DR. JAY SHANKAR BALACHANDRAN MD
NPI 1396786273
Internal Medicine - Pulmonary Disease in Mequon, WI

Q: What is Jay Balachandran's NPI number?

The NPI number for Jay Balachandran is 1396786273. It was assigned to this individual provider in the NPPES registry on June 9, 2006.

Q: What is Jay Balachandran's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Pulmonary Disease, with taxonomy code 207RP1001X.

Q: When was this NPI record last updated?

The NPPES record for Jay Balachandran was last updated on November 7, 2016. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since June 09, 2006PECOS EnrolledAccepts Medicare Assignment

81.48/100

CMS Quality Rating

13133 N PORT WASHINGTON RD, SUITE 104, MEQUON, WI 53097(262) 243-5044(262) 243-2510 Get Directions Write a Review

NPPES record last updated: November 7, 2016. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Nov 7, 2016, Jan 29, 2016, Dec 23, 2015 (3 updates tracked since 2015).

On this page

About Dr. Jay Shankar Balachandran Md NPPES

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

DR. JAY SHANKAR BALACHANDRAN MD (NPI 1396786273) is an individual pulmonary disease provider in Mequon, Wisconsin, licensed in Wisconsin (64930) and active in the NPI registry since June 2006. He is enrolled in Medicare PECOS, is affiliated with Ascension Ne Wisconsin - St Elizabeth Campus, and is a graduate of University Of Wisconsin School Of Medicine (2003).

NPPES Registry Identity

NPI1396786273

Entity TypeIndividualMale

Primary Taxonomy207RP1001X

Provider Legal NameDR. JAY SHANKAR BALACHANDRANCredential: MD

Location Address13133 N PORT WASHINGTON RD, SUITE 104Mequon, WI 53097-2419

Mailing Address788 N Jefferson St, Suite 300/attn. Kaaren ButzenMilwaukee, WI 53202-3718 · (414) 272-8950 · Fax (414) 272-0859

Phone(262) 243-5044

Fax(262) 243-2510

Sole ProprietorNo

Medical School CMSUniversity Of Wisconsin School Of MedicineGraduated 2003

Enumeration DateJune 9, 2006

Last NPPES UpdateNovember 7, 20163 updates tracked since enumeration

✔ NPI 1396786273 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyInternal Medicine · Pulmonary DiseaseAllopathic & Osteopathic Physicians

Taxonomy Code207RP1001X

License✔ Licensed in WI · 64930

Definition

An internist who treats diseases of the lungs and airways. The pulmonologist diagnoses and treats cancer, pneumonia, pleurisy, asthma, occupational and environmental diseases, bronchitis, sleep disorders, emphysema and other complex disorders of the lungs.

Also ListedInternal Medicine · Critical Care MedicineTaxonomy 207RC0200X · License 64930 (WI)

Also ListedInternal Medicine · Sleep MedicineTaxonomy 207RS0012X · License 64930 (WI)

13133 N PORT WASHINGTON RD, Mequon, WI 53097

Open in Google Maps ↗

Other Identifiers 2

Medicaid1396786273WI

Medicare PINK400266197WI

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, Network Health.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. Jay Shankar Balachandran 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 ID8022012079

PECOS Enrollment IDI20151229001002

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 18

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.

Test for exercise-induced lung stress 94618

An exercise-induced lung stress test assesses how your lungs respond to physical activity. During the test, you'll exercise on a treadmill or stationary bike while your heart rate, breathing, blood pressure, and oxygen levels are monitored. This helps identify any abnormal lung responses to exercise.

328 services227 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.

247 services168 patients

Test to examine how well the lungs exchange gases 94729

This is a test called a pulmonary function test, which helps understand the efficiency of your lungs. It measures how much air your lungs can hold, how quickly you can move air in and out of your lungs, and how well your lungs put oxygen into and remove carbon dioxide from your blood.

160 services148 patients

Test to determine lung volumes using sensors 94726

This test, called spirometry, measures lung capacity using sensors. You breathe into a mouthpiece attached to a device that records the amount and rate of air you inhale and exhale. It helps diagnose and monitor lung conditions.

