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MATTHEW BALLENBERGER MD
NPI 1497296685
Internal Medicine - Pulmonary Disease in Riverside, RI

Active since March 20, 2017PECOS EnrolledAccepts Medicare Assignment
91.25/100
CMS Quality Rating
375 WAMPANOAG TRL, RIVERSIDE, RI 02915(401) 649-4070(401) 649-4071 Get Directions Write a Review

NPPES record last updated: May 30, 2024. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: May 1, 2024, Jun 16, 2023, Jan 14, 2021 and 1 more (4 updates tracked since 2017).

About Matthew Ballenberger Md NPPES

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

MATTHEW BALLENBERGER MD (NPI 1497296685) is an individual pulmonary disease provider in Riverside, Rhode Island, licensed in Rhode Island (MD19716) and active in the NPI registry since March 2017. He is enrolled in Medicare PECOS, is affiliated with Newport Hospital, and maintains 2 additional practice locations.

NPPES Registry Identity

NPI1497296685
Entity TypeIndividualMale
Primary Taxonomy207RP1001X
Provider Legal NameMATTHEW BALLENBERGERCredential: MD
Location Address375 WAMPANOAG TRLRiverside, RI 02915-2232
Mailing AddressDept 3010, Po Box 986524Boston, MA 02298-6524 · (833) 924-5546
Phone(401) 649-4070
Fax(401) 649-4071
Sole ProprietorNo
Medical School CMSOtherGraduated 2017
Enumeration DateMarch 20, 2017
Last NPPES UpdateMay 30, 20244 updates tracked since enumeration
NPPES CertifiedMay 30, 2024
✔ NPI 1497296685 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 4

★ Primary SpecialtyInternal Medicine · Pulmonary DiseaseAllopathic & Osteopathic Physicians
Taxonomy Code207RP1001X
License✔ Licensed in RI · MD19716
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 MedicineTaxonomy 207R00000X · License 73520 (CT), 306174 (NY)
Also ListedInternal Medicine · Critical Care MedicineTaxonomy 207RC0200X · License MD19716 (RI)
Also ListedInternal Medicine · Sleep MedicineTaxonomy 207RS0012X · License MD19716 (RI)
375 WAMPANOAG TRL, Riverside, RI 02915
Open in Google Maps ↗

Secondary Practice Locations 2

Location 120 York StNew Haven, CT 06510-3220 · Phone (203) 688-4242
Location 2100 E 77th StNew York, NY 10075-1850 · Phone (212) 434-2140

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

Matthew Ballenberger 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 ID6507298882
PECOS Enrollment IDI20240530000419
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

5

Medicare enrollment records show Matthew Ballenberger reassigns Medicare billing to 5 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Brown Medicine
Same address
Endocrinology, Diabetes & Metabolism
375 WAMPANOAG TRL
Riverside, RI 02915
  • Reassigned Medicare billing, Rhode Island enrollment
  • 256 clinicians in this Medicare group
NPI 1104564137 (401) 444-7793
Lifespan Physician Group, Inc.
Same address
General Practice
375 WAMPANOAG TRL
Riverside, RI 02915
  • Reassigned Medicare billing, Rhode Island enrollment
  • 1,372 clinicians in this Medicare group
NPI 1215899869 (401) 649-4000
Rhode Island Hospital
3.3 mi
Multi-Specialty
593 EDDY ST
Providence, RI 02903
  • Reassigned Medicare billing, Rhode Island enrollment
  • 358 clinicians in this Medicare group
NPI 1154537520 (401) 444-6905
The Miriam Hospital
4.7 mi
General Acute Care Hospital
164 SUMMIT AVE
Providence, RI 02906
  • Reassigned Medicare billing, Rhode Island enrollment
  • 47 clinicians in this Medicare group
NPI 1770520462 (401) 793-2500
North Shore-Lij Medical PC
141 mi
Urology
1010 NORTHERN BLVD STE 110
Great Neck, NY 11021
  • Reassigned Medicare billing, New York enrollment
  • 9,353 clinicians in this Medicare group
NPI 1053688572 (516) 321-7400

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 4

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.

