Active NPI 1295093052 Individual Practitioner Male Practitioner

Dr. Nicholas Ballay , MD

Surgery • Athens, TN

✓ Accepts Medicare Assignment

Professional Overview & Biography Verified Profile Summary

Dr. Nicholas Ballay, MD is a certified Surgery practicing in Athens, TN. With approximately 14 years of clinical experience since completing medical education in 2012, Dr. Ballay delivers high-quality medical care to the local community at 719 COOK DR.

Dr. Ballay is affiliated with Advanced Diagnostic Imaging Pc and accepts Medicare assignment.

Frequently performed procedures and clinical services include established patient outpatient office visit, new patient outpatient office visit, biopsy of esophagus, stomach, and/or upper small bowel using a flexible endoscope. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.

Practice Location & Contact Primary Location

Practice Address

719 Cook Dr

Athens, TN 37303

Telephone 4237452344

Fax 4237452314

Associated Practice Facility / Clinic

🏢 Athens Physicians Practice, Llc Facility NPI 1689055774

Medicare Profile & Education

Medical School

Other

Graduation Year

2012

Medicare Assignment

✓ Accepts Assignment

Telehealth Flag

In-Person Only

Specialty Benchmarks & Practice Insights

Comparative analytics for Surgery in Athens, TN

Established Specialist (10-20 Yrs)

Practitioner Clinical Experience

14 Yrs -14.3 yrs vs City Avg

City Avg: 28.3 Yrs

State Avg: 26.3 Yrs

Regional Practice Density

5 Specialists

Practicing in Athens, TN (682 Statewide)

Telehealth Adoption Rate

0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount

78.2% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Ballay (14 Years) 14 Yrs

Athens Specialty Average (28.3 Years) 28.3 Yrs

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2024)

Reporting Year:

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	160	115	$309.27	$116.96
99213 Established patient office or other outpatient visit, typically 15 minutes	117	83	$212.37	$83.09
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	69	69	$467.52	$153.03
43239 Biopsy of esophagus, stomach, and/or upper small bowel using a flexible endoscope	45	43	$635.36	$72.80
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	38	37	$585.81	$159.56
45384 Removal of polyps or growths of large bowel using a flexible endoscope with electrical cautery	29	29	$1155.38	$204.03
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	26	26	$304.65	$99.45
G0105 Colorectal cancer screening; colonoscopy on individual at high risk	21	21	$923.00	$161.33
99222 Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes	13	12	$397.65	$119.93
45378 Diagnostic exam of large bowel using a flexible endoscope	12	11	$1002.66	$138.49

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	148	107	$308.41	$117.42
99213 Established patient office or other outpatient visit, typically 15 minutes	95	76	$212.37	$83.38
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	84	84	$467.52	$150.94
43239 Biopsy of esophagus, stomach, and/or upper small bowel using a flexible endoscope	49	48	$692.64	$72.53
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	46	46	$304.65	$103.13
45378 Diagnostic exam of large bowel using a flexible endoscope	37	37	$935.92	$163.20
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	29	28	$585.81	$158.46
47562 Removal of gallbladder using an endoscope	25	25	$2805.35	$594.10
45384 Removal of polyps or growths of large bowel using a flexible endoscope with electrical cautery	24	24	$1190.73	$185.32
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	19	13	$204.12	$73.87
99285 Emergency department visit for life threatening or functioning severity	13	12	$752.40	$164.18

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99213 Established patient office or other outpatient visit, typically 15 minutes	109	84	$180.90	$82.80
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	79	79	$251.52	$101.38
43239 Biopsy of esophagus, stomach, and/or upper small bowel using a flexible endoscope	48	46	$1246.45	$79.94
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	34	32	$95.01	$50.45
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	34	30	$250.87	$117.22
45378 Diagnostic exam of large bowel using a flexible endoscope	33	33	$1252.49	$161.73
45384 Removal of polyps or growths of large bowel using a flexible endoscope with electrical cautery	27	27	$1763.00	$196.31
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	26	12	$153.43	$64.25
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	18	18	$445.61	$179.07
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	18	18	$369.81	$151.74
36556 Insertion of non-tunneled central venous tube for infusion (5 years or older)	12	11	$637.82	$76.95

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99213 Established patient office or other outpatient visit, typically 15 minutes	54	46	$142.15	$81.68
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	46	46	$204.76	$100.13
43239 Biopsy of esophagus, stomach, and/or upper small bowel using a flexible endoscope	36	35	$1000.00	$89.94
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	35	31	$86.29	$50.04
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	30	30	$303.73	$150.25
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	27	27	$398.26	$173.77
45378 Diagnostic exam of large bowel using a flexible endoscope	24	24	$1200.00	$159.00
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	21	19	$202.57	$116.19
99233 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes	19	11	$200.84	$92.82
47562 Removal of gallbladder using an endoscope	19	19	$3302.63	$538.23
45384 Removal of polyps or growths of large bowel using a flexible endoscope with electrical cautery	16	16	$1600.00	$190.76
36556 Insertion of non-tunneled central venous tube for infusion (5 years or older)	11	11	$500.00	$76.22

