1. Home
  2. Directory
  3. Massachusetts
  4. Worcester
  5. Internal Medicine
  6. NPI Profile

ASHFAQ S. BALLA MD
NPI 1740228220
Internal Medicine - Nephrology in Worcester, MA

Active since June 04, 2006PECOS EnrolledAccepts Medicare Assignment
97.02/100
CMS Quality Rating
55 LAKE AVE N, WORCESTER, MA 01655(508) 856-3155(508) 856-3111 Get Directions Write a Review

NPPES record last updated: November 17, 2020. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Nov 17, 2020, Sep 28, 2020, Nov 22, 2016 (3 updates tracked since 2016).

About Ashfaq S. Balla Md NPPES

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

ASHFAQ S. BALLA MD (NPI 1740228220) is an individual nephrology provider in Worcester, Massachusetts, licensed in Massachusetts (242372) and active in the NPI registry since June 2006. He is enrolled in Medicare PECOS, is affiliated with Umass Memorial Health - Harrington Hospital, and maintains 2 additional practice locations.

NPPES Registry Identity

NPI1740228220
Entity TypeIndividualMale
Primary Taxonomy207RN0300X
Provider Legal NameASHFAQ S. BALLACredential: MD
Location Address55 LAKE AVE NWorcester, MA 01655-0002
Mailing AddressPo Box 415348Boston, MA 02241-5348 · (800) 225-8885 · Fax (508) 334-1977
Phone(508) 856-3155
Fax(508) 856-3111
Sole ProprietorNo
Medical School CMSOtherGraduated 1994
Enumeration DateJune 4, 2006
Last NPPES UpdateNovember 17, 20203 updates tracked since enumeration
NPPES CertifiedNovember 17, 2020
✔ NPI 1740228220 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal Medicine · NephrologyAllopathic & Osteopathic Physicians
Taxonomy Code207RN0300X
License✔ Licensed in MA · 242372
Definition
An internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not function. This specialist consults with surgeons about kidney transplantation.
55 LAKE AVE N, Worcester, MA 01655
Open in Google Maps ↗

Secondary Practice Locations 2

Location 1188 Worcester Providence TpkeSutton, MA 01590 · Phone (508) 755-9535 · Fax (508) 755-1006
Location 285 Prescott StWorcester, MA 01605 · Phone (508) 755-9535 · Fax (508) 755-1006

Other Identifiers 1

Medicaid110084568AMA

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield.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

Ashfaq S. Balla 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 ID2567568892
PECOS Enrollment IDI20100304000564
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 10

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.
264 services125 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.
120 services76 patients
Dialysis services, 2-3 physician visits per month (20 years or older) 90961
Dialysis is a treatment that performs the function of healthy kidneys if they're not working properly. It removes waste and excess fluid from your blood. 2-3 physician visits per month are recommended for monitoring your health and adjusting your treatment as needed. This service is available for those aged 20 years and older.
97 services22 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.
87 services46 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.
82 services53 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.
78 services76 patients

Hospital Affiliations CMS Care Compare 4

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

Umass Memorial Health - Harrington Hospital

Acute Care Hospitals · Southbridge, MA
3/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number220019
Location100 South StreetSouthbridge, MA 01550 · Worcester County
Emergency services

Umass Memorial Healthcare-Marlborough Hospital

Acute Care Hospitals · Marlborough, MA
3/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number220049
Location157 Union StreetMarlborough, MA 01752 · Middlesex County
Emergency services

Milford Regional Medical Center

Acute Care Hospitals · Milford, MA
4/5 CMS rating
OwnershipVoluntary non-profit - Other
CMS Certification Number220090
Location14 Prospect StreetMilford, MA 01757 · Worcester County
Emergency services Birthing friendly

Umass Memorial Medical Center/University Campus

Acute Care Hospitals · Worcester, MA
4/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number220163
Location55 Lake Avenue NorthWorcester, MA 01655 · Worcester County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 01655 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
$134.47 typical visit price
range $58.86 – $177.36
Typical copayment $33.61 (range $14.71 – $44.34)
Most-billed visit code 99204
Established Patient
$103.48 typical visit price
range $19.11 – $144.84
Typical copayment $25.87 (range $4.77 – $36.21)
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.

97.02/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored through an Alternative Payment Model
Quality78.09
Promoting Interoperability100
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.

HILLARY R. IRONS MD
Emergency Medicine
55 LAKE AVE N
WORCESTER, MA 01655
Worcester County (508) 421-1400
MS. EILEEN A. DUHAMEL NP
Nurse Practitioner
55 LAKE AVE N, DEPARTMENT OF RADIOLOGY
WORCESTER, MA 01655
Worcester County (508) 334-2710
EWA HRYNISZYN CRNA
Nurse Anesthetist, Certified Registered
55 LAKE AVE N, DEPARTMENT OF ANESTHESIOLOGY
WORCESTER, MA 01655
Worcester County (508) 334-3271
HELEN COPSEY PA-C
Physician Assistant
55 LAKE AVE N
WORCESTER, MA 01655
Worcester County (508) 334-8585
DR. ADEPEJU GBADEBO CHAMPION M.D.
Internal Medicine
55 LAKE AVE N
WORCESTER, MA 01655
Worcester County (508) 334-2731
SOWMYA KORAPATI
Internal Medicine (Hematology & Oncology)
55 LAKE AVE N
WORCESTER, MA 01655
Worcester County (508) 334-3550
LAYLA FAKHRZADEH M.D.
Anesthesiology
55 LAKE AVE N, ANESTHESIOLOGY
WORCESTER, MA 01655
Worcester County (508) 334-3271
YOONYIE CHO M.D.
Anesthesiology
55 LAKE AVE N
WORCESTER, MA 01655
Worcester County (508) 334-1000

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 Ashfaq Balla's NPI number?

The NPI number for Ashfaq Balla is 1740228220. It was assigned to this individual provider in the NPPES registry on June 4, 2006.

Where is Ashfaq Balla located?

Ashfaq Balla practices at 55 Lake Ave N, Worcester, MA 01655. The listed phone number is (508) 856-3155.

What is Ashfaq Balla's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Nephrology, with taxonomy code 207RN0300X.

Is Ashfaq Balla enrolled in Medicare?

Yes. Ashfaq Balla 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 Ashfaq Balla accept?

Health plans from Anthem Blue Cross and Blue Shield list Ashfaq Balla 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 Ashfaq Balla affiliated with any hospitals?

According to CMS data, Ashfaq Balla is affiliated with Umass Memorial Health - Harrington Hospital, Umass Memorial Healthcare-Marlborough Hospital, Milford Regional Medical Center and Umass Memorial Medical Center/University Campus.

When was this NPI record last updated?

The NPPES record for Ashfaq Balla was last updated on November 17, 2020. 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.