CATHLEEN M BALLANCE MD
NPI 1760451488
Pediatrics in Neptune, NJ


Quality Rating: 90.92 out of 100 score

NPI Status: Active since March 15, 2006

Contact Information

1945 ROUTE 33
NEPTUNE, NJ
ZIP 07753
Phone: (732) 776-4267
Fax: (732) 776-3161

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  • Individual
  • Female
  • Pediatrics
  • PECOS Enrolled

About CATHLEEN BALLANCE

This page provides the complete NPI Profile along with additional information for Cathleen Ballance, a pediatrician established in Neptune, New Jersey with a medical specialization in Pediatrics. The healthcare provider is registered in the NPI registry with number 1760451488 assigned on March 2006. The practitioner's primary taxonomy code is 208000000X with license number 25MA06124800 (NJ). The provider is registered as an individual and her NPI record was last updated 15 years ago.

NPI
1760451488
Provider Name
CATHLEEN M BALLANCE MD
Gender
Female
Entity Type
Individual
Location Address
1945 ROUTE 33 NEPTUNE, NJ 07753
Location Phone
(732) 776-4267
Location Fax
(732) 776-3161
Mailing Address
1945 ROUTE 33 NEPTUNE, NJ 07753
Mailing Phone
(732) 776-4267
Mailing Fax
(732) 776-3161
Is Sole Proprietor?
No
Enumeration Date
03-15-2006
Last Update Date
11-22-2010
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A pediatrician like Cathleen Ballance is a physician who has completed a pediatric residency and is board-certified or board-eligible in a pediatric specialty. Pediatric care providers are trained to care for newborns, infants, children and adolescents. A pediatrician could perform physical exams, manage vaccinations, monitor development milestones, diagnose illnesses, infections, injuries or other health problems, 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

Pediatrics

Taxonomy Code
208000000X
Type
Allopathic & Osteopathic Physicians
License No.
25MA06124800
License State
NJ
Taxonomy Description
A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.

Insurance Plans Accepted

According to publicly available information the provider might be accepting the following health plans from these health insurance companies:

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
G61555MEDICARE UPIN (02)NJ 
960033UWHMEDICARE PIN (08)NJ 

Medicare Participation & PECOS Enrollment Status

Cathleen Ballance 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 07753 ZIP code area.

New Patients Visit Costs *

The most utilized procedure code for new patients office visits is 99203

  • Average New Patient Price $94.9
  • Minimum New Patient Price $61.59
  • Maximum New Patient Price $185.05
  • Average New Patient Copayment $23.72
  • Minimum New Patient Copayment $15.39
  • Maximum New Patient Copayment $46.26

Established Patients Visit Costs *

The most utilized procedure code for established patients office visits is 99214

  • Average Established Patient Price $107.94
  • Minimum Established Patient Price $20.08
  • Maximum Established Patient Price $150.98
  • Average Established Patient Copayment $26.98
  • Minimum Established Patient Copayment $5.02
  • Maximum Established Patient Copayment $37.74

* 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.

Overall MIPS Quality Performance

The provider participated in CMS Quality Payment Program under the Merit-based Incentive Payment System (MIPS) and has an overall final score of 90.92, based on four performance areas: quality, improvement activities, promoting interoperability, and cost. The purpose of this information is to help people with Medicare make informed decisions and incentivize doctors and clinicians to maximize performance.

The Merit-based Incentive Payment System (MIPS) is a way providers could use to participate in CMS Quality Payment Program (QPP). The MIPS program affects clinician reimbursement for Part B covered professional services and also rewards them for improving the quality of patient care and outcomes.

  • Final Score: 90.92 out of 100

    The MIPS program evaluates providers across multiple categories with a specific weight for each category resulting a in a MIPS final score that ranges from 0 to 100 points. The MIPS Final Score determines whether providers receive a negative, neutral or positive MIPS payment adjustment.

  • Quality Score: 77.5

    The Quality category assesses providers performance on clinical practices and patient outcomes under the traditional MIPS program. The quality measures help identify the quality of healthcare processes, outcomes, and patient experiences. The Quality measure category compromises 40% providers final MPIS scores.

    There are six collection types for MIPS quality measures: Electronic Clinical Quality Measures (eCQMs), MIPS Clinical Quality Measures (CQMs), Qualified Clinical Data Registry (QCDR) Measures, Medicare Part B claims measures, CMS Web Interface measures and The Consumer Assessment of Healthcare Providers and Systems (CAHPS) for MIPS Survey.

  • Promoting Interoperability Score: 100

    The Interoperability category measures the providers ability to use technology to exchange and make use of healthcare information in a way that is less burdensome and improves outcomes. The Interoperability measure category compromises 25% providers final MPIS scores.

    The MIPS Interoperability measure focuses on the use of certified electronic health record technology (CEHRT) to improve patient access health information, the exchange of information between clinicians and pharmacies and the systematic collection, analysis, and interpretation of healthcare data.

  • Improvement Activities Score: 40

    The Improvement Activities performance category evaluates the providers participation in clinical activities that support the improvement of clinical practice, care delivery, and outcomes. Providers have the option to choose 2 to 4 activities from an inventory of over 100 improvement activities. Providers typically choose the activities that best fit their needs. The improvement activities measure category compromises 15% providers final MPIS scores.

    The Improvement measures aim to better patient engagement, patient safety and other areas of patient care. The Improvement Activities category compromises 15% of providers final MPIS scores.

  • Cost Score: N/A

    The Cost performance category asses the amount and types of services provided and how clinicians coordinate care and seek improvement of health outcomes by ensuring patients receive the appropriate services.