153 services146 patients

Test to measure expiratory airflow and volume changes before and after medication administration 94060

This procedure measures how air flows in and out of your lungs. It's done before and after medication to see if the treatment improves your breathing. It's a simple, non-invasive test that involves breathing into a device called a spirometer.

147 services139 patients

Home sleep test (hst) with type iii portable monitor, unattended; minimum of 4 channels: 2 respiratory movement/airflow, 1 ecg/heart rate and 1 oxygen saturation G0399

A Home Sleep Test (HST) with a Type III Portable Monitor is an unattended test that records your breathing, heart rate, and oxygen levels during sleep. This test uses a minimum of 4 channels to monitor these parameters, helping to diagnose sleep disorders.

76 services73 patients

Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes 99233

Follow-up hospital inpatient care per day typically involves a 35-minute check-up by your healthcare provider. This service includes monitoring your health progress, adjusting your treatment plan if needed, and answering any questions you may have about your condition or care.

66 services32 patients

Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more 99215

This service involves a follow-up appointment for existing patients, lasting between 40 to 54 minutes. During this time, your healthcare provider will assess your current health status, discuss any changes or concerns, review your treatment plan, and answer any questions you may have.

57 services51 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.

44 services44 patients

Test to measure oxygen level in blood using ear or finger device continuously overnight 94762

This procedure involves using a small device, placed on your ear or finger, to continuously monitor your blood oxygen level overnight. It's painless, non-invasive, and helps assess your body's oxygen supply during sleep.

40 services30 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.

31 services31 patients

Test to measure expiratory airflow and volume 94010

This test, known as spirometry, assesses how well your lungs work. It measures how much air you can inhale, how much you can exhale and how quickly you can exhale. It's non-invasive and helps diagnose conditions like asthma or COPD.

26 services24 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.

26 services26 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.

22 services20 patients

New patient office or other outpatient visit with a high level of medical decision making, if using time, 60 minutes or more 99205

This is a first-time patient visit where a healthcare professional spends 60-74 minutes with you. It involves a comprehensive evaluation, including your medical history and current health condition. They'll also advise on preventive health measures and formulate a treatment plan if needed.

21 services21 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.

18 services17 patients

Sleep study in sleep lab with continuous airway pressure (6 years or older) 95811

A sleep study in a sleep lab with continuous airway pressure is a test for individuals aged 6 and above. It monitors your sleep patterns to check for disorders like sleep apnea. Continuous airway pressure helps keep your airways open while you sleep, improving your breathing.

15 services15 patients

Sleep study in sleep lab (6 years or older) 95810

A sleep study in a sleep lab is a non-invasive overnight test that monitors your body while you sleep. It helps doctors understand your sleep patterns and identify any issues like sleep apnea or insomnia. You'll be connected to equipment that tracks your heart rate, brain waves, breathing, and movements.

12 services12 patients

Hospital Affiliations CMS Care Compare 5

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

Ascension NE Wisconsin - St Elizabeth Campus

Acute Care Hospitals · Appleton, WI

4/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number520009

Location1506 S Oneida StAppleton, WI 54915 · Outagamie County

Emergency services Birthing friendly

Ascension Columbia St Mary's Hospital Milwaukee

Acute Care Hospitals · Milwaukee, WI

3/5 CMS rating

OwnershipVoluntary non-profit - Church

CMS Certification Number520051

Location2323 N Lake DrMilwaukee, WI 53211 · Milwaukee County

Emergency services Birthing friendly

Ascension St Francis Hospital

Acute Care Hospitals · Milwaukee, WI

4/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number520078

Location3237 S 16th StMilwaukee, WI 53215 · Milwaukee County

Emergency services

Ascension SE Wisconsin Hospital

Acute Care Hospitals · Milwaukee, WI

4/5 CMS rating

OwnershipVoluntary non-profit - Church

CMS Certification Number520136

Location5000 W Chambers StMilwaukee, WI 53210 · Milwaukee County

Emergency services Birthing friendly

Froedtert Memorial Lutheran Hospital

Acute Care Hospitals · Milwaukee, WI

5/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number520177

Location9200 W Wisconsin AveMilwaukee, WI 53226 · Milwaukee County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 53097 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

