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DR. BENJAMIN P. DEBELAK D.O.
NPI 1790808848
Orthopaedic Surgery in Gallatin, TN

Active since April 06, 2007PECOS EnrolledAccepts Medicare Assignment
253 W MAIN ST, GALLATIN, TN 37066(615) 826-7171 Get Directions Write a Review

NPPES record last updated: September 10, 2020. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Sep 10, 2020, Aug 21, 2020, Jun 8, 2020 (3 updates tracked since 2020).

About Dr. Benjamin P. Debelak D.o. NPPES

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

DR. BENJAMIN P. DEBELAK D.O. (NPI 1790808848) is an individual orthopaedic surgery provider in Gallatin, Tennessee, licensed in Tennessee (3817) and active in the NPI registry since April 2007. He is enrolled in Medicare PECOS, is affiliated with Sumner Regional Medical Center, and maintains 2 additional practice locations.

NPPES Registry Identity

NPI1790808848
Entity TypeIndividualMale
Primary Taxonomy207X00000X
Provider Legal NameDR. BENJAMIN P. DEBELAKCredential: D.O.
Location Address253 W MAIN STGallatin, TN 37066-3290
Mailing AddressPo Box 370Fortson, GA 31808-0370 · Fax (706) 494-3008
Phone(615) 826-7171
Sole ProprietorNo
Medical School CMSOtherGraduated 2005
Enumeration DateApril 6, 2007
Last NPPES UpdateSeptember 10, 20203 updates tracked since enumeration
NPPES CertifiedSeptember 10, 2020
✔ NPI 1790808848 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyOrthopaedic SurgeryAllopathic & Osteopathic Physicians
Taxonomy Code207X00000X
Licenses✔ Licensed in TN · 3817✔ Licensed in NC · 2014-00194
Definition

An orthopaedic surgeon is trained in the preservation, investigation and restoration of the form and function of the extremities, spine and associated structures by medical, surgical and physical means. An orthopaedic surgeon is involved with the care of patients whose musculoskeletal problems include congenital deformities, trauma, infections, tumors, metabolic disturbances of the musculoskeletal system, deformities, injuries and degenerative diseases of the spine, hands, feet, knee, hip, shoulder and elbow in children and adults. An orthopaedic surgeon is also concerned with primary and secondary muscular problems and the effects of central or peripheral nervous system lesions of the musculoskeletal system.

Also ListedOrthopaedic Surgery · Sports MedicineTaxonomy 207XX0005X · License 2014-00194 (NC)
253 W MAIN ST, Gallatin, TN 37066
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Secondary Practice Locations 2

Location 1353 New Shackle Island Rd Ste 141CHendersonville, TN 37075-2366 · Phone (615) 826-7171
Location 23443 Dickerson Pike Ste 190Nashville, TN 37207-2533 · Phone (615) 860-1580 · Fax (615) 860-1580

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include AmeriHealth Caritas Next, BlueCross BlueShield of Tennessee, UnitedHealthcare.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. Benjamin P. Debelak D.o. 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 ID1456543743
PECOS Enrollment IDI20191008002051
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.

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.
222 services116 patients
Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg J0702
This injection contains two medications, betamethasone acetate and betamethasone sodium phosphate. It is used to reduce inflammation and pain. It's given by a healthcare professional, often directly into the area causing discomfort.
156 services67 patients
Aspiration and/or injection of fluid from large joint 20610
This procedure involves using a needle to remove (aspiration) or introduce (injection) fluid into a large joint like the knee or hip. It can help diagnose conditions, relieve discomfort, or deliver medication directly to the joint.
140 services70 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.
98 services75 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.
55 services55 patients
X-ray of knee, 3 views 73562
An X-ray of the knee, 3 views, is a non-invasive imaging test. It uses a small amount of radiation to produce images of the knee from three different angles. This helps medical professionals to diagnose and monitor conditions like arthritis, fractures, or infections. The process is quick and painless.
54 services39 patients

Hospital Affiliations CMS Care Compare 5

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

Sumner Regional Medical Center

Acute Care Hospitals · Gallatin, TN
1/5 CMS rating
OwnershipProprietary
CMS Certification Number440003
Location555 Hartsville PikeGallatin, TN 37066 · Sumner County
Emergency services Birthing friendly

Tristar Skyline Medical Center

Acute Care Hospitals · Nashville, TN
1/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number440006
Location3441 Dickerson PikeNashville, TN 37207 · Davidson County
Emergency services

Tristar Northcrest Medical Center

Acute Care Hospitals · Springfield, TN
2/5 CMS rating
OwnershipVoluntary non-profit - Other
CMS Certification Number440065
Location100 Northcrest DriveSpringfield, TN 37172 · Robertson County
Emergency services Birthing friendly

Tristar Summit Medical Center

Acute Care Hospitals · Hermitage, TN
2/5 CMS rating
OwnershipProprietary
CMS Certification Number440150
Location5655 Frist BlvdHermitage, TN 37076 · Davidson County
Emergency services Birthing friendly

Tristar Hendersonville Medical Center

Acute Care Hospitals · Hendersonville, TN
4/5 CMS rating
OwnershipProprietary
CMS Certification Number440194
Location355 New Shackle Island RdHendersonville, TN 37075 · Sumner County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 37066 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
$81.53 typical visit price
range $52.64 – $160.89
Typical copayment $20.38 (range $13.16 – $40.22)
Most-billed visit code 99203
Established Patient
$66.01 typical visit price
range $16.72 – $131.41
Typical copayment $16.50 (range $4.18 – $32.85)
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.