    Although providers don't determine the price of healthcare services they are important in delivering high-quality care at a reasonable cost. The Cost measures category compromises 20% of providers final MPIS scores.

  • Cost Score: N/A

    The Cost performance category asses the amount and types of services provided and how clinicians coordinate care and seek improvement of health outcomes by ensuring patients receive the appropriate services.

    Although providers don't determine the price of healthcare services they are important in delivering high-quality care at a reasonable cost. The Cost measures category compromises 20% of providers final MPIS scores.

Reviews for CATHLEEN M BALLANCE 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.
1760451488
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
27120852416
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 7 + 1 + 2 + 0 + 8 + 5 + 2 + 4 + 1 + 6 + 24 = 62
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
70 - 62 = 88

The NPI number 1760451488 is valid because the calculated check digit 8 using the Luhn validation algorithm matches the last digit of the original NPI number.

Other Providers at the Same Location


The following 20 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1346247368MERIDIAN HOSPITALS CORPORATION
Organization
General Acute Care Hospital1945 ROUTE 33
NEPTUNE, NJ 07753
(732) 775-5500
1942208137MERIDIAN HOSPITALS CORPORATION
Organization
Psychiatric Unit1945 ROUTE 33
NEPTUNE, NJ 07753
(732) 775-5500
1851399042MERIDIAN HOSPITALS CORPORATION
Organization
Clinic/Center (End-Stage Renal Disease (ESRD) Treatment)1945 ROUTE 33
NEPTUNE, NJ 07753
(732) 775-5500
1609877786 ALEJANDRO L RODRIGUEZ MD
Individual
Thoracic Surgery (Cardiothoracic Vascular Surgery)1945 ROUTE 33
NEPTUNE, NJ 07753
(732) 776-4292
1275524548DR. JANET LYNN SCHAIRER M.D.
Individual
Pediatrics1945 ROUTE 33 DEPT OF PEDIATRICS
NEPTUNE, NJ 07753
(732) 776-4270
1346229986MRS. ANGELA MUSIAL FAY MS
Individual
Genetic Counselor, MS1945 ROUTE 33
NEPTUNE, NJ 07753
(732) 836-4632
1922078054MS. MARYANNE - CROWTHER NURSE PRACTITIONER
Individual
Nurse Practitioner (Adult Health)1945 ROUTE 33 JSUMC, ACKERMAN 369
NEPTUNE, NJ 07753
(732) 776-4196
1407824303MRS. ANDREA STEVENS PA-C
Individual
Physician Assistant (Surgical)1945 ROUTE 33
NEPTUNE, NJ 07753
(732) 775-5500
1710956438 ALAN CABASSO MD
Individual
Pediatrics1945 ROUTE 33
NEPTUNE, NJ 07753
(732) 776-4267
1619936960 PAUL M SCHWARTZBERG MD
Individual
Pediatrics1945 ROUTE 33
NEPTUNE, NJ 07753
(732) 776-4267
1306805700 SRIVIDYA NAGANATHAN MD
Individual
Pediatrics1945 ROUTE 33
NEPTUNE, NJ 07753
(732) 776-4267
1861401135 BRUCE D. FISHER M.D.
Individual
Internal Medicine (Infectious Disease)1945 ROUTE 33 DEPARTMENT OF MEDICINE - JERSEY SHORE UNIV MED CTR
NEPTUNE, NJ 07753
(732) 776-4420
1245319615 MATTHEW J MACCARRICK MD
Individual
Pediatrics (Pediatric Critical Care Medicine)1945 ROUTE 33 ACKERMAN
NEPTUNE, NJ 07753
(732) 776-4420
1083764823 ANNE M ANSELMO-MURPHY
Individual
Nurse Practitioner1945 ROUTE 33 JERSEY SHORE UNIVERSITY MEDICAL CENTER
NEPTUNE, NJ 07753
(732) 202-8071
1043438989 MICHELLE CATALANO PA
Individual
Physician Assistant1945 ROUTE 33
NEPTUNE, NJ 07753
(732) 897-3980
1972794428MR. CRAIG MICHAEL WHITEHEAD PT
Individual
Physical Therapist1945 ROUTE 33
NEPTUNE, NJ 07753
(732) 775-5500
1043487713 MELISSA MECKA
Individual
Nurse Practitioner (Family)1945 ROUTE 33
NEPTUNE, NJ 07753
(732) 202-8074
1073778072MS. CHRISTINA RAMES PHARM.D.
Individual
Pharmacist1945 ROUTE 33
NEPTUNE, NJ 07753
(732) 776-4759
1346492808 KENNETH M MCHALE CRNA
Individual
Nurse Anesthetist, Certified Registered1945 ROUTE 33
NEPTUNE, NJ 07753
(732) 775-5550
1568615060 GIRISH C SHARMA MD
Individual
Pediatrics (Pediatric Gastroenterology)1945 ROUTE 33
NEPTUNE, NJ 07753
(732) 776-4860

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1760451488, enumerated in the NPI registry as an "individual" on March 15, 2006

The provider is located at 1945 Route 33 Neptune, Nj 07753 and the phone number is (732) 776-4267

The provider's speciality is Pediatrics with taxonomy code 208000000X

The provider might be accepting Accepts: Medicare and Medicaid. 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.

The provider has an overall high rating in the following quality measures: uses technology to exchange and make use of healthcare information.

Medicare beneficiaries should expect a typical cost of $94.9 with an average copayment of $23.72 for new patient appointments. Established patients should expect a typical charge of $107.94 and an average copayment of 26.98. Please review your insurance plan or contact the provider directly to determine your specific costs.

This NPI record was last updated on March 15, 2006. 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.