$123.69 typical visit price

range $53.90 – $163.24

Typical copayment $30.92 (range $13.47 – $40.81)

Most-billed visit code 99204

Established Patient

$95.41 typical visit price

range $17.40 – $133.76

Typical copayment $23.85 (range $4.35 – $33.44)

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.

81.48/100

MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program

Scored as part of a group practice

Quality

88.39

Promoting Interoperability

100

Improvement Activities

Cost

49.87

Referred Medical Equipment & Supplies CMS DME claims 27

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

Sterile water/saline, 500 ml A4217

DME-Medical/Surgical Supplies · category DA000N

1 supplier13 claims498 services$3.03 avg. paid by Medicare

Tubing with integrated heating element for use with positive airway pressure device A4604

DME-Other DME · category DE001N

14 suppliers237 claims237 services$33.76 avg. paid by Medicare

Administration set, with small volume nonfiltered pneumatic nebulizer, disposable A7003

DME-Other DME · category DE000N

2 suppliers16 claims34 services$1.16 avg. paid by Medicare

Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable A7005

DME-Other DME · category DE000N

5 suppliers12 claims12 services$12.07 avg. paid by Medicare

Full face mask used with positive airway pressure device, each A7030

DME-Other DME · category DE001N

13 suppliers151 claims151 services$74.18 avg. paid by Medicare

Face mask interface, replacement for full face mask, each A7031

DME-Other DME · category DE001N

13 suppliers150 claims414 services$28.09 avg. paid by Medicare

Cushion for use on nasal mask interface, replacement only, each A7032

DME-Other DME · category DE001N

15 suppliers100 claims566 services$15.14 avg. paid by Medicare

Pillow for use on nasal cannula type interface, replacement only, pair A7033

DME-Other DME · category DE001N

6 suppliers50 claims293 services$12.28 avg. paid by Medicare

Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap A7034

DME-Other DME · category DE001N

13 suppliers168 claims168 services$46.84 avg. paid by Medicare

Headgear used with positive airway pressure device A7035

DME-Other DME · category DE001N

15 suppliers167 claims167 services$15.55 avg. paid by Medicare

Tubing used with positive airway pressure device A7037

DME-Other DME · category DE001N

10 suppliers52 claims52 services$9.46 avg. paid by Medicare

Filter, disposable, used with positive airway pressure device A7038

DME-Other DME · category DE001N

16 suppliers279 claims1,547 services$1.64 avg. paid by Medicare

Filter, non disposable, used with positive airway pressure device A7039

DME-Other DME · category DE001N

6 suppliers27 claims27 services$5.19 avg. paid by Medicare

Water chamber for humidifier, used with positive airway pressure device, replacement, each A7046

DME-Other DME · category DE001N

15 suppliers136 claims136 services$11.68 avg. paid by Medicare

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

DME-Oxygen and Supplies · category DC000N

3 suppliers59 claims75 services$14.04 avg. paid by Medicare

Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) E0466

DME-Other DME · category DE005N

3 suppliers31 claims31 services$777.42 avg. paid by Medicare

Respiratory assist device, bi-level pressure capability, with back-up rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) E0471

DME-Other DME · category DE001N

4 suppliers52 claims58 services$190.10 avg. paid by Medicare

Oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, custom fabricated, includes fitting and adjustment E0486

DME-Other DME · category DE000N

3 suppliers20 claims20 services$1,159.44 avg. paid by Medicare

Humidifier, heated, used with positive airway pressure device E0562

DME-Other DME · category DE001N

5 suppliers15 claims15 services$127.72 avg. paid by Medicare

Humidifier, heated, used with positive airway pressure device E0562

DME-Other DME · category DE001N

3 suppliers37 claims43 services$13.33 avg. paid by Medicare

Nebulizer, with compressor E0570

DME-Other DME · category DE000N

4 suppliers67 claims74 services$3.63 avg. paid by Medicare

Continuous positive airway pressure (cpap) device E0601

DME-Other DME · category DE001N

9 suppliers239 claims239 services$28.38 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

