1. Home
  2. Directory
  3. South Dakota
  4. Sioux Falls
  5. Preventive Medicine
  6. NPI Profile

CLAYTON GERALD VANBALEN MD
NPI 1316943251
Preventive Medicine - Occupational Medicine in Sioux Falls, SD

Active since June 24, 2005PECOS EnrolledAccepts Medicare Assignment
900 E 54TH ST N, SIOUX FALLS, SD 57104(605) 338-9300(605) 338-9301 Get Directions Write a Review

NPPES record last updated: March 2, 2021. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Clayton Gerald Vanbalen Md NPPES

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

CLAYTON GERALD VANBALEN MD (NPI 1316943251) is an individual occupational medicine provider in Sioux Falls, South Dakota, licensed in South Dakota (2540) and active in the NPI registry since June 2005. He is enrolled in Medicare PECOS, is affiliated with Avera St Mary's Hospital, and is a graduate of Sanford School Of Medicine Of University Of South Dakota (1979).

NPPES Registry Identity

NPI1316943251
Entity TypeIndividualMale
Primary Taxonomy2083X0100X
Provider Legal NameCLAYTON GERALD VANBALENCredential: MD
Location Address900 E 54TH ST NSioux Falls, SD 57104
Mailing AddressPo Box 5074Sioux Falls, SD 57117-5074 · (605) 328-6585 · Fax (605) 328-6512
Phone(605) 338-9300
Fax(605) 338-9301
Sole ProprietorNo
Medical School CMSSanford School Of Medicine Of University Of South DakotaGraduated 1979
Enumeration DateJune 24, 2005
Last NPPES UpdateMarch 2, 2021
NPPES CertifiedMarch 2, 2021
✔ NPI 1316943251 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyPreventive Medicine · Occupational MedicineAllopathic & Osteopathic Physicians
Taxonomy Code2083X0100X
License✔ Licensed in SD · 2540
Definition
Occupational medicine focuses on the health of workers, including the ability to perform work; the physical, chemical, biological, and social environments of the workplace; and the health outcomes of environmental exposures. Practitioners in this field address the promotion of health in the work place, and the prevention and management of occupational and environmental injury, illness, and disability.
Also ListedFamily MedicineTaxonomy 207Q00000X · License 2540 (SD)
Also ListedPreventive Medicine · Preventive Medicine/Occupational Environmental MedicineTaxonomy 2083P0500X · License 2540 (SD)
900 E 54TH ST N, Sioux Falls, SD 57104
Open in Google Maps ↗

Other Identifiers 1

Medicaid5602923SD

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Sunflower Health Plan, Ambetter Health, Ambetter Health of Delaware 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

Clayton Gerald Vanbalen 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 ID345210753
PECOS Enrollment IDI20041101000769
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

4

Medicare enrollment records show Clayton Vanbalen reassigns Medicare billing to 4 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Sanford Clinic
Same address
Occupational Medicine
900 E 54TH ST N STE 200
Sioux Falls, SD 57104
  • Reassigned Medicare billing, South Dakota enrollment
  • 826 clinicians in this Medicare group
NPI 1053792465 (701) 323-8170
Avera Mckennan
3.2 mi
Internal Medicine
300 N DAKOTA AVE., STE. 117
Sioux Falls, SD 57104
  • Reassigned Medicare billing, South Dakota enrollment
  • 1,277 clinicians in this Medicare group
NPI 1083894067 (605) 322-6800
Sanford Medical Center
4.4 mi
Family Medicine
1420 W 22NDST STE 104
Sioux Falls, SD 57105
  • Reassigned Medicare billing, South Dakota enrollment
  • 1,097 clinicians in this Medicare group
NPI 1093090342 (605) 328-4897
Avera St. Mary's
188 mi
Physical Therapist
1211 E WELLS AVE
Pierre, SD 57501
  • Reassigned Medicare billing, South Dakota enrollment
  • Medicare enrollment name: Avera St Marys
  • 197 clinicians in this Medicare group
NPI 1972082683 (605) 224-3100

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 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 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.
320 services274 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.
114 services102 patients
Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only 93010
A routine electrocardiogram (ECG) with 12 leads is a simple, non-invasive test that records the electrical activity of your heart. It helps in identifying heart conditions by detecting irregularities in your heart rhythms. The results are interpreted and a report is provided.
21 services21 patients
Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more 99212
This is a routine check-up for patients who have previously seen the doctor. During this 10-19 minute visit, the doctor will review your health status, discuss any concerns, and manage ongoing treatments or medications. It's a chance to ensure your health is on track.
14 services12 patients
New patient office or other outpatient visit with straightforward medical decision making, if using time, 15 minutes or more 99202
This service involves an initial visit to the doctor's office or other outpatient setting. It typically lasts between 15-29 minutes. The doctor will review your medical history, conduct a physical examination, and discuss your health concerns. It's a chance to establish your health baseline and address any immediate medical issues.
11 services11 patients

Hospital Affiliations CMS Care Compare

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

Avera St Mary's Hospital

Acute Care Hospitals · Pierre, SD
4/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number430015
Location801 E SiouxPierre, SD 57501 · Hughes County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 57104 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
$126.78 typical visit price
range $55.52 – $167.23
Typical copayment $31.69 (range $13.88 – $41.80)
Most-billed visit code 99204
Established Patient
$97.88 typical visit price
range $18.08 – $137.08
Typical copayment $24.47 (range $4.52 – $34.27)
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.

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.

RONALD MARK ROSSING MD
Preventive Medicine (Occupational Medicine)
900 E 54TH ST N
SIOUX FALLS, SD 57104
Minnehaha County (605) 328-9300
CHERIE AMBER GRAVES MOTR/L
Occupational Therapist
900 E 54TH ST N, STE 200
SIOUX FALLS, SD 57104
Minnehaha County (605) 328-9300
SANDI SORUM
Occupational Therapist
900 E 54TH ST N, SUITE 200
SIOUX FALLS, SD 57104
Minnehaha County (605) 328-9300

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 Clayton Vanbalen's NPI number?

The NPI number for Clayton Vanbalen is 1316943251. It was assigned to this individual provider in the NPPES registry on June 24, 2005.

Where is Clayton Vanbalen located?

Clayton Vanbalen practices at 900 E 54th St N, Sioux Falls, SD 57104. The listed phone number is (605) 338-9300.

What is Clayton Vanbalen's specialty?

The primary specialty registered for this NPI is Preventive Medicine, specializing in Occupational Medicine, with taxonomy code 2083X0100X.

Is Clayton Vanbalen enrolled in Medicare?

Yes. Clayton Vanbalen 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 Clayton Vanbalen's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Clayton Vanbalen reassigns Medicare benefits to 4 organizations: Sanford Clinic (Sioux Falls, SD), Avera Mckennan (Sioux Falls, SD), Sanford Medical Center (Sioux Falls, SD) and Avera St. Mary's (Pierre, SD). 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 Clayton Vanbalen's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Clayton Vanbalen accept?

Health plans from Ambetter Health, Ambetter Health of Delaware, Ambetter from Sunflower Health Plan, Avera Health Plans and Oscar Insurance Company and 1 other insurer list Clayton Vanbalen 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 Clayton Vanbalen affiliated with any hospitals?

According to CMS data, Clayton Vanbalen is affiliated with Avera St Mary's Hospital.

When was this NPI record last updated?

The NPPES record for Clayton Vanbalen was last updated on March 2, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.