RONALDO S BALBOA M.D.
NPI 1417941055
Internal Medicine in Port Huron, MI
NPI Status: Active since September 09, 2005
Contact Information
1201 STONE ST
STE. 5
PORT HURON, MI
ZIP 48060
Phone: (810) 966-9556
Fax: (810) 966-4898
- Individual
- Male
- Years of Experience 68
- Internal Medicine
- Accepts Insurance
- Accepts Medicare Approved Payment
- PECOS Enrolled
- CLIA Number: 23D0364136
- CLIA Cert. Type: Physician Office
- CLIA Exp. Date: 08-31-2026
About RONALDO BALBOA
This page provides the complete NPI Profile along with additional information for Ronaldo Balboa, an internist established in Port Huron, Michigan with a medical specialization in Internal Medicine and more than 68 years of experience. The healthcare provider is registered in the NPI registry with number 1417941055 assigned on September 2005. The practitioner's primary taxonomy code is 207R00000X with license number RB028997 (MI). The provider is registered as an individual and his NPI record was last updated 16 years ago.
- NPI
- 1417941055
- Provider Name
- RONALDO S BALBOA M.D.
- Gender
- Male
- Entity Type
- Individual
- Location Address
- 1201 STONE ST STE. 5 PORT HURON, MI 48060
- Location Phone
- (810) 966-9556
- Location Fax
- (810) 966-4898
- Mailing Address
- 1201 STONE ST STE. 5 PORT HURON, MI 48060
- Mailing Phone
- (810) 966-9556
- Mailing Fax
- (810) 966-4898
- Medical School Name
- OTHER
- Graduation Year
- 1958
- Is Sole Proprietor?
- No
- Enumeration Date
- 09-09-2005
- Last Update Date
- 06-17-2009
- Code Navigator
An internist like Ronaldo Balboa is a physician who has completed an internal medicine residency and is board-certified or board-eligible in an internist specialty. Internists are trained to care for adults of all ages for many different medical conditions. An internist typically monitors chronic physical conditions, identifies acute diseases, provides family planning, provides counseling about wellness and disease prevention, 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
Internal Medicine
- Taxonomy Code
- 207R00000X
- Type
- Allopathic & Osteopathic Physicians
- License No.
- RB028997
- License State
- MI
- Taxonomy Description
- A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- Blue Cross� Preferred HMO Bronze Extra - HMO
- Blue Cross� Preferred HMO Bronze Saver HSA - HMO
- Blue Cross� Preferred HMO Bronze Secure - HMO
- Blue Cross� Preferred HMO Gold - HMO
- Blue Cross� Preferred HMO Gold Extra - HMO
- Blue Cross� Preferred HMO Silver - HMO
- Blue Cross� Preferred HMO Silver Extra - HMO
- Blue Cross� Preferred HMO Silver Saver - HMO
- Blue Cross� Preferred HMO Value - HMO
- Blue Cross� Select HMO Bronze Extra - HMO
- Blue Cross� Premier PPO Bronze Extra - PPO
- Blue Cross� Premier PPO Bronze HSA - PPO
- Blue Cross� Premier PPO Bronze Secure - PPO
- Blue Cross� Premier PPO Gold - PPO
- Blue Cross� Premier PPO Gold Extra - PPO
- Blue Cross� Premier PPO Silver - PPO
- Blue Cross� Premier PPO Silver Extra - PPO
- Blue Cross� Premier PPO Silver Saver HSA - PPO
- Blue Cross� Premier PPO Value - PPO
- Bronze First - HMO
- Bronze First Adult Vision & Fitness - HMO
- Diabetes Gold - HMO
- Diabetes Gold Adult Vision & Fitness - HMO
- Diabetes Silver - HMO
- Diabetes Silver Adult Vision & Fitness - HMO
- Gold - HMO
- Gold Adult Vision & Fitness - HMO
- HDHP Preventive Silver - HMO
- Healthy Heart Gold - HMO
- MHP Bronze - HMO
- MHP Bronze Saver (Expanded) - HMO
- MHP Expanded Bronze Standard - HMO
- MHP Gold - HMO
- MHP Gold Standard - HMO
- MHP Silver Exchange - HMO
- MHP Silver Exchange Rewards - HMO
- MHP Silver Standard - HMO
- MHP Young Adult/Catastrophic - HMO
- MyPriority Balanced Silver - HMO
- MyPriority Premier Silver - HMO
- MyPriority Standard Bronze - HMO
- MyPriority Standard Bronze - Travel - HMO
- MyPriority Standard Gold - HMO
- MyPriority Standard Silver - HMO
- MyPriority Standard Silver - Travel - HMO
- MyPriority Value Bronze - HMO
- MyPriority Value Bronze HSA - 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.
