DR. UMASHANKAR K BALLEHANINNA M.D
NPI 1578721767
Surgery - Vascular Surgery in Sayre, PA

Active since May 25, 2008PECOS EnrolledAccepts Medicare Assignment
82.9/100
CMS Quality Rating

NPPES record last updated: March 4, 2021. Verified against the NPPES registry weekly; last sync: September 06, 2026.

Record update history: Mar 4, 2021, Nov 3, 2016, Jun 27, 2016 (3 updates tracked since 2016).

About Dr. Umashankar K Ballehaninna M.d NPPES

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

DR. UMASHANKAR K BALLEHANINNA M.D (NPI 1578721767) is an individual vascular surgery provider in Sayre, Pennsylvania, licensed in Pennsylvania (MD458572) and active in the NPI registry since May 2008. He is enrolled in Medicare PECOS, is affiliated with Middlesboro Arh Hospital, and is a graduate of Other (2003).

NPPES Registry Identity

NPI1578721767
Entity TypeIndividualMale
Primary Taxonomy2086S0129X
Provider Legal NameDR. UMASHANKAR K BALLEHANINNACredential: M.D
Location Address1 GUTHRIE SQSayre, PA 18840-1625
Mailing Address1 Guthrie SqSayre, PA 18840-1625 · (570) 888-5858
Sole ProprietorYes
Medical School CMSOtherGraduated 2003
Enumeration DateMay 25, 2008
Last NPPES UpdateMarch 4, 20213 updates tracked since enumeration
NPPES CertifiedMarch 4, 2021
NPI 1578721767 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

Primary SpecialtySurgery · Vascular SurgeryAllopathic & Osteopathic Physicians
Taxonomy Code2086S0129X
License Licensed in PA · MD458572
Definition
A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart.
1 GUTHRIE SQ, Sayre, PA 18840

Accepted 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. Umashankar K Ballehaninna M.d 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 ID2365760972
PECOS Enrollment IDI20240208002908
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 16

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.

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
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.
44 services40 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.
38 services33 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.
31 services29 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.
26 services26 patients
Ultrasound study of one arm or leg veins with compression and maneuvers 93971
This is a non-invasive procedure using sound waves to visualize veins in an arm or leg. It involves applying gentle pressure and performing certain movements. It helps identify any abnormal blood flow or clots, ensuring vascular health.
23 services23 patients

Hospital Affiliations CMS Care Compare 5

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

Middlesboro Arh Hospital

Acute Care Hospitals · Middlesboro, KY
2/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number180020
Location3600 West Cumberland AvenueMiddlesboro, KY 40965 · Bell County
Emergency services Birthing friendly

University Health System, Inc

Acute Care Hospitals · Knoxville, TN
3/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number440015
Location1924 Alcoa HighwayKnoxville, TN 37920 · Knox County
Emergency services Birthing friendly

Lafollette Medical Center

Acute Care Hospitals · La Follette, TN
2/5 CMS rating
OwnershipVoluntary non-profit - Church
CMS Certification Number440033
Location923 East Central AvenueLa Follette, TN 37766 · Campbell County
Emergency services

Claiborne Medical Center

Acute Care Hospitals · Tazewell, TN
OwnershipGovernment - Local
CMS Certification Number440057
Location1850 Old Knoxville HighwayTazewell, TN 37879 · Claiborne County
Emergency services

Physicians Regional Medical Center

Acute Care Hospitals · Powell, TN
2/5 CMS rating
OwnershipProprietary
CMS Certification Number440120
Location7565 Dannaher Way PowellPowell, TN 37849 · Knox County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 18840 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
$84.88 typical visit price
range $54.64 – $166.87
Typical copayment $21.22 (range $13.66 – $41.71)
Most-billed visit code 99203
Established Patient
$68.36 typical visit price
range $17.33 – $135.84
Typical copayment $17.09 (range $4.33 – $33.96)
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.

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.

82.9/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice
Quality74.09
Promoting Interoperability100
Improvement Activities40
Cost65.94

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.

Psychologist
1 GUTHRIE SQ
SAYRE, PA 18840
Emergency Medicine
1 GUTHRIE SQ
SAYRE, PA 18840
Occupational Therapist
1 GUTHRIE SQ
SAYRE, PA 18840
Internal Medicine
1 GUTHRIE SQ
SAYRE, PA 18840
Student in an Organized Health Care Education/Training Program
1 GUTHRIE SQ
SAYRE, PA 18840
Radiology (Diagnostic Radiology)
1 GUTHRIE SQ
SAYRE, PA 18840
Hospitalist
1 GUTHRIE SQ
SAYRE, PA 18840
Physician Assistant
1 GUTHRIE SQ
SAYRE, PA 18840

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 Umashankar Ballehaninna's NPI number?

The NPI number for Umashankar Ballehaninna is 1578721767. It was assigned to this individual provider in the NPPES registry on May 25, 2008.

Where is Umashankar Ballehaninna located?

Umashankar Ballehaninna practices at 1 Guthrie Sq, Sayre, PA 18840. The listed phone number is (570) 887-2848.

What is Umashankar Ballehaninna's specialty?

The primary specialty registered for this NPI is Surgery, specializing in Vascular Surgery, with taxonomy code 2086S0129X.

Is Umashankar Ballehaninna enrolled in Medicare?

Yes. Umashankar Ballehaninna 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 Umashankar Ballehaninna accept?

Health plans from Ambetter Health, Ambetter Health of Delaware, Ambetter from Buckeye Health Plan and BlueCross BlueShield of Tennessee list Umashankar Ballehaninna 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 Umashankar Ballehaninna affiliated with any hospitals?

According to CMS data, Umashankar Ballehaninna is affiliated with Middlesboro Arh Hospital, University Health System, Inc, Lafollette Medical Center, Claiborne Medical Center and Physicians Regional Medical Center.

When was this NPI record last updated?

The NPPES record for Umashankar Ballehaninna was last updated on March 4, 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.