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

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  • 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
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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)
1207Q00000XAllopathic & 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.
1164659819
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
211241251882
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 = 99

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 Assistant9600 E INDEPENDENCE BLVD
MATTHEWS, NC 28105
(704) 384-8441
1891044574 STACIA LYNN CHEADLE PA-C
Individual
Physician Assistant9600 E INDEPENDENCE BLVD
MATTHEWS, NC 28105
(704) 815-5624
1942552674MRS. ERICKA NICOLE NORRIS P.A.
Individual
Physician Assistant9600 E INDEPENDENCE BLVD
MATTHEWS, NC 28105
(704) 815-5624
1083290282NH CORPORATE HEALTH, LLC
Organization
Preventive Medicine (Occupational Medicine)9600 E INDEPENDENCE BLVD
MATTHEWS, NC 28105
(704) 316-4846
1639982432NH 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.