MS. MICHELLE ALMODOVAR BALMACEDA MD
NPI 1164659819
Family Medicine in Matthews, NC
NPI Status: Active since June 19, 2009
Contact Information
9600 E INDEPENDENCE BLVD
MATTHEWS, NC
ZIP 28105
Phone: (704) 384-8441
Fax: (704) 384-8442
- Individual
- Female
- Family Medicine
- Accepts Insurance
- PECOS Enrolled
- Medicare Quality Reporting
About MICHELLE BALMACEDA
This page provides the complete NPI Profile along with additional information for Michelle Balmaceda, a primary care provider established in Matthews, North Carolina with a medical specialization in Family Medicine. The healthcare provider is registered in the NPI registry with number 1164659819 assigned on June 2009. The practitioner's primary taxonomy code is 207Q00000X with license number 2016-01789 (NC). The provider is registered as an individual and her NPI record was last updated 4 years ago.
- NPI
- 1164659819
- Provider Name
- MS. MICHELLE ALMODOVAR BALMACEDA MD
- Gender
- Female
- Entity Type
- Individual
- Location Address
- 9600 E INDEPENDENCE BLVD MATTHEWS, NC 28105
- Location Phone
- (704) 384-8441
- Location Fax
- (704) 384-8442
- Mailing Address
- PO BOX 751803 CHARLOTTE, NC 28275
- Mailing Phone
- (704) 384-8441
- Mailing Fax
- (704) 384-8442
- Is Sole Proprietor?
- No
- Enumeration Date
- 06-19-2009
- Last Update Date
- 08-11-2021
- Code Navigator
A primary care provider (PCP) like Michelle Balmaceda sees people with common medical problems. The primary care provider might be a doctor, physician assistant, nurse practitioner or clinic that are usually involved in your long-term care. A PCP might provide preventive care, treat common medical conditions, identify urgent medical problems and refer you to specialists when necessary. Primary care is usually provided in an outpatient facility but if you are admitted to a hospital your PCP may assist in your care. The most common medical conditions seen by primary care providers are: hypertension, upper respiratory tract infections, depression or anxiety, back pain, arthritis, dermatitis, diabetes, urinary tract infections, etc .
Location Map
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
Family Medicine
- Taxonomy Code
- 207Q00000X
- Type
- Allopathic & Osteopathic Physicians
- License No.
- 2016-01789
- License State
- NC
- Taxonomy Description
- 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.
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 | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | 34762 (SC) |
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- Bronze First 7500 $25 Generic Drugs - HMO
- Bronze First 7500 $25 Generic Drugs Adult Vision & Fitness - HMO
- Core Gold 1500 $10 Generic Drugs - HMO
- Core Gold 1500 $10 Generic Drugs Adult Vision & Fitness - HMO
- Diabetes Gold 1100 $0 Select Drugs & Specialized Services - HMO
- Diabetes Gold 1100 $0 Select Drugs & Specialized Services Adult Vision & Fitness - HMO
- Diabetes Silver 4000 $0 Select Drugs & Specialized Services - HMO
- Diabetes Silver 4000 $0 Select Drugs & Specialized Services Adult Vision & Fitness - HMO
- Gold 1500 $15 Generic Drugs - HMO
- Gold 1500 $15 Generic Drugs Adult Vision & Fitness - HMO
- HDHP Preventive Silver 5500 $0 Select Drugs - HMO
- Healthy Heart Gold 1500 $0 Select Drugs & Specialized Services - HMO
- Healthy Heart Gold 1500 $0 Select Drugs & Specialized Services Adult Vision & Fitness - HMO
- Healthy Heart Silver 4500 $0 Select Drugs & Specialized Services - HMO
- Healthy Heart Silver 4500 $0 Select Drugs & Specialized Services Adult Vision & Fitness - HMO
- Low Premium Silver 6000 $3 Generic Drugs - HMO
- Low Premium Silver 6000 $3 Generic Drugs Adult Vision & Fitness - HMO
- Silver 5000 $20 Generic Drugs - HMO
- Silver 5000 $20 Generic Drugs Adult Vision & Fitness - HMO
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Medicare Participation & PECOS Enrollment Status
Michelle Balmaceda 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
Physician 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 28105 ZIP code area.
