CYNTHIA ANN BALLENGER MD
NPI 1811095771
Radiology - Radiation Oncology in Smithfield, NC
NPI Status: Active since September 21, 2006
Contact Information
514 N BRIGHTLEAF BLVD STE 1200
SMITHFIELD, NC
ZIP 27577
Phone: (919) 209-3555
- Individual
- Female
- Radiology
- Radiation Oncology
- Accepts Insurance
- PECOS Enrolled
- Medicare Quality Reporting
About CYNTHIA BALLENGER
This page provides the complete NPI Profile along with additional information for Cynthia Ballenger, a provider established in Smithfield, North Carolina with a medical specialization in Radiology, focusing in radiation oncology . The healthcare provider is registered in the NPI registry with number 1811095771 assigned on September 2006. The practitioner's primary taxonomy code is 2085R0001X with license number 96-01555 (NC). The provider is registered as an individual and her NPI record was last updated 6 years ago.
- NPI
- 1811095771
- Provider Name
- CYNTHIA ANN BALLENGER MD
- Gender
- Female
- Entity Type
- Individual
- Location Address
- 514 N BRIGHTLEAF BLVD STE 1200 SMITHFIELD, NC 27577
- Location Phone
- (919) 209-3555
- Mailing Address
- 2234 COLONIAL BLVD ATTN: PAYER CONTRACTING & RELATIONS FORT MYERS, FL 33907
- Mailing Phone
- (239) 931-7342
- Mailing Fax
- Is Sole Proprietor?
- No
- Enumeration Date
- 09-21-2006
- Last Update Date
- 03-23-2020
- Code Navigator
Location Map
Secondary Locations
- 801 WH Smith Blvd
Greenville, NC 27834
(252) 329-0025
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Radiology Radiation Oncology
- Taxonomy Code
- 2085R0001X
- Type
- Allopathic & Osteopathic Physicians
- License No.
- 96-01555
- License State
- NC
- Taxonomy Description
- A radiologist who deals with the therapeutic applications of radiant energy and its modifiers and the study and management of disease, especially malignant tumors.
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 2085R0001X | Allopathic & Osteopathic Physicians | Radiology | 0101 230080 (VA) |
| 2 | 2085R0001X | Allopathic & Osteopathic Physicians | Radiology | 051907 (GA) |
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- Blue Advantage Bronze Basic | 3 Free PCP | $25 Tier 1 Rx | Integrated | Nationwide Doctors - PPO
- Blue Advantage Bronze Complete | $60 PCP | $20 Tier 1 Rx | Nationwide Doctors - PPO
- Blue Advantage Bronze HSA Eligible | Integrated | Nationwide Doctors - PPO
- Blue Advantage Bronze Standard | Nationwide Doctors - PPO
- Blue Advantage Gold Premier A | 3 Free PCP | $10 Tier 1 Rx | Nationwide Doctors - PPO
- Blue Advantage Gold Standard A | Nationwide Doctors - PPO
- Blue Advantage Silver Choice A | 3 Free PCP | $15 Tier 1 Rx | Nationwide Doctors - PPO
- Blue Advantage Silver Preferred | 3 Free PCP | $10 Tier 1 Rx | Integrated | Nationwide Doctors - PPO
- Blue Advantage Silver Standard | Nationwide Doctors - PPO
- Blue Care Bronze Basic | 3 Free PCP | $25 Tier 1 Rx | Integrated | Statewide Doctors - HMO
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 12773 | OTHER (01) | NC | BCBS |
| 205504 | OTHER (01) | NC | MEDCOST |
| P01619309 | OTHER (01) | NC | RR MEDICARE |
| 1811095771 | MEDICAID (05) | NC | |
| 7331362 | OTHER (01) | NC | AETNA |
| 8373963 | OTHER (01) | NC | CIGNA |
| 8912773 | MEDICAID (05) | NC | |
| P00612671 | OTHER (01) | NC | RAILROAD MEDICARE |
Medicare Participation & PECOS Enrollment Status
Cynthia Ballenger is enrolled in PECOS and is eligible to order or refer health care services for Medicare patients. The provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.
What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.
Is the provider registered in PECOS? Yes
Eligible to Order or Refer Part B Clinical Laboratory and Imaging: Yes
Eligible to Order or Refer Durable Medical Equipment (DMEPOS): Yes
Eligible to Order or Refer a Home Health Agency (HHA): Yes
Eligible to Order or Refer Power Mobility Devices: Yes
Areas of Expertise
The following services and procedures, recently provided to Medicare patients, illustrate the range of care this provider offers. This list reflects the variety of services available to all patients visiting the practice and is based on 2022 Medicare dataset. In general, the more frequently a provider treats specific conditions or performs particular procedures, the more experienced they become in addressing similar patient needs. The provider has delivered many of the services listed below to Medicare patients. Please note that this list does not include services provided to patients who are not covered by Medicare.
