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DR. ANIL R BALANI M.D.
NPI 1972779098
Internal Medicine - Gastroenterology in Pennington, NJ

Active since May 08, 2008PECOS EnrolledAccepts Medicare Assignment
95.77/100
CMS Quality Rating
2 CAPITAL WAY STE 380, PENNINGTON, NJ 08534(609) 537-5000(609) 537-5050 Get Directions Write a Review

NPPES record last updated: December 10, 2020. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Dec 10, 2020, Feb 26, 2018 (2 updates tracked since 2018).

About Dr. Anil R Balani M.d. NPPES

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

DR. ANIL R BALANI M.D. (NPI 1972779098) is an individual gastroenterology provider in Pennington, New Jersey, licensed in New Jersey (25MA08408000) and active in the NPI registry since May 2008. He is enrolled in Medicare PECOS, is affiliated with Capital Health Medical Center - Hopewell, and maintains a secondary practice location in Cherry Hill.

NPPES Registry Identity

NPI1972779098
Entity TypeIndividualMale
Primary Taxonomy207RG0100X
Provider Legal NameDR. ANIL R BALANICredential: M.D.
Location Address2 CAPITAL WAY STE 380Pennington, NJ 08534-2521
Mailing Address2 Capital Way Ste 456Pennington, NJ 08534-2521 · (609) 537-5000 · Fax (609) 537-5050
Phone(609) 537-5000
Fax(609) 537-5050
Sole ProprietorNo
Medical School CMSState University Of New York At Stony Brook, School Of MedicineGraduated 2002
Enumeration DateMay 8, 2008
Last NPPES UpdateDecember 10, 20202 updates tracked since enumeration
NPPES CertifiedDecember 10, 2020
✔ NPI 1972779098 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal Medicine · GastroenterologyAllopathic & Osteopathic Physicians
Taxonomy Code207RG0100X
Licenses✔ Licensed in NJ · 25MA08408000✔ Licensed in NY · 236993✔ Licensed in PA · MD434248
Definition
An internist who specializes in diagnosis and treatment of diseases of the digestive organs including the stomach, bowels, liver and gallbladder. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer and jaundice and performs complex diagnostic and therapeutic procedures using endoscopes to visualize internal organs.
2 CAPITAL WAY STE 380, Pennington, NJ 08534
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Secondary Practice Location 1

Location 11939 Route 70 E, Suite 250Cherry Hill, NJ 08003-4505 · Phone (856) 429-4433 · Fax (856) 424-6732

Other Identifiers 2

Medicaid0169781NJ
OtherP00855787NJ · Rr Mcr Ptan

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter Health, Ambetter Health of Delaware, Oscar Health.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. Anil R Balani M.d. 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 ID7012082407
PECOS Enrollment IDI20080820000003
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 Anil Balani reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Capital Health Medical Group
7.2 mi
Internal Medicine
750 BRUNSWICK AVE
Trenton, NJ 08638
  • Reassigned Medicare billing, New Jersey enrollment
  • 581 clinicians in this Medicare group
NPI 1437516887 (609) 815-7829

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 7

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.
72 services37 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.
55 services37 patients
Biopsy of large bowel using a flexible endoscope 45380
A biopsy of the large bowel using a flexible endoscope is a procedure where a thin, flexible tube with a camera is inserted through the rectum to examine the bowel. If abnormal tissue is found, a small sample is taken for further examination. This helps in diagnosing conditions like inflammation, polyps, or cancer.
49 services49 patients
Removal of polyps or growths of large bowel using an endoscope with mechanical snare 45385
This procedure involves using a thin, flexible tube called an endoscope to examine the large bowel. If any abnormal growths or polyps are found, a tool called a mechanical snare is used to remove them. This is a common method to prevent potential health issues.
35 services34 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.
34 services34 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.
15 services12 patients

Hospital Affiliations CMS Care Compare 2

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

Capital Health Medical Center - Hopewell

Acute Care Hospitals · Pennington, NJ
3/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number310044
LocationOne Capital WayPennington, NJ 08534 · Mercer County
Emergency services Birthing friendly

Capital Health Regional Medical Center

Acute Care Hospitals · Trenton, NJ
1/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number310092
Location750 Brunswick AveTrenton, NJ 08638 · Mercer County
Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 08534 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
$140.34 typical visit price
range $61.59 – $185.05
Typical copayment $35.08 (range $15.39 – $46.26)
Most-billed visit code 99204
Established Patient
$107.94 typical visit price
range $20.08 – $150.98
Typical copayment $26.98 (range $5.02 – $37.74)
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.

95.77/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored through an Alternative Payment Model
Quality76.75
Promoting Interoperability100
Improvement Activities40

Reported Quality Measures

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.
100%619 patients5/55-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%1,713 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
99%107 patients5/55-star benchmark: 99%
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.
99%161 patients4/55-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.
80%664 patients4/55-star benchmark: 97%
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…
92%364 patients4/55-star benchmark: 97%
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% · 133 patients
89%133 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…
88%664 patients4/55-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…
59%664 patients3/55-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.
61%664 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.

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.

MS. TEHINN TSAI APN
Nurse Practitioner (Family)
2 CAPITAL WAY STE 380
PENNINGTON, NJ 08534
Mercer County (609) 537-5000
DR. JASON N ROGART MD
Internal Medicine (Gastroenterology)
2 CAPITAL WAY STE 380
PENNINGTON, NJ 08534
Mercer County (609) 537-5000
MRS. KOY TRAKOONTRIPOP GOLA PA-C
Physician Assistant
2 CAPITAL WAY STE 380
PENNINGTON, NJ 08534
Mercer County (609) 537-5000

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 Anil Balani's NPI number?

The NPI number for Anil Balani is 1972779098. It was assigned to this individual provider in the NPPES registry on May 8, 2008.

Where is Anil Balani located?

Anil Balani practices at 2 Capital Way Ste 380, Pennington, NJ 08534. The listed phone number is (609) 537-5000.

What is Anil Balani's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Gastroenterology, with taxonomy code 207RG0100X.

Is Anil Balani enrolled in Medicare?

Yes. Anil Balani 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 Anil Balani's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Anil Balani reassigns Medicare benefits to Capital Health Medical Group (Trenton, NJ). 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 Anil Balani's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Anil Balani accept?

Health plans from Ambetter Health, Ambetter Health of Delaware and Oscar Health list Anil Balani 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 Anil Balani affiliated with any hospitals?

According to CMS data, Anil Balani is affiliated with Capital Health Medical Center - Hopewell and Capital Health Regional Medical Center.

When was this NPI record last updated?

The NPPES record for Anil Balani was last updated on December 10, 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.