*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 |
|---|---|---|---|
| 1006297 | MEDICAID (05) | MI | |
| 0740374 | MEDICARE PIN (08) | MI | |
| B45815 | MEDICARE UPIN (02) | MI |
Medicare Participation & PECOS Enrollment Status
Ronaldo Balboa is registered with Medicare and accepts claims assignment, this means the provider accepts the approved amount for the cost of rendered services as full payment. Participating providers may not charge beneficiaries more than the approved amount for their services. Please keep in mind that beneficiaries still have to pay a coinsurance or copayment amount for a visit or service.
Ronaldo Balboa 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
PECOS PAC ID: 7012826886
What is the PECOS Associate Control ID?
A PAC ID is a unique 10-digit number assigned to an individual or organization healthcare provider in PECOS. The PAC ID is used to link together all the provider information, like tax identification numbers and organizational names. A PAC ID can be connected to multiple Enrollment IDs if an individual or organization has enrolled in PECOS more than once.PECOS Enrollment ID: I20090728000335
What is the Provider Enrollment ID?
The Enrollment ID is a unique alphanumeric 15-digit code assigned to each new provider's PECOS enrollment application. The Enrollment ID is used to link together all the provider enrollment information like enrollment type, state, provider specialty, and reassignment of benefits.Accepts Medicare Assignment? Yes
What does it mean "accepts medicare assignment"?
When a provider accepts Medicare assignment, the provider agrees to be paid directly by Medicare and to accept the payment amount approved by Medicare. Additionally, the provider agrees to not bill patients for more than the Medicare deductible and coinsurance amounts.
A provider who doesn't accept assignment may charge you up to 15% over the Medicare-approved amount. This is known as the limiting charge. You may have to pay this amount, or it may be covered by another insurer.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
Provider Referred Orders for Durable Medical Equipment, Devices & Supplies
The following list reflects the services, supplies or durable medical equipment ordered by this provider to a DME supplier on behalf of patients. The information below is derived from Medicare claims data and reflects the BETOS category, HCPCS code information and the number times each service was submitted under the Medicare fee-for-service program.
Durable Medical Equipment
DME-Other DME (DE017N)
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips (HCPCS:A4253)
6 DME suppliers used 12 Medicare Claims 36 Services Paid
DME-Other DME (DE001N)
Continuous positive airway pressure (cpap) device (HCPCS:E0601)
2 DME suppliers used 12 Medicare Claims 12 Services Paid
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.
Administration of influenza virus vaccine
Annual alcohol misuse screening, 15 minutes
Annual depression screening, 15 minutes
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit
Established patient office or other outpatient visit, 30-39 minutes
Influenza vaccine, quadrivalent inactivated, 0.5 ml dosage
Insertion of needle into vein for collection of blood sample
The administration of the influenza virus vaccine, also known as the flu shot, is a simple procedure to protect against the flu. A healthcare provider injects a small dose of the vaccine into your arm. This stimulates your immune system to produce antibodies, which will help your body fight off the flu if exposed.
This service was performed 12 times for 12 patientsAn annual alcohol misuse screening is a 15-minute check-up to assess your drinking habits. It helps identify if you're consuming alcohol in a way that could harm your health. This is not a judgment, but a tool to promote your wellbeing.
This service was performed 28 times for 28 patientsAn annual depression screening is a short, routine evaluation to check for signs of depression. It involves answering a series of questions about your feelings, thoughts, and behaviors. The process takes about 15 minutes and helps detect depression early for better management.