3d radiation therapy planning
Calculation of radiation therapy dose
Complex radiation therapy planning
Ct guidance for insertion of radiation therapy fields
Design and construction of complex radiation treatment device
Design and construction of radiation treatment device for high precision radiation therapy
Established patient office or other outpatient visit, 20-29 minutes
Established patient office or other outpatient visit, 30-39 minutes
Established patient office or other outpatient visit, 40-54 minutes
High precision radiation therapy planning
New patient office or other outpatient visit, 60-74 minutes
Obtaining data needed to develop the optimal radiation treatment, 1 treatment area
Obtaining data needed to develop the optimal radiation treatment, 3 or more treatment areas or any number of treatment areas where special treatment is involved
Obtaining respiratory data needed to develop the optimal radiation treatment
Prolonged office or other outpatient evaluation and management service(s) beyond the maximum required time of the primary procedure which has been selected using total time on the date of the primary service; each additional 15 minutes by the physician or
Radiation treatment management, 5 treatment sessions
Special radiation treatment
3D radiation therapy planning is a procedure that uses computer imaging to map out the area needing treatment. This ensures the radiation targets the disease precisely, while minimizing exposure to surrounding healthy tissues. It's a key step in preparing for effective radiation therapy.
This service was performed 25 times for 23 patientsRadiation therapy dose calculation is a process to determine the exact amount of radiation needed to treat a specific area in the body. This calculation helps ensure the treatment is effective while minimizing harm to healthy tissues. It's a key part of planning your radiation therapy.
This service was performed 189 times for 62 patientsComplex radiation therapy planning is a process to determine the most effective way to deliver radiation to a specific area in your body. It involves detailed imaging to map your body's structure, allowing for precise targeting of cancer cells while sparing healthy tissue.
This service was performed 69 times for 65 patientsCT guidance for insertion of radiation therapy fields involves using a CT scan to accurately map the area of your body where radiation will be applied. This ensures the radiation targets only the necessary area, minimizing impact to healthy tissues.
This service was performed 1,072 times for 57 patientsThe design and construction of a complex radiation treatment device is a process where a specialized instrument is created. This device targets harmful cells with high-energy rays to destroy or damage them, while minimizing impact on healthy cells. This aids in treating conditions like cancer.
This service was performed 192 times for 65 patientsA radiation treatment device is custom-made for each patient to target cancer cells with high precision. It's designed to focus radiation on the tumor, sparing healthy tissue. This process ensures effective therapy while minimizing side effects.
This service was performed 54 times for 40 patientsThis 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.
This service was performed 18 times for 15 patientsThis 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.
This service was performed 38 times for 36 patientsThis 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.
This service was performed 39 times for 37 patientsHigh precision radiation therapy planning involves detailed mapping of your body to target cancer cells accurately. Advanced imaging techniques help identify the exact location of the tumor, minimizing harm to healthy tissues. This personalized approach enhances effectiveness and reduces side effects.
This service was performed 43 times for 39 patientsThis is a first-time patient visit where a healthcare professional spends 60-74 minutes with you. It involves a comprehensive evaluation, including your medical history and current health condition. They'll also advise on preventive health measures and formulate a treatment plan if needed.
This service was performed 56 times for 56 patientsThis procedure involves gathering essential information to create the best radiation treatment plan for a specific area. It includes scanning the treatment area and using this data to calculate the precise dose of radiation needed to target the disease effectively, while sparing healthy tissue.
This service was performed 33 times for 26 patientsThis procedure involves collecting necessary data to plan the best radiation treatment. It may cover 3 or more areas or any area requiring special attention. Data collection includes imaging scans and tests to understand the disease's extent and to tailor a precise, effective treatment plan.
This service was performed 31 times for 26 patientsObtaining respiratory data is vital for optimal radiation treatment. This involves tracking your breathing patterns to ensure the precise delivery of radiation to the target area, minimizing damage to healthy tissue. It's a non-invasive process and contributes to effective treatment.
This service was performed 13 times for 12 patientsThis service refers to extended doctor visits where your healthcare provider spends additional time evaluating and managing your health beyond the primary procedure's required time. This includes each extra 15 minutes spent by the physician on the same day as the primary service.
This service was performed 44 times for 29 patientsRadiation treatment management involves a series of 5 sessions where targeted radiation is used to destroy or shrink cancer cells in your body. Each session is carefully planned to maximize effectiveness while minimizing harm to healthy tissues. You may experience side effects which will be closely monitored and managed for your comfort.
This service was performed 271 times for 65 patientsSpecial radiation treatment is a medical procedure that uses high-energy rays to destroy or damage cancer cells. It's a targeted approach that aims to minimize harm to healthy tissues. The treatment duration varies based on individual health conditions.
This service was performed 19 times for 18 patientsPhysician Visit Costs
The pricing information below displays the copayment minimum, maximum and average amount that patients under Medicare are charged when visiting this provider as a new or established patient. Please keep in mind that these prices are just for reference purposes, and the actual prices charged by the provider might be different.
