DR. GAUTAM BALAKRISHNAN MD
NPI 1609214519
Internal Medicine - Pulmonary Disease in Saint Joseph, MO

Q: What is Gautam Balakrishnan's NPI number?

The NPI number for Gautam Balakrishnan is 1609214519. It was assigned to this individual provider in the NPPES registry on June 13, 2013.

Q: What is Gautam Balakrishnan's specialty?

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

Active since June 13, 2013PECOS EnrolledAccepts Medicare Assignment

76.92/100

CMS Quality Rating

5301 FARAON ST STE 210B, SAINT JOSEPH, MO 64506(816) 271-1385(816) 271-1379 Get Directions Write a Review

NPPES record last updated: May 26, 2021. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: May 26, 2021, Aug 9, 2019 (2 updates tracked since 2019).

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About Dr. Gautam Balakrishnan Md NPPES

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

DR. GAUTAM BALAKRISHNAN MD (NPI 1609214519) is an individual pulmonary disease provider in Saint Joseph, Missouri, licensed in Missouri (2016023333) and active in the NPI registry since June 2013. He is enrolled in Medicare PECOS, is affiliated with Amberwell Atchison Association, and maintains a secondary practice location in Des Moines.

NPPES Registry Identity

NPI1609214519

Entity TypeIndividualMale

Primary Taxonomy207RP1001X

Provider Legal NameDR. GAUTAM BALAKRISHNANCredential: MD

Location Address5301 FARAON ST STE 210BSaint Joseph, MO 64506

Mailing Address5301 Faraon St Ste 210bSaint Joseph, MO 64506-3512 · (816) 271-1385 · Fax (816) 271-1379

Phone(816) 271-1385

Fax(816) 271-1379

Sole ProprietorYes

Medical School CMSOtherGraduated 2010

Enumeration DateJune 13, 2013

Last NPPES UpdateMay 26, 20212 updates tracked since enumeration

NPPES CertifiedMay 26, 2021

✔ NPI 1609214519 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyInternal Medicine · Pulmonary DiseaseAllopathic & Osteopathic Physicians

Taxonomy Code207RP1001X

License✔ Licensed in MO · 2016023333

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 R9809 (IA)

5301 FARAON ST STE 210B, Saint Joseph, MO 64506

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Secondary Practice Location 1

Location 11415 Woodland Ave, Suite 140Des Moines, IA 50309-3203 · Phone (515) 241-5995 · Fax (515) 241-6576

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arkansas Health & Wellness, Ambetter from Sunflower Health Plan, Ambetter Health and more.Insurance ›

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

Dr. Gautam Balakrishnan 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 ID3072749258

PECOS Enrollment IDI20190812002324

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

Medicare enrollment records show Gautam Balakrishnan reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Heartland Regional Medical Center

0.1 mi

General Practice

5325 FARAON ST
Saint Joseph, MO 64506

Reassigned Medicare billing, Missouri enrollment
471 clinicians in this Medicare group

NPI 1477575405 (816) 271-6000

Mosaic Medical Center - Maryville

41 mi

Specialist

2016 S MAIN ST
Maryville, MO 64468

Reassigned Medicare billing, Missouri enrollment
341 clinicians in this Medicare group

NPI 1184189797 (660) 562-2525

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 20

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.

Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes 99232

Follow-up hospital inpatient care involves daily check-ups while you're admitted in the hospital. Typically, a healthcare provider spends about 25 minutes each day reviewing your condition, adjusting treatment if needed, and answering any questions you might have.

540 services210 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.

401 services253 patients

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.

200 services95 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.

126 services122 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.

125 services121 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.

120 services117 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.

95 services94 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.

79 services61 patients

Irrigation and suction of lung airways to obtain cells using an endoscope 31624

This is a procedure where a thin, flexible tube called an endoscope is inserted through your mouth into the lungs. A small amount of saline is then introduced to wash the airways. The fluid, along with cells from the lung, is suctioned back for analysis.

67 services60 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.

62 services61 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.

51 services51 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.

33 services33 patients

Aspiration of initial secretion of lung airway using an endoscope 31645

This procedure involves using a thin, flexible tube called an endoscope to collect initial secretions from your lung airway. This helps doctors diagnose and treat respiratory conditions. It's a safe, minimally invasive procedure.

28 services27 patients

Exam of lung airways with diagnostic or therapeutic procedure on growths using an endoscope and ultrasound 31654

This procedure involves using a specialized instrument, called an endoscope, to examine the lung airways. An ultrasound is also used to get a clearer image of any growths. If necessary, the doctor can perform procedures to diagnose or treat these growths.

28 services26 patients

Subsequent hospital care with straightforward or low level of medical decision making, per day, if using time, at least 25 minutes 99231

Follow-up hospital inpatient care is a daily service where a healthcare professional checks on your health progress during your hospital stay. Each session typically lasts 15 minutes, involving updates on your condition and adjustments to your treatment plan, if necessary.

26 services24 patients

Needle biopsy of windpipe cartilage, airway, and/or lung using an endoscope 31629

A needle biopsy of windpipe cartilage, airway, or lung involves using a thin, flexible tube with a camera (endoscope) to access and collect tissue samples. This procedure helps doctors diagnose lung conditions or diseases effectively and safely.

24 services24 patients

Computer-assisted image-guided navigation of lung airways using an endoscope 31627

This procedure involves the use of a special camera, called an endoscope, and computer technology to create real-time images of your lung airways. This helps doctors navigate through your lungs accurately, aiding in diagnosis or treatment.

20 services19 patients

Biopsy of lobe of lung using an endoscope, 1 lobe 31628

A lung biopsy is a procedure where a small piece of lung tissue is taken for testing. An endoscope, a flexible tube with a light and camera, is used. It's inserted through the mouth or nose, down the windpipe, and into one lobe of the lung.

16 services16 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.

16 services16 patients

Exam of lung airways and sampling of lymph nodes using an endoscope and ultrasound guidance, 1-2 lymph nodes 31652

This procedure involves a special tube with a camera (endoscope) entering your lung airways. Guided by ultrasound, it collects samples from 1-2 lymph nodes. This helps doctors understand and diagnose potential issues in your lungs.

11 services11 patients

Hospital Affiliations CMS Care Compare 3

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

Amberwell Atchison Association

Critical Access Hospitals · Atchison, KS

OwnershipVoluntary non-profit - Private

CMS Certification Number171382

Location800 Raven Hill DriveAtchison, KS 66002 · Atchison County

Emergency services Birthing friendly

Mosaic Life Care At St Joseph

Acute Care Hospitals · Saint Joseph, MO

4/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number260006

Location5325 Faraon StreetSaint Joseph, MO 64506 · Buchanan County

Emergency services Birthing friendly

Mosaic Medical Center Albany

Critical Access Hospitals · Albany, MO

OwnershipVoluntary non-profit - Private

CMS Certification Number261328

Location705 N College StreetAlbany, MO 64402 · Gentry County

Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 64506 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

$121.96 typical visit price

range $52.28 – $161.24

Typical copayment $30.49 (range $13.07 – $40.31)

Most-billed visit code 99204

Established Patient

$93.24 typical visit price

range $16.30 – $131.05

Typical copayment $23.31 (range $4.07 – $32.76)

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.

76.92/100

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

Scored as part of a group practice

Quality

66.53

Promoting Interoperability

100

Improvement Activities

Cost

56.53

Referred Medical Equipment & Supplies CMS DME claims 15

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

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