6 suppliers174 claims178 services$72.40 avg. paid by Medicare

Portable oxygen concentrator, rental E1392

DME-Oxygen and Supplies · category DC002N

5 suppliers100 claims100 services$30.86 avg. paid by Medicare

Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg J7613

DME-Drugs Administered Through DME · category DG006N

6 suppliers19 claims4,881 services$0.04 avg. paid by Medicare

Budesonide, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, up to 0.5 mg J7626

DME-Drugs Administered Through DME · category DG000N

4 suppliers11 claims660 services$0.66 avg. paid by Medicare

Pharmacy dispensing fee for inhalation drug(s); per 30 days Q0513

DME-Other DME · category DE000N

9 suppliers28 claims28 services$24.20 avg. paid by Medicare

Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Leave this field empty

Other Providers at the Same Location NPPES 20

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

MRS. MARY KATHERINE KAUTZ APNP

Nurse Practitioner (Gerontology)

13133 N PORT WASHINGTON RD, SUITE 122
MEQUON, WI 53097

Ozaukee County (262) 243-3700

MILWAUKEE ORTHOPAEDIC GROUP LTD

Specialist

13133 N PORT WASHINGTON RD, SUITE 104
MEQUON, WI 53097

Ozaukee County (414) 276-6000

KATHARINE W. SCHENCK PA-C

Physician Assistant

13133 N PORT WASHINGTON RD, SUITE 104
MEQUON, WI 53097

Ozaukee County (262) 243-5044

DREW M ELGIN M.D.

Internal Medicine (Gastroenterology)

13133 N PORT WASHINGTON RD, SUITE G16
MEQUON, WI 53097

Ozaukee County (262) 243-2500

JOAN T. HARNEY GNADT, MD, SC

Internal Medicine (Cardiovascular Disease)

13133 N PORT WASHINGTON RD, SUITE 11
MEQUON, WI 53097

Ozaukee County (262) 243-6000

SCOTT A JORGENSEN M.D.

Internal Medicine

13133 N PORT WASHINGTON RD, SUITE G18
MEQUON, WI 53097

Ozaukee County (262) 243-5000

CANDACE MOORE NP

Nurse Practitioner

13133 N PORT WASHINGTON RD, SUITE G-18
MEQUON, WI 53097

Ozaukee County (262) 243-5000

EAMEN GEBOY APNP

Nurse Practitioner (Adult Health)

13133 N PORT WASHINGTON RD
MEQUON, WI 53097

Ozaukee County (262) 243-5000

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 Jay Balachandran's NPI number?

The NPI number for Jay Balachandran is 1396786273. It was assigned to this individual provider in the NPPES registry on June 9, 2006.

Where is Jay Balachandran located?

Jay Balachandran practices at 13133 N Port Washington Rd Suite 104, Mequon, WI 53097. The listed phone number is (262) 243-5044.

What is Jay Balachandran's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Pulmonary Disease, with taxonomy code 207RP1001X.

Is Jay Balachandran enrolled in Medicare?

Yes. Jay Balachandran 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 Jay Balachandran accept?

Health plans from Anthem Blue Cross and Blue Shield and Network Health list Jay Balachandran 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 Jay Balachandran affiliated with any hospitals?

According to CMS data, Jay Balachandran is affiliated with Ascension NE Wisconsin - St Elizabeth Campus, Ascension Columbia St Mary's Hospital Milwaukee, Ascension St Francis Hospital, Ascension SE Wisconsin Hospital and Froedtert Memorial Lutheran Hospital.

When was this NPI record last updated?

The NPPES record for Jay Balachandran was last updated on November 7, 2016. NPI Profile syncs with the weekly NPPES data releases published by CMS.