This service was performed 28 times for 28 patientsAn annual wellness visit is a yearly appointment with your primary care provider to create or update a personalized prevention plan. This plan helps prevent illness based on your current health and risk factors. It's a subsequent visit, meaning it follows an initial assessment.
This service was performed 28 times for 28 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 93 times for 38 patientsThe quadrivalent inactivated influenza vaccine is a shot given to protect against four strains of the flu virus. This 0.5 ml dosage helps your body develop immunity to the virus. It's an important step in preventing flu-related complications.
This service was performed 12 times for 12 patientsThis procedure involves inserting a small needle into a vein, typically in your arm, to collect a blood sample. It's a quick and simple process to help diagnose or monitor health conditions. You may feel a small prick, but discomfort is minimal.
This service was performed 19 times for 17 patientsPhysician Visit Costs
The typical physician office visit costs for Medicare beneficiaries in this area are: $31.53 for a new patient copayment and $24.11 for an established patient copayment.
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 48060 ZIP code area.
New Patients Visit Costs *
The most utilized procedure code for new patients office visits is 99204
- Average New Patient Price $126.15
- Minimum New Patient Price $54.34
- Maximum New Patient Price $166.68
- Average New Patient Copayment $31.53
- Minimum New Patient Copayment $13.58
- Maximum New Patient Copayment $41.67
Established Patients Visit Costs *
The most utilized procedure code for established patients office visits is 99214
- Average Established Patient Price $96.44
- Minimum Established Patient Price $17.09
- Maximum Established Patient Price $135.4
- Average Established Patient Copayment $24.11
- Minimum Established Patient Copayment $4.27
- Maximum Established Patient Copayment $33.85
* 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.
Find Provider Hospital Affiliations - Privileges
Doctors and physicians must apply for hospital privileges to treat patients at hospitals. Find out if your doctor has privileges to practice at your preferred hospital by using the hospital affiliation information below based on recent medical claims.
Hospital affiliation is identified through self-reporting data, inpatient, outpatient, physician and ancillary service claims linked by the medical claims NPI number and place of service code. Additionally, to further determine provider hospital affiliation the clinician must have provided services to at least three patients on three different dates in the last 12 months. Ronaldo Balboa is affiliated with the following medical facilities:
| Hospital Name | Address | Phone | Hospital Type | Overall Rating |
|---|---|---|---|---|
| MCLAREN PORT HURON | 1221 PINE GROVE AVE PORT HURON, MI 48060 | (810) 987-5000 | Acute Care Hospitals |
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 23D0364136
- Facility Type
- Physician Office
- Certificate Effective Date
- September 01, 2024
- Certificate Expiration Date
- August 31, 2026
- Laboratory Director
- RONALDO S. BALBOA
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Ronaldo Balboa to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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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 | 4 | 1 | 7 | 9 | 4 | 1 | 0 | 5 | 5 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 4 | 2 | 7 | 18 | 4 | 2 | 0 | 10 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 4 + 2 + 7 + 1 + 8 + 4 + 2 + 0 + 1 + 0 + 24 = 55 | |||||||||
| Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit. | |||||||||
| 60 - 55 = 5 | 5 | ||||||||
The NPI number 1417941055 is valid because the calculated check digit 5 using the Luhn validation algorithm matches the last digit of the original NPI number.
Other Providers at the Same Location
The following 16 providers are registered at the same or nearby location.
