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DR. CARLOS ROBERTO PONCE MD
NPI 1386709707
Internal Medicine - Gastroenterology in Brownsville, TX

Active since December 26, 2006PECOS EnrolledAccepts Medicare Assignment
5700 N EXPRESSWAY, #303, BROWNSVILLE, TX 78526(956) 542-1531(956) 542-0028 Get Directions Write a Review

NPPES record last updated: March 16, 2017. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Dr. Carlos Roberto Ponce Md NPPES

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

DR. CARLOS ROBERTO PONCE MD (NPI 1386709707) is an individual gastroenterology provider in Brownsville, Texas, licensed in Texas (M5886) and active in the NPI registry since December 2006. He is enrolled in Medicare PECOS, is affiliated with Valley Baptist Medical Center- Brownsville, and is a graduate of Texas Tech University Health Science Center School Of Medicine (1999).

NPPES Registry Identity

NPI1386709707
Entity TypeIndividualMale
Primary Taxonomy207RG0100X
Provider Legal NameDR. CARLOS ROBERTO PONCECredential: MD
Location Address5700 N EXPRESSWAY, #303Brownsville, TX 78526-4310
Mailing Address5700 N Expressway, #303Brownsville, TX 78526-4353 · (956) 542-1531 · Fax (956) 542-0028
Phone(956) 542-1531
Fax(956) 542-0028
Sole ProprietorYes
Medical School CMSTexas Tech University Health Science Center School Of MedicineGraduated 1999
Enumeration DateDecember 26, 2006
Last NPPES UpdateMarch 16, 2017
✔ NPI 1386709707 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyInternal Medicine · GastroenterologyAllopathic & Osteopathic Physicians
Taxonomy Code207RG0100X
Licenses✔ Licensed in TX · M5886✔ Licensed in GA · 051371
Definition
An internist who specializes in diagnosis and treatment of diseases of the digestive organs including the stomach, bowels, liver and gallbladder. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer and jaundice and performs complex diagnostic and therapeutic procedures using endoscopes to visualize internal organs.
Also ListedInternal Medicine · HepatologyTaxonomy 207RI0008X · License M5886 (TX)
5700 N EXPRESSWAY, Brownsville, TX 78526
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Other Identifiers 4

Medicaid191309701TX
Medicaid191309702TX
Medicare PIN8J4354TX
Medicare PIN8F8401TX

Accepted Insurance

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

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. Carlos Roberto Ponce 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 ID5496853103
PECOS Enrollment IDI20070604000632
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 8

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.

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.
66 services65 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.
65 services41 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.
50 services42 patients
Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes 99222
Initial hospital inpatient care is a service where a healthcare provider spends about 50 minutes per day overseeing your care while you're admitted in the hospital. This includes reviewing your health status, planning your treatment, and ensuring your safety and comfort.
48 services47 patients
Diagnostic exam of large bowel using a flexible endoscope 45378
This procedure, known as a colonoscopy, involves using a flexible tube with a light and camera to examine the large intestine. It helps detect any abnormalities such as polyps or inflammation. It's a standard procedure to ensure gut health.
31 services31 patients
New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more 99203
This service involves an initial office or outpatient visit for a new patient. The healthcare professional will spend 30-44 minutes understanding your health history, current issues, and discussing possible treatment plans. It's a comprehensive evaluation to start your healthcare journey.
24 services24 patients

Hospital Affiliations CMS Care Compare 2

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

Valley Baptist Medical Center- Brownsville

Acute Care Hospitals · Brownsville, TX
3/5 CMS rating
OwnershipProprietary
CMS Certification Number450028
Location1040 W Jefferson StBrownsville, TX 78520 · Cameron County
Emergency services Birthing friendly

Valley Regional Medical Center

Acute Care Hospitals · Brownsville, TX
2/5 CMS rating
OwnershipProprietary
CMS Certification Number450662
Location100 A Alton GloorBrownsville, TX 78526 · Cameron County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 78526 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
$126.40 typical visit price
range $54.84 – $166.88
Typical copayment $31.60 (range $13.71 – $41.72)
Most-billed visit code 99204
Established Patient
$97.05 typical visit price
range $17.52 – $136.11
Typical copayment $24.26 (range $4.38 – $34.02)
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.