New Patients Visit Costs *
The most utilized procedure code for new patients office visits is 99203
- Average New Patient Price $83.9
- Minimum New Patient Price $54.12
- Maximum New Patient Price $165.09
- Average New Patient Copayment $20.97
- 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 99214
- Average Established Patient Price $95.94
- Minimum Established Patient Price $17.21
- Maximum Established Patient Price $134.61
- Average Established Patient Copayment $23.98
- 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 |
|---|---|---|
| Colorectal Cancer Screening | 67% | 101 |
| Percentage of adults 50-75 years of age who had appropriate screening for colorectal cancer | ||
| Pneumococcal Vaccination Status for Older Adults | 57% | 181 |
| Percentage of patients 65 years of age and older who have ever received a pneumococcal vaccine | ||
| Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan | 35% | 200 |
| 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 | ||
| Preventive Care and Screening: Screening for Depression and Follow-Up Plan | 1% | 165 |
| 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 | ||
| Screening for Osteoporosis for Women Aged 65-85 Years of Age | 53% | 79 |
| Percentage of female patients aged 65-85 years of age who ever had a central dual-energy X-ray absorptiometry (DXA) to check for osteoporosis | ||
Reviews for MS. MICHELLE ALMODOVAR BALMACEDA MD
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NPI Validation Check Digit Calculation
The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.
| Start with the original NPI number, the last digit is the check digit and is not used in the calculation. | |||||||||
| 1 | 1 | 6 | 4 | 6 | 5 | 9 | 8 | 1 | 9 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 1 | 12 | 4 | 12 | 5 | 18 | 8 | 2 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 1 + 1 + 2 + 4 + 1 + 2 + 5 + 1 + 8 + 8 + 2 + 24 = 61 | |||||||||
| Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit. | |||||||||
| 70 - 61 = 9 | 9 | ||||||||
The NPI number 1164659819 is valid because the calculated check digit 9 using the Luhn validation algorithm matches the last digit of the original NPI number.
Other Providers at the Same Location
The following 5 providers are registered at the same or nearby location.
| NPI | Name / Type | Taxonomy | Address |
|---|---|---|---|
| 1073989984 | CAROLINE MCLEOD HARRIS PA-C Individual | Physician Assistant | 9600 E INDEPENDENCE BLVD MATTHEWS, NC 28105 (704) 384-8441 |
| 1891044574 | STACIA LYNN CHEADLE PA-C Individual | Physician Assistant | 9600 E INDEPENDENCE BLVD MATTHEWS, NC 28105 (704) 815-5624 |
| 1942552674 | MRS. ERICKA NICOLE NORRIS P.A. Individual | Physician Assistant | 9600 E INDEPENDENCE BLVD MATTHEWS, NC 28105 (704) 815-5624 |
| 1083290282 | NH CORPORATE HEALTH, LLC Organization | Preventive Medicine (Occupational Medicine) | 9600 E INDEPENDENCE BLVD MATTHEWS, NC 28105 (704) 316-4846 |
| 1639982432 | NH CORPORATE HEALTH, LLC Organization | Preventive Medicine (Occupational Medicine) | 9600 E INDEPENDENCE BLVD MATTHEWS, NC 28105 (704) 316-4846 |
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1164659819, enumerated in the NPI registry as an "individual" on June 19, 2009
The provider is located at 9600 E Independence Blvd Matthews, Nc 28105 and the phone number is (704) 384-8441
The provider's speciality is Family Medicine with taxonomy code 207Q00000X
The provider might be accepting Accepts: CareSource. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.
Yes, as of June 20, 2025 the provider is registered in PECOS and is eligible to order health care services or supplies for Medicare patients. If you are a beneficiary 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.
Medicare beneficiaries should expect a typical cost of $83.9 with an average copayment of $20.97 for new patient appointments. Established patients should expect a typical charge of $95.94 and an average copayment of 23.98. Please review your insurance plan or contact the provider directly to determine your specific costs.
This NPI record was last updated on June 19, 2009. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
NPI Profile data is regularly updated with the latest NPI registry information, if you would like to update or remove your NPI Profile in this website please contact us.