Reported Quality Measures

Breast Cancer Screening
Percentage of women 50-74 years of age who had a mammogram to screen for breast cancer
37%327 patients2/55-star benchmark: 92%
Care Plan
Percentage of patients aged 65 years and older who have an advance care plan or surrogate decision maker documented in the medical record that an advance care plan was discussed but the patient did not wish or was not able to name a surrogate decision maker…
58%495 patients3/55-star benchmark: 100%
Colorectal Cancer Screening
Percentage of adults 50-75 years of age who had appropriate screening for colorectal cancer
50%613 patients3/55-star benchmark: 85%
Diabetes: Eye Exam
Percentage of patients 18-75 years of age with diabetes who had a retinal or dilated eye exam by an eye care professional during the measurement period or a negative retinal exam (no evidence of retinopathy) in the 12 months prior to the measurement period
26%84 patients2/55-star benchmark: 100%
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.
99%2,949 patients4/55-star benchmark: 100%
e-Prescribing
At least one permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using certified EHR technology.
95%575 patients4/55-star benchmark: 99%
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
32%417 patients2/55-star benchmark: 99%
Health Information Exchange
The MIPS eligible clinician that transitions or refers their patient to another setting of care or health care clinician (1) uses CEHRT to create a summary of care record; and (2) electronically transmits such summary to a receiving health care clinician for…
84%344 patients4/55-star benchmark: 88%
Medication Reconciliation
The MIPS eligible clinician performs medication reconciliation for at least one transition of care in which the patient is transitioned into the care of the MIPS eligible clinician.
100%647 patients5/55-star benchmark: 100%
Patient-Specific Education
The MIPS eligible clinician must use clinically relevant information from CEHRT to identify patient-specific educational resources and provide access to those materials to at least one unique patient seen by the MIPS eligible clinician.
73%1,360 patients4/55-star benchmark: 97%
Pneumococcal Vaccination Status for Older Adults
Percentage of patients 65 years of age and older who have ever received a pneumococcal vaccine
41%417 patients2/55-star benchmark: 90%
Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan
Percentage of patients aged 18 years and older with a BMI documented during the current encounter or during the previous twelve months AND with a BMI outside of normal parameters, a follow-up plan is documented during the encounter or during the previous…
31%1,131 patients2/55-star benchmark: 97%
Preventive Care and Screening: Influenza Immunization
Percentage of patients aged 6 months and older seen for a visit between October 1 and March 31 who received an influenza immunization OR who reported previous receipt of an influenza immunization
14%810 patients1/55-star benchmark: 88%
Preventive Care and Screening: Screening for Depression and Follow-Up Plan
Percentage of patients aged 12 years and older screened for depression on the date of the encounter using an age appropriate standardized depression screening tool AND if positive, a follow-up plan is documented on the date of the positive screen
14%1,013 patients1/55-star benchmark: 96%
Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention
Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months AND who received tobacco cessation intervention if identified as a tobacco user
Patients screenedForUse: 99% · 496 patients
Patients tobacco: 10% · 77 patients
78%496 patients4/55-star benchmark: 98%
Provide Patient Access
At least one patient seen by the MIPS eligible clinician during the performance period is provided timely access to view online, download, and transmit to a third party their health information subject to the MIPS eligible clinician's discretion to withhold…
100%1,360 patients5/55-star benchmark: 100%
Secure Messaging
For at least one unique patient seen by the MIPS eligible clinician during the performance period, a secure message was sent using the electronic messaging function of CEHRT to the patient (or the patient-authorized representative), or in response to a secure…
11%1,360 patients1/55-star benchmark: 89%
View, Download, or Transmit (VDT)
At least one patient seen by the MIPS eligible clinician during the performance period (or patient-authorized representative) views, downloads or transmits their health information to a third party during the performance period.
24%1,360 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

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

Shoulder orthosis, acromio/clavicular (canvas and webbing type), prefabricated, off-the-shelf L3670
DME-Orthotic Devices · category DF000N
2 suppliers16 claims16 services$109.10 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 3

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

MRS. YOLANDA DORSEY NP
Nurse Practitioner (Family)
253 W MAIN ST
GALLATIN, TN 37066
Sumner County (615) 451-1959
SUMNER COMPREHENSIVE CARE INC.
Psychiatry & Neurology (Neurology)
253 W MAIN ST
GALLATIN, TN 37066
Sumner County (615) 451-1959
MOORE LIFE HEALTHCARE, PC
Clinic/Center (Urgent Care)
253 W MAIN ST
GALLATIN, TN 37066
Sumner County (615) 461-8784

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 Benjamin Debelak's NPI number?

The NPI number for Benjamin Debelak is 1790808848. It was assigned to this individual provider in the NPPES registry on April 6, 2007.

Where is Benjamin Debelak located?

Benjamin Debelak practices at 253 W Main St, Gallatin, TN 37066. The listed phone number is (615) 826-7171.

What is Benjamin Debelak's specialty?

The primary specialty registered for this NPI is Orthopaedic Surgery with taxonomy code 207X00000X.

Is Benjamin Debelak enrolled in Medicare?

Yes. Benjamin Debelak 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 Benjamin Debelak accept?

Health plans from AmeriHealth Caritas Next, BlueCross BlueShield of Tennessee and UnitedHealthcare list Benjamin Debelak 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 Benjamin Debelak affiliated with any hospitals?

According to CMS data, Benjamin Debelak is affiliated with Sumner Regional Medical Center, Tristar Skyline Medical Center, Tristar Northcrest Medical Center, Tristar Summit Medical Center and Tristar Hendersonville Medical Center.

When was this NPI record last updated?

The NPPES record for Benjamin Debelak was last updated on September 10, 2020. NPI Profile syncs with the weekly NPPES data releases published by CMS.