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99213 Established patient office or other outpatient visit, typically 15 minutes	40	34	$136.13	$67.11
43239 Biopsy of esophagus, stomach, and/or upper small bowel using a flexible endoscope	36	36	$997.36	$75.81
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	35	34	$73.57	$40.11
45378 Diagnostic exam of large bowel using a flexible endoscope	31	31	$1200.00	$164.47
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	28	28	$196.75	$96.31
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	27	27	$288.15	$147.48
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	24	24	$188.25	$97.61
45384 Removal of polyps or growths of large bowel using a flexible endoscope with electrical cautery	18	18	$1544.44	$190.01
36556 Insertion of non-tunneled central venous tube for infusion (5 years or older)	15	14	$506.67	$78.57
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	14	14	$362.86	$185.09
47562 Removal of gallbladder using an endoscope	12	12	$3400.03	$541.22

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	73	73	$155.00	$95.59
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	54	46	$60.00	$39.37
43239 Biopsy of esophagus, stomach, and/or upper small bowel using a flexible endoscope	43	42	$920.35	$78.18
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	33	33	$220.00	$142.75
45378 Diagnostic exam of large bowel using a flexible endoscope	31	31	$1090.97	$166.61
99213 Established patient office or other outpatient visit, typically 15 minutes	23	22	$97.61	$65.79
99211 Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional	23	20	$40.00	$19.91
47562 Removal of gallbladder using an endoscope	14	14	$3097.14	$582.70
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	14	14	$301.43	$182.35
45384 Removal of polyps or growths of large bowel using a flexible endoscope with electrical cautery	12	12	$1401.67	$208.51

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	11	11	$155.00	$95.31

Medical Specialties & State Licenses

CMS Verified: 2023-07-19

Surgery Primary Specialty

NUCC Taxonomy Code: 208600000X

State License TN MD0000056407

A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery.

Hospital & Practice Group Affiliations

Advanced Diagnostic Imaging Pc

719 Cook Dr, Athens, TN 373033495

Phone: 4237452344

Secondary Practice Locations

304 Wright St Fl 3

Sweetwater, TN 378741181

Phone: 4232520288

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

3 Associated Practitioners

Dr. Preston Brown , MD

Surgery

NPI 1306806112

Doctor of Medicine (M.D.)

Dr. Thomas Layman , MD

Surgery

NPI 1417917212

Doctor of Medicine (M.D.)

Dr. Michael Sumida , MD

Surgery

NPI 1609835115

Doctor of Medicine (M.D.)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

11 Historical Events

📍

Updated Business Mailing Address April 25, 2023

Registered at 3024 BUSINESS PARK CIR, GOODLETTSVILLE, TN 370723132 (Tel: 6152392018)

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) April 25, 2023

Surgery (License #MD0000056407 in TN)

📍

Updated Practice Location May 26, 2018

Registered at 719 COOK DR, ATHENS, TN 37303 (Tel: 4237452344)

📍

Updated Business Mailing Address May 26, 2018

Registered at PO BOX 688, ATHENS, TN 373710688 (Tel: 4237452344)

👤

Provider Name / Credentials Updated May 26, 2018

Recorded as NICHOLAS BALLAY, MD

✅

NPI Profile Active April 30, 2012

NPI status registered as active in NPPES database

📍

Updated Practice Location April 30, 2012

Registered at 960 E 3RD ST, SUITE 104, CHATTANOOGA, TN 374032104 (Tel: 4237787695)

📍

Updated Business Mailing Address April 30, 2012

Registered at 960 E 3RD ST, SUITE 104, CHATTANOOGA, TN 374032104 (Tel: 4237787695)

👤

Provider Name / Credentials Updated April 30, 2012

Recorded as NICHOLAS BALLAY

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) April 30, 2012

Student in an Organized Health Care Education/Training Program

🟢

Initial NPI Registration & Enumeration April 30, 2012

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

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NPI Administrative Meta

NPI Number: 1295093052

Entity Type:

Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)

Enumeration Date: April 30, 2012

Last Update: July 19, 2023

Sole Proprietor: Yes

Update or Correct Profile

Mailing Address

3024 Business Park Cir

Goodlettsville, TN 370723132

Phone: 6152392018

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).

⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.