NICHOLAS BALLAY MD
NPI 1295093052
Surgery in Athens, TN

Q: What is Nicholas Ballay's NPI number?

The NPI number for Nicholas Ballay is 1295093052. It was assigned to this individual provider in the NPPES registry on April 30, 2012.

Q: What is Nicholas Ballay's specialty?

The primary specialty registered for this NPI is Surgery with taxonomy code 208600000X.

Q: When was this NPI record last updated?

The NPPES record for Nicholas Ballay was last updated on July 19, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.

Active since April 30, 2012PECOS EnrolledAccepts Medicare Assignment

719 COOK DR, ATHENS, TN 37303(423) 745-2344(423) 745-2314 Get Directions Write a Review

NPPES record last updated: July 19, 2023. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Jul 19, 2023, May 26, 2018 (2 updates tracked since 2018).

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About Nicholas Ballay Md NPPES

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

NICHOLAS BALLAY MD (NPI 1295093052) is an individual surgery provider in Athens, Tennessee, licensed in Tennessee (MD0000056407) and active in the NPI registry since April 2012. He is enrolled in Medicare PECOS, is affiliated with Starr Regional Medical Center Athens, and maintains a secondary practice location in Sweetwater.

NPPES Registry Identity

NPI1295093052

Entity TypeIndividualMale

Primary Taxonomy208600000X

Provider Legal NameNICHOLAS BALLAYCredential: MD

Location Address719 COOK DRAthens, TN 37303

Mailing Address3024 Business Park CirGoodlettsville, TN 37072-3132 · (615) 239-2018

Phone(423) 745-2344

Fax(423) 745-2314

Sole ProprietorYes

Medical School CMSOtherGraduated 2012

Enumeration DateApril 30, 2012

Last NPPES UpdateJuly 19, 20232 updates tracked since enumeration

NPPES CertifiedJuly 19, 2023

✔ NPI 1295093052 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySurgeryAllopathic & Osteopathic Physicians

Taxonomy Code208600000X

License✔ Licensed in TN · MD0000056407

Definition

A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery.

719 COOK DR, Athens, TN 37303

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Secondary Practice Location 1

Location 1304 Wright St Fl 3Sweetwater, TN 37874-1181 · Phone (423) 252-0288

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arkansas Health & Wellness, Ambetter Health, Ambetter of Alabama and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Nicholas Ballay Md 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 ID4385881804

PECOS Enrollment IDI20190108001320

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.

Medicare Billing Reassignments

Medicare enrollment records show Nicholas Ballay reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Advanced Diagnostic Imaging, PC

133 mi

Internal Medicine

3024 BUSINESS PARK CIR
Goodlettsville, TN 37072

Reassigned Medicare billing, Tennessee enrollment
734 clinicians in this Medicare group

NPI 1093741464 (615) 239-2061

Advanced Specialists, PC

133 mi

Internal Medicine

3024 BUSINESS PARK CIR
Goodlettsville, TN 37072

Reassigned Medicare billing, Tennessee enrollment
317 clinicians in this Medicare group

NPI 1649133463 (615) 239-2018

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims 10

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.

160 services115 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.

117 services83 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.

69 services69 patients

Biopsy of esophagus, stomach, and/or upper small bowel using a flexible endoscope 43239

This procedure involves using a thin, flexible tube with a light and camera, known as an endoscope, to examine the esophagus, stomach, and upper part of the small intestine. Small tissue samples are taken for further examination to help diagnose various conditions.

45 services43 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.

38 services37 patients

Removal of polyps or growths of large bowel using a flexible endoscope with electrical cautery 45384

This procedure involves using a flexible tube with a camera, called an endoscope, to view the large intestine. If any abnormal growths or polyps are found, they are removed with an electrically-heated instrument. This is a common way to prevent bowel issues.

29 services29 patients

Hospital Affiliations CMS Care Compare 2

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

Starr Regional Medical Center Athens

Acute Care Hospitals · Athens, TN

4/5 CMS rating

OwnershipProprietary

CMS Certification Number440068

Location1114 W Madison AveAthens, TN 37371 · Mc Minn County

Emergency services Birthing friendly

Sweetwater Hospital Association

Acute Care Hospitals · Sweetwater, TN

1/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number440084

Location304 Wright StSweetwater, TN 37874 · Monroe County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 37303 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

$81.53 typical visit price

range $52.64 – $160.89

Typical copayment $20.38 (range $13.16 – $40.22)

Most-billed visit code 99203

Established Patient

$66.01 typical visit price

range $16.72 – $131.41

Typical copayment $16.50 (range $4.18 – $32.85)

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.

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.

Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing E0431

DME-Oxygen and Supplies · category DC000N

1 supplier12 claims12 services$14.29 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

1 supplier12 claims12 services$81.57 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 7

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

DR. WILLIAM R BOWERS MD

Family Medicine

719 COOK DR, SUITE 102
ATHENS, TN 37303

McMinn County (423) 745-1277

MARTHA JEAN PASCARELLA NP

Nurse Practitioner (Family)

719 COOK DR, SUITE 102
ATHENS, TN 37303

McMinn County (423) 745-1277

PRESTON W BROWN M.D.

Surgery

719 COOK DR, STE 109
ATHENS, TN 37303

McMinn County (423) 745-2344

THOMAS S LAYMAN M.D.

Surgery

719 COOK DR, SUITE 110
ATHENS, TN 37303

McMinn County (423) 745-2344

MICHAEL P SUMIDA M.D.

Surgery

719 COOK DR, STE 109
ATHENS, TN 37303

McMinn County (423) 745-2344

ATHENS PHYSICIANS PRACTICE, LLC

Orthopaedic Surgery

719 COOK DR, SUITE 104
ATHENS, TN 37303

McMinn County (423) 746-2941

CHATTANOOGA ORTHOPAEDIC GROUP, PC

Orthopaedic Surgery

719 COOK DR
ATHENS, TN 37303

McMinn County (423) 624-2696

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 Nicholas Ballay's NPI number?

The NPI number for Nicholas Ballay is 1295093052. It was assigned to this individual provider in the NPPES registry on April 30, 2012.

Where is Nicholas Ballay located?

Nicholas Ballay practices at 719 Cook Dr, Athens, TN 37303. The listed phone number is (423) 745-2344.

What is Nicholas Ballay's specialty?

The primary specialty registered for this NPI is Surgery with taxonomy code 208600000X.

Is Nicholas Ballay enrolled in Medicare?

Yes. Nicholas Ballay 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.

Which organizations bill Medicare for Nicholas Ballay's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Nicholas Ballay reassigns Medicare benefits to 2 organizations: Advanced Diagnostic Imaging, PC (Goodlettsville, TN) and Advanced Specialists, PC (Goodlettsville, TN). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Nicholas Ballay's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Nicholas Ballay accept?

Health plans from Ambetter Health, Ambetter from Arkansas Health & Wellness, Ambetter of Alabama, Ambetter of North Carolina and Ambetter of Tennessee and 4 other insurers list Nicholas Ballay 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 Nicholas Ballay affiliated with any hospitals?

According to CMS data, Nicholas Ballay is affiliated with Starr Regional Medical Center Athens and Sweetwater Hospital Association.

When was this NPI record last updated?

The NPPES record for Nicholas Ballay was last updated on July 19, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.