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SUMANTH BALGURI MD, FAAFP
NPI 1598077679
Family Medicine in Fort Smith, AR

Active since July 06, 2010PECOS EnrolledAccepts Medicare Assignment
7301 ROGERS AVE, FORT SMITH, AR 72903(479) 314-6030(479) 314-2021 Get Directions Write a Review

NPPES record last updated: July 10, 2023. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jul 10, 2023, Jul 6, 2023, Jun 18, 2018 (3 updates tracked since 2018).

About Sumanth Balguri Md, Faafp NPPES

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

SUMANTH BALGURI MD, FAAFP (NPI 1598077679) is an individual family medicine provider in Fort Smith, Arkansas, licensed in Arkansas (E-8115) and active in the NPI registry since July 2010. He is enrolled in Medicare PECOS, maintains a secondary practice location in Fort Smith, and is a graduate of Other (2007).

NPPES Registry Identity

NPI1598077679
Entity TypeIndividualMale
Primary Taxonomy207Q00000X
Provider Legal NameSUMANTH BALGURICredential: MD, FAAFP
Location Address7301 ROGERS AVEFort Smith, AR 72903-4100
Mailing Address7301 Rogers AveFort Smith, AR 72903-4100 · (479) 314-6030 · Fax (479) 314-2021
Phone(479) 314-6030
Fax(479) 314-2021
Sole ProprietorNo
Medical School CMSOtherGraduated 2007
Enumeration DateJuly 6, 2010
Last NPPES UpdateJuly 10, 20233 updates tracked since enumeration
NPPES CertifiedJuly 10, 2023
✔ NPI 1598077679 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Licenses✔ Licensed in AR · E-8115✔ Licensed in NY · 288945✔ Licensed in OK · 27769
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
7301 ROGERS AVE, Fort Smith, AR 72903
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Secondary Practice Location 1

Location 11000 S Waldron RdFort Smith, AR 72903-2550 · Phone (479) 221-9922 · Fax (479) 221-9988

Other Identifiers 1

Medicaid198945001AR

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arkansas Health & Wellness, Ambetter from Home State Health, 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

Sumanth Balguri Md, Faafp 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 ID2769625508
PECOS Enrollment IDI20130827000583
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 9

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 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.
213 services89 patients
Insertion of needle into vein for collection of blood sample 36415
This procedure involves inserting a small needle into a vein, typically in your arm, to collect a blood sample. It's a quick and simple process to help diagnose or monitor health conditions. You may feel a small prick, but discomfort is minimal.
147 services85 patients
Advance care planning, first 30 minutes 99497
Advance care planning is a process where you discuss your healthcare preferences with your doctor. This conversation, lasting up to 30 minutes, helps ensure your wishes are respected if you're unable to communicate them in the future. It's about your care, your way.
54 services54 patients
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit G0439
An annual wellness visit is a yearly appointment with your primary care provider to create or update a personalized prevention plan. This plan helps prevent illness based on your current health and risk factors. It's a subsequent visit, meaning it follows an initial assessment.
45 services45 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.
32 services25 patients
Administration of influenza virus vaccine G0008
The administration of the influenza virus vaccine, also known as the flu shot, is a simple procedure to protect against the flu. A healthcare provider injects a small dose of the vaccine into your arm. This stimulates your immune system to produce antibodies, which will help your body fight off the flu if exposed.
20 services20 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 72903 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
$79.72 typical visit price
range $51.36 – $157.74
Typical copayment $19.93 (range $12.84 – $39.43)
Most-billed visit code 99203
Established Patient
$91.63 typical visit price
range $16.16 – $128.77
Typical copayment $22.90 (range $4.04 – $32.19)
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
68%498 patients4/55-star benchmark: 85%
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.
97%2,213 patients4/55-star benchmark: 100%
Falls: Screening for Future Fall Risk
Percentage of patients 65 years of age and older who were screened for future fall risk during the measurement period
91%359 patients4/55-star benchmark: 99%
Pneumococcal Vaccination Status for Older Adults
Percentage of patients 65 years of age and older who have ever received a pneumococcal vaccine
81%359 patients4/55-star benchmark: 90%
Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents
Percentage of patients 3-17 years of age who had an outpatient visit with a Primary Care Physician (PCP) or Obstetrician/Gynecologist (OB/GYN) and who had evidence of the following during the measurement period. Three rates are reported.
99%154 patients
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.

Referred Medical Equipment & Supplies CMS DME claims 4

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

Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips A4253
DME-Other DME · category DE017N
6 suppliers21 claims59 services$5.17 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
2 suppliers18 claims19 services$89.49 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
3 suppliers13 claims2,998 services$0.03 avg. paid by Medicare
Pharmacy dispensing fee for inhalation drug(s); per 30 days Q0513
DME-Other DME · category DE000N
4 suppliers14 claims14 services$26.12 avg. paid by Medicare
Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

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.

RUBINE FLEMING MD
Student in an Organized Health Care Education/Training Program
7301 ROGERS AVE
FORT SMITH, AR 72903
Sebastian County (479) 314-6000
DR. DAVID A HEBERT M.D.
Internal Medicine
7301 ROGERS AVE
FORT SMITH, AR 72903
Sebastian County (479) 314-6000
THOMAS STEPHEN LEITZSCH DO
Emergency Medicine
7301 ROGERS AVE
FORT SMITH, AR 72903
Sebastian County (479) 314-6241
ZACHARY MILLER POWERS DO
Student in an Organized Health Care Education/Training Program
7301 ROGERS AVE
FORT SMITH, AR 72903
Sebastian County (479) 314-6000
GEOFFREY LOUX
Pharmacist
7301 ROGERS AVE
FORT SMITH, AR 72903
Sebastian County (479) 314-6140
MONISH SHARMA
Student in an Organized Health Care Education/Training Program
7301 ROGERS AVE
FORT SMITH, AR 72903
Sebastian County (479) 314-6107
ADVANCE CARE HOSPITAL
Long Term Care Hospital
7301 ROGERS AVE, 4TH FLOOR
FORT SMITH, AR 72903
Sebastian County (479) 314-4900
DR. KEVIN ALLEN DAVIS M.D.
Internal Medicine (Infectious Disease)
7301 ROGERS AVE
FORT SMITH, AR 72903
Sebastian County (501) 593-3845

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 Sumanth Balguri's NPI number?

The NPI number for Sumanth Balguri is 1598077679. It was assigned to this individual provider in the NPPES registry on July 6, 2010.

Where is Sumanth Balguri located?

Sumanth Balguri practices at 7301 Rogers Ave, Fort Smith, AR 72903. The listed phone number is (479) 314-6030.

What is Sumanth Balguri's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Sumanth Balguri enrolled in Medicare?

Yes. Sumanth Balguri 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 Sumanth Balguri accept?

Health plans from Ambetter from Arkansas Health & Wellness, Ambetter from Home State Health, Ambetter from Louisiana Healthcare Connections, Ambetter from Magnolia Health and Ambetter from Superior HealthPlan and 5 other insurers list Sumanth Balguri 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.

When was this NPI record last updated?

The NPPES record for Sumanth Balguri was last updated on July 10, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.