Reported Quality Measures

Colorectal Cancer Screening
Percentage of adults 50-75 years of age who had appropriate screening for colorectal cancer
85%658 patients5/55-star benchmark: 85%
Diabetes: Medical Attention for Nephropathy
The percentage of patients 18-75 years of age with diabetes who had a nephropathy screening test or evidence of nephropathy during the measurement period
65%214 patients3/55-star benchmark: 99%
Documentation of Current Medications in the Medical Record
Percentage of visits for patients aged 18 years and older for which the eligible professional or eligible clinician attests to documenting a list of current medications using all immediate resources available on the date of the encounter.
99%1,554 patients4/55-star benchmark: 100%
e-Prescribing
At least one permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using certified EHR technology.
99%176 patients4/55-star benchmark: 100%
Medication Reconciliation
The MIPS eligible clinician performs medication reconciliation for at least one transition of care in which the patient is transitioned into the care of the MIPS eligible clinician.
96%564 patients4/55-star benchmark: 100%
Patient-Specific Education
The MIPS eligible clinician must use clinically relevant information from CEHRT to identify patient-specific educational resources and provide access to those materials to at least one unique patient seen by the MIPS eligible clinician.
98%464 patients4/55-star benchmark: 99%
Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan
Percentage of patients aged 18 years and older with a BMI documented during the current encounter or during the previous twelve months AND with a BMI outside of normal parameters, a follow-up plan is documented during the encounter or during the previous…
95%1,014 patients4/55-star benchmark: 97%
Provide Patient Access
At least one patient seen by the MIPS eligible clinician during the performance period is provided timely access to view online, download, and transmit to a third party their health information subject to the MIPS eligible clinician's discretion to withhold…
95%464 patients4/55-star benchmark: 100%
Secure Messaging
For at least one unique patient seen by the MIPS eligible clinician during the performance period, a secure message was sent using the electronic messaging function of CEHRT to the patient (or the patient-authorized representative), or in response to a secure…
2%464 patients1/55-star benchmark: 59%
Use of High-Risk Medications in the Elderly
Percentage of patients 65 years of age and older who were ordered high-risk medications. Two rates are submitted. 1) Percentage of patients who were ordered at least one high-risk medication.
Lower rates are better for this measure.
Patients 2+: 0% · 456 patients
0%456 patients5/55-star benchmark: 100%
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.

Other Providers at the Same Location NPPES 9

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

HYPERBARIC SOUTH PA
Specialist
5700 N EXPRESSWAY, 305B
BROWNSVILLE, TX 78526
Cameron County (956) 546-3400
ROBERTO PONCE MD PA
Internal Medicine (Gastroenterology)
5700 N EXPRESSWAY, #303
BROWNSVILLE, TX 78526
Cameron County (956) 542-1531
GLADYS P BEMBO DPM PA
Podiatrist
5700 N EXPRESSWAY, SUITE 305B
BROWNSVILLE, TX 78526
Cameron County (956) 504-1469
JENNIFER NINO GARCIA LVN
Licensed Vocational Nurse
5700 N EXPRESSWAY
BROWNSVILLE, TX 78526
Cameron County (956) 630-7300
JOSE LUIS AYALA DPM PA
Podiatrist
5700 N EXPRESSWAY, SUITE 305B
BROWNSVILLE, TX 78526
Cameron County (956) 504-1469
CARLOS R PONCE MD PA
Internal Medicine (Gastroenterology)
5700 N EXPRESSWAY, STE 303
BROWNSVILLE, TX 78526
Cameron County (956) 542-1531
AESTHETIC VEIN AND LASER INSTITUTE, P.L.L.C.
Thoracic Surgery (Cardiothoracic Vascular Surgery)
5700 N EXPRESSWAY, STE 102
BROWNSVILLE, TX 78526
Cameron County (956) 350-6561
DR. FILIBERTO RODRIGUEZ MD
Plastic Surgery
5700 N EXPRESSWAY, SUITE102
BROWNSVILLE, TX 78526
Cameron County (956) 350-6561

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 Carlos Ponce's NPI number?

The NPI number for Carlos Ponce is 1386709707. It was assigned to this individual provider in the NPPES registry on December 26, 2006.

Where is Carlos Ponce located?

Carlos Ponce practices at 5700 N Expressway #303, Brownsville, TX 78526. The listed phone number is (956) 542-1531.

What is Carlos Ponce's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Gastroenterology, with taxonomy code 207RG0100X.

Is Carlos Ponce enrolled in Medicare?

Yes. Carlos Ponce 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.

What insurance does Carlos Ponce accept?

Health plans from Ambetter from Arizona Complete Health, Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections, Ambetter from Superior HealthPlan and Ambetter of Oklahoma and 5 other insurers list Carlos Ponce 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 Carlos Ponce affiliated with any hospitals?

According to CMS data, Carlos Ponce is affiliated with Valley Baptist Medical Center- Brownsville and Valley Regional Medical Center.

When was this NPI record last updated?

The NPPES record for Carlos Ponce was last updated on March 16, 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.