For patients covered under private health plans the prices below are also useful as healthcare pricing for private insurance is usually established as a function of Medicare prices. Private insurance covered patients should check their individual plans to determine the exact pricing.
The prices below reflect the costs for new and established patients in the 27577 ZIP code area.
New Patients Visit Costs *
The most utilized procedure code for new patients office visits is 99205
- Average New Patient Price $165.09
- Minimum New Patient Price $54.12
- Maximum New Patient Price $165.09
- Average New Patient Copayment $41.27
- Minimum New Patient Copayment $13.53
- Maximum New Patient Copayment $41.27
Established Patients Visit Costs *
The most utilized procedure code for established patients office visits is 99213
- Average Established Patient Price $67.72
- Minimum Established Patient Price $17.21
- Maximum Established Patient Price $134.61
- Average Established Patient Copayment $16.93
- Minimum Established Patient Copayment $4.3
- Maximum Established Patient Copayment $33.65
* The physician office visit costs information is generated by statistical analysis of similar providers in the same geographical area. The pricing information above IS NOT the amount charged by this provider.
Quality Reporting
The provider participated in CMS Quality Payment Program. The Quality Payment Program aims to improve population health, reduce costs and improve the care received by Medicare beneficiaries. The following quality measures meet Medicare's statistical reporting standards. Not all providers report the same information, because not all providers give the same services to patients. The quality information is just a snapshot of some the care providers give to their patients. Reporting more or less information is not a reflection of quality.
| Quality Measure | Performance | Number of Patients |
|---|---|---|
| Breast Cancer Screening | 77% | 94 |
| Percentage of women 50-74 years of age who had a mammogram to screen for breast cancer | ||
| Closing the Referral Loop: Receipt of Specialist Report | 12% | 155 |
| Percentage of patients with referrals, regardless of age, for which the referring provider receives a report from the provider to whom the patient was referred | ||
| Colorectal Cancer Screening | 81% | 145 |
| Percentage of adults 50-75 years of age who had appropriate screening for colorectal cancer | ||
| Documentation of Current Medications in the Medical Record | 22% | 305 |
| 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. This list must include ALL known prescriptions, over-the-counters, herbals, and vitamin/mineral/dietary (nutritional) supplements AND must contain the medications' name, dosage, frequency and route of administration | ||
| Implementation of formal quality improvement methods, practice changes, or other practice improvement processes | Yes | N/A |
| Adopt a formal model for quality improvement and create a culture in which all staff actively participates in improvement activities that could include one or more of the following such as: • Multi-Source Feedback; • Train all staff in quality improvement methods; • Integrate practice change/quality improvement into staff duties; • Engage all staff in identifying and testing practices changes; • Designate regular team meetings to review data and plan improvement cycles; • Promote transparency and accelerate improvement by sharing practice level and panel level quality of care, patient experience and utilization data with staff; and/or • Promote transparency and engage patients and families by sharing practice level quality of care, patient experience and utilization data with patients and families, including activities in which clinicians act upon patient experience data. | ||
| Oncology: Medical and Radiation - Pain Intensity Quantified | 94% | 537 |
| Percentage of patient visits, regardless of patient age, with a diagnosis of cancer currently receiving chemotherapy or radiation therapy in which pain intensity is quantified | ||
| Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan | 78% | 204 |
| 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 twelve months of the current encounter Normal Parameters: Age 18 years and older BMI >= 18.5 and < 25 kg/m2 | ||
| Use of High-Risk Medications in the Elderly | 0% "Inverse Quality Measure" This is an inverse quality measure, a lower rate means the provider is rated better. | 100 |
| Percentage of patients 65 years of age and older who were ordered high-risk medications. Two rates are submitted. 1) Percentage of patients who were ordered at least one high-risk medication. 2) Percentage of patients who were ordered at least two of the same high-risk medication | ||
| Use of Patient Safety Tools | Yes | N/A |
| Use of tools that assist specialty practices in tracking specific measures that are meaningful to their practice, such as use of a surgical risk calculator, evidence based protocols such as Enhanced Recovery After Surgery (ERAS) protocols, the CDC Guide for Infection Prevention for Outpatient Settings, (https://www.cdc.gov/hai/settings/outpatient/outpatient-care-guidelines.html), predictive algorithms, or other such tools. | ||
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1811095771, we treat the final digit (1) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 59. The final step is to find the difference between that total and the next multiple of ten (60 - 59 = 1).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 59 is 60. The difference is the calculated check digit.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1811095771, enumerated as an "individual" on September 21, 2006.
The provider is located at 514 N BRIGHTLEAF BLVD STE 1200 SMITHFIELD, NC 27577 and the phone number is (919) 209-3555.
Radiology with taxonomy code 2085R0001X and a focus in Radiation Oncology.
The provider might be accepting Accepts: Blue Cross and Blue Shield of NC, Blue Cross Blue. Please consult your insurance carrier or call the provider to verify.
