 – $40.56)
Most-billed visit code 99204
Established Patient
$93.94 typical visit price
range $16.53 – $131.99
Typical copayment $23.48 (range $4.13 – $32.99)
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.

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.

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 suppliers20 claims20 services$102.43 avg. paid by Medicare
Portable oxygen concentrator, rental E1392
DME-Oxygen and Supplies · category DC002N
2 suppliers12 claims12 services$36.80 avg. paid by Medicare
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service K0553
DME-Other DME · category DE017N
2 suppliers13 claims13 services$180.53 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 2

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

BLUEGRASS PEDIATRICS AND INTERNAL MEDICINE, PLLC
Pediatrics
196 BEVINS LN, SUITE F
GEORGETOWN, KY 40324
Scott County (502) 863-2818
KENTUCKY MSO LLC
Pediatrics
196 BEVINS LN, SUITE F
GEORGETOWN, KY 40324
Scott County (502) 863-2818

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 Andrew Balbaugh's NPI number?

The NPI number for Andrew Balbaugh is 1265640411. It was assigned to this individual provider in the NPPES registry on May 20, 2007.

Where is Andrew Balbaugh located?

Andrew Balbaugh practices at 196 Bevins Ln Suite F, Georgetown, KY 40324. The listed phone number is (502) 863-2818.

What is Andrew Balbaugh's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Is Andrew Balbaugh enrolled in Medicare?

Yes. Andrew Balbaugh 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 Andrew Balbaugh affiliated with any hospitals?

According to CMS data, Andrew Balbaugh is affiliated with Georgetown Community Hospital.

When was this NPI record last updated?

The NPPES record for Andrew Balbaugh was last updated on February 11, 2017. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 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.