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DR. CARLOS ENRIQUE BALLESTAS MD
NPI 1609812437
Family Medicine in Sunrise, FL

Active since June 21, 2006PECOS EnrolledAccepts Medicare Assignment
12651 W SUNRISE BLVD STE 202, SUNRISE, FL 33323(954) 838-8801(954) 838-8807 Get Directions Write a Review

NPPES record last updated: February 10, 2022. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Feb 10, 2022, Nov 6, 2020 (2 updates tracked since 2020).

About Dr. Carlos Enrique Ballestas Md NPPES

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

DR. CARLOS ENRIQUE BALLESTAS MD (NPI 1609812437) is an individual family medicine provider in Sunrise, Florida, licensed in Florida (ME110974) and active in the NPI registry since June 2006. He is enrolled in Medicare PECOS, is affiliated with Westside Regional Medical Center, and is a graduate of Other (1999).

NPPES Registry Identity

NPI1609812437
Entity TypeIndividualMale
Primary Taxonomy207Q00000X
Provider Legal NameDR. CARLOS ENRIQUE BALLESTASCredential: MD
Location Address12651 W SUNRISE BLVD STE 202Sunrise, FL 33323-0906
Mailing Address12651 W Sunrise Blvd Ste 202Sunrise, FL 33323-0906 · (954) 838-8801 · Fax (954) 838-8807
Phone(954) 838-8801
Fax(954) 838-8807
Sole ProprietorNo
Medical School CMSOtherGraduated 1999
Enumeration DateJune 21, 2006
Last NPPES UpdateFebruary 10, 20222 updates tracked since enumeration
NPPES CertifiedNovember 6, 2020
✔ NPI 1609812437 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Licenses✔ Licensed in FL · ME110974✔ Licensed in TX · M2549
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.
12651 W SUNRISE BLVD STE 202, Sunrise, FL 33323
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Other Identifiers 1

Medicaid1791238-02TX

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter Health, Ambetter of Alabama, AmeriHealth Caritas Next 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. Carlos Enrique Ballestas 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 ID5597770941
PECOS Enrollment IDI20120113000395
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 Reassignment

Medicare enrollment records show Carlos Ballestas reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

East Florida Primary Care LLC
4.3 mi
Family Medicine
8395 W OAKLAND PARK BLVD, SUITE E
Sunrise, FL 33351
  • Reassigned Medicare billing, Florida enrollment
  • 6 clinicians in this Medicare group
NPI 1811121205 (954) 741-7500

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.

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.
111 services61 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.
25 services19 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.
16 services16 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.
12 services12 patients

Hospital Affiliations CMS Care Compare

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

Westside Regional Medical Center

Acute Care Hospitals · Plantation, FL
3/5 CMS rating
OwnershipProprietary
CMS Certification Number100228
Location8201 W Broward BlvdPlantation, FL 33324 · Broward County

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 33323 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
$91.69 typical visit price
range $58.56 – $179.05
Typical copayment $22.92 (range $14.64 – $44.76)
Most-billed visit code 99203
Established Patient
$103.21 typical visit price
range $18.44 – $144.68
Typical copayment $25.80 (range $4.61 – $36.17)
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.

Referred Medical Equipment & Supplies CMS DME claims

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

Collagen dressing, sterile, size 16 sq. in. or less, each A6021
DME-Medical/Surgical Supplies · category DA023N
2 suppliers11 claims1,250 services$19.12 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

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

NIKKI JOSEPH
Family Medicine
12651 W SUNRISE BLVD STE 202
SUNRISE, FL 33323
Broward County (954) 838-8801

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 Carlos Ballestas's NPI number?

The NPI number for Carlos Ballestas is 1609812437. It was assigned to this individual provider in the NPPES registry on June 21, 2006.

Where is Carlos Ballestas located?

Carlos Ballestas practices at 12651 W Sunrise Blvd Ste 202, Sunrise, FL 33323. The listed phone number is (954) 838-8801.

What is Carlos Ballestas's specialty?

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

Is Carlos Ballestas enrolled in Medicare?

Yes. Carlos Ballestas 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 organization bills Medicare for Carlos Ballestas's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Carlos Ballestas reassigns Medicare benefits to East Florida Primary Care LLC (Sunrise, FL). The 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 Carlos Ballestas's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Carlos Ballestas accept?

Health plans from Ambetter Health, Ambetter of Alabama, AmeriHealth Caritas Next, AvMed and Florida Blue (BlueCross BlueShield FL) and 4 other insurers list Carlos Ballestas 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 Carlos Ballestas affiliated with any hospitals?

According to CMS data, Carlos Ballestas is affiliated with Westside Regional Medical Center.

When was this NPI record last updated?

The NPPES record for Carlos Ballestas was last updated on February 10, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.