Michael Balk

Medicare-allowed amount

About $909 in 2021

The total amount Medicare approved for these services in 2021. It includes what Medicare paid and what patients or their other insurance owed, such as the deductible and coinsurance.

It shows the total cost of this clinician's Original Medicare services under Medicare's fee rules.

Source: CMS, Medicare Physician & Other Practitioners – by Provider and Service, 2021.

Paid by Medicare

About $650 in 2021

The part of the Medicare-allowed amount that Medicare itself paid in 2021, after patients' deductibles and coinsurance.

The gap between the allowed amount and this number is roughly what patients and their other insurance paid.

Source: CMS, Medicare Physician & Other Practitioners – by Provider and Service, 2021.

30-day fills

48 standardized 30-day fills in 2021

CMS converts prescriptions to 30-day supplies so they can be compared. A 90-day prescription counts as about three 30-day fills.

Part D drug cost

$344 in 2021

The total cost of these prescriptions in 2021, paid by Medicare drug plans, patients and other payers together.

It shows the total spending on drugs this clinician prescribed, not what any one patient paid.

Source: CMS, Medicare Part D Prescribers – by Provider and Drug, 2021.

Industry payments (Open Payments)

Fewer than 11 payment records totaling $124.99 in 2023

Drug and medical device companies must report certain payments to doctors and some other clinicians to CMS, such as meals, travel, speaking fees or research funding.

It shows reported financial ties between this clinician and companies. You can ask your clinician about them.

These records are submitted by drug and medical device companies, and a reported payment does not necessarily mean the financial relationship is improper.

General: payments not tied to research, such as meals, travel, consulting or speaking fees.

A reported payment does not necessarily mean the financial relationship is improper. Research payments can go to a hospital or university for a study the clinician leads, not to the clinician personally. Clinicians can dispute records with the company that reported them.

Source: CMS Open Payments, program year 2023.

Guide: How to read an Open Payments record

NPI first issued

2020

The year this clinician's National Provider Identifier (NPI) was issued. An NPI is a unique 10-digit ID that US health care providers use for billing.

Source: CMS NPPES NPI Registry.

Medicare assignment not listed

CMS data do not show whether this clinician accepts Medicare assignment. This does not mean they do not accept Medicare. Ask the office.

Medicare assignment applies to Original Medicare. It does not tell you whether the clinician is in a Medicare Advantage plan's network, accepts other insurance, or is taking new patients.

Source: CMS Doctors and Clinicians; Medicare.gov, “Does your provider accept Medicare as full payment?”

Guide: What Medicare assignment means

No telehealth indicator

CMS shows this indicator only when recent Medicare claims include telehealth services. The clinician may still offer telehealth; ask the office.

Source: CMS, Telehealth Indicator on Medicare Care Compare (fact sheet, January 2023); CMS Doctors and Clinicians.

Guide: How Medicare covers telehealth