Critical care, first 30-74 minutes 99291
Critical care involves immediate and constant attention by a team of specially-trained health professionals. It's for patients with life-threatening conditions, requiring first 30-74 minutes of intense monitoring and treatment.
36 services23 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.
25 services23 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.
18 services12 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.
16 services16 patients

Hospital Affiliations CMS Care Compare 3

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

Newport Hospital

Acute Care Hospitals · Newport, RI
4/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number410006
Location11 Friendship StreetNewport, RI 02840 · Newport County
Emergency services Birthing friendly

Rhode Island Hospital

Acute Care Hospitals · Providence, RI
3/5 CMS rating
OwnershipTribal
CMS Certification Number410007
Location593 Eddy StreetProvidence, RI 02903 · Providence County
Emergency services

The Miriam Hospital

Acute Care Hospitals · Providence, RI
5/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number410012
Location164 Summit AvenueProvidence, RI 02906 · Providence County
Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 02915 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
$134.17 typical visit price
range $58.57 – $177.03
Typical copayment $33.54 (range $14.64 – $44.25)
Most-billed visit code 99204
Established Patient
$103.10 typical visit price
range $18.92 – $144.38
Typical copayment $25.77 (range $4.73 – $36.09)
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.

91.25/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored through an Alternative Payment Model
Quality74.92
Promoting Interoperability91.67
Improvement Activities40

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.

JONATHAN A LEVISS MD
Internal Medicine
375 WAMPANOAG TRL
RIVERSIDE, RI 02915
Providence County (401) 649-4020
THOMAS D DENUCCI M.D.
Internal Medicine (Gastroenterology)
375 WAMPANOAG TRL, SUITE 202A
RIVERSIDE, RI 02915
Providence County (401) 649-4030
MRIGANKA SINGH M.D.
Internal Medicine (Geriatric Medicine)
375 WAMPANOAG TRL
RIVERSIDE, RI 02915
Providence County (401) 649-4010
KRISTEN TILLQUIST DO
Internal Medicine (Nephrology)
375 WAMPANOAG TRL
RIVERSIDE, RI 02915
Providence County (401) 649-4060
DONNA MARIE RONDEAU-MARZULLO NP
Nurse Practitioner (Gerontology)
375 WAMPANOAG TRL, SUITE 102
RIVERSIDE, RI 02915
Providence County (401) 649-4010
DR. ANKUR SHAH M.D.
Internal Medicine (Nephrology)
375 WAMPANOAG TRL
RIVERSIDE, RI 02915
Providence County (401) 649-4060
REGINALD Y GOHH MD
Internal Medicine (Nephrology)
375 WAMPANOAG TRL, SUITE 302A
RIVERSIDE, RI 02915
Providence County (401) 649-4060
GABRIELLE HERMES BURKE NP
Nurse Practitioner (Family)
375 WAMPANOAG TRL
RIVERSIDE, RI 02915
Providence County (401) 649-4030

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 Matthew Ballenberger's NPI number?

The NPI number for Matthew Ballenberger is 1497296685. It was assigned to this individual provider in the NPPES registry on March 20, 2017.

Where is Matthew Ballenberger located?

Matthew Ballenberger practices at 375 Wampanoag Trl, Riverside, RI 02915. The listed phone number is (401) 649-4070.

What is Matthew Ballenberger's specialty?

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

Is Matthew Ballenberger enrolled in Medicare?

Yes. Matthew Ballenberger 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 Matthew Ballenberger's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Matthew Ballenberger reassigns Medicare benefits to 5 organizations: Brown Medicine (Riverside, RI), Lifespan Physician Group, Inc. (Riverside, RI), Rhode Island Hospital (Providence, RI), The Miriam Hospital (Providence, RI) and North Shore-Lij Medical PC (Great Neck, NY). 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 Matthew Ballenberger's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

Is Matthew Ballenberger affiliated with any hospitals?

According to CMS data, Matthew Ballenberger is affiliated with Newport Hospital, Rhode Island Hospital and The Miriam Hospital.

When was this NPI record last updated?

The NPPES record for Matthew Ballenberger was last updated on May 30, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.