| NPI | Name / Type | Taxonomy | Address |
|---|---|---|---|
| 1538153176 | RIAD ROBERT HAJJAR M.D. Individual | Internal Medicine | 1201 STONE ST STE. 5 PORT HURON, MI 48060 (810) 966-9556 |
| 1356317556 | THANAA AL-HAMAD MD Individual | Internal Medicine (Gastroenterology) | 1201 STONE ST SUITE 3 PORT HURON, MI 48060 (810) 982-8742 |
| 1164620753 | RIAD R. HAJJAR MD PC Organization | Internal Medicine | 1201 STONE ST STE 5 PORT HURON, MI 48060 (810) 966-9556 |
| 1053689695 | MRS. ELIZABETH MAY HELMREICH ANP-BC Individual | Nurse Practitioner (Adult Health) | 1201 STONE ST SUITE 5 PORT HURON, MI 48060 (810) 966-9556 |
| 1841383924 | MARWAN IBRAHIM SHUAYTO M.D. Individual | Psychiatry & Neurology (Neurology) | 1201 STONE ST SUITE 8 PORT HURON, MI 48060 (810) 989-0000 |
| 1346506391 | DIANE MARIE SCHUNK ACNP Individual | Nurse Practitioner (Acute Care) | 1201 STONE ST STE 8 PORT HURON, MI 48060 (810) 989-0000 |
| 1770555062 | MR. PATRICK JOHN GEML PA-C, MPAS Individual | Physician Assistant | 1201 STONE ST PORT HURON, MI 48060 (801) 982-9414 |
| 1659331023 | MS. ANGELA KATHLEEN O'TOOLE DPT Individual | Physical Therapist | 1201 STONE ST STE 8 PORT HURON, MI 48060 (810) 989-0000 |
| 1902970262 | SYED A S MAKKI MD PC Organization | Psychiatry & Neurology (Psychiatry) | 1201 STONE ST SUITE 4 PORT HURON, MI 48060 (810) 982-8484 |
| 1689879660 | DR. SYED A S MAKKI MD Individual | Psychiatry & Neurology (Psychiatry) | 1201 STONE ST SUITE 4 PORT HURON, MI 48060 (810) 982-8484 |
| 1477576163 | ERIN DIMAMBRO PA-C Individual | Physician Assistant | 1201 STONE ST STE 5 PORT HURON, MI 48060 (810) 966-9556 |
| 1619361870 | JANETTE C. GUERTIN ACNP-BC Individual | Nurse Practitioner (Acute Care) | 1201 STONE ST PORT HURON, MI 48060 (810) 989-0000 |
| 1275991341 | JASON GO Individual | Acupuncturist | 1201 STONE ST SUITE 3 PORT HURON, MI 48060 (312) 622-3659 |
| 1003325598 | MS. SALWA WADUD CHOUDHURY PA-C Individual | Physician Assistant (Medical) | 1201 STONE ST SUITE #3 PORT HURON, MI 48060 (810) 985-5000 |
| 1578819850 | MAWAN SHUAYTO MD PC Organization | Psychiatry & Neurology (Neurology) | 1201 STONE ST SUITE 8 PORT HURON, MI 48060 (810) 989-0000 |
| 1720413115 | RAFIA KHALIL ARTHRITIS & RHEUMATOLOGY CENTER PC Organization | Specialist | 1201 STONE ST SUITE 3 PORT HURON, MI 48060 (810) 985-5000 |
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1417941055, enumerated in the NPI registry as an "individual" on September 09, 2005
The provider is located at 1201 Stone St Ste. 5 Port Huron, Mi 48060 and the phone number is (810) 966-9556
The provider's speciality is Internal Medicine with taxonomy code 207R00000X
The provider has more than 68 years of experience.
The provider might be accepting Accepts: Blue Care Network of Michigan, Blue Cross Blue. 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 $126.15 with an average copayment of $31.53 for new patient appointments. Established patients should expect a typical charge of $96.44 and an average copayment of 24.11. Please review your insurance plan or contact the provider directly to determine your specific costs.
The most common procedures or services performed by this practitioner are: Administration of influenza virus vaccine, Annual alcohol misuse screening, 15 minutes, Annual depression screening, 15 minutes, Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit, Established patient office or other outpatient visit, 30-39 minutes, Influenza vaccine, quadrivalent inactivated, 0.5 ml dosage and Insertion of needle into vein for collection of blood sample.
The provider's CLIA number is 23D0364136 for a "physician office" facility with a CLIA Certificate of Waiver. This CLIA certificate is issued to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria..
The practitioner is affiliated to the following hospital(s): MCLAREN PORT HURON. Hospital affiliations are identified through self-reporting data and service claims based on the place of service.
This NPI record was last updated on September 09, 2005. 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].
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