2026 NPPES data Specialist NPI 1225035959 MD
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DAVID BALABAN, MD

Specialist in CHARLOTTESVILLE, Virginia. CMS National Plan and Provider Enumeration System profile including specialty classification, practice address, and Medicare prescribing data when reported.

Federal data — no proprietary rating. PlainDoctor publishes the actual CMS NPPES and Medicare records — NPI registration, specialty, practice location, and prescribing data — without a composite score or editorial opinion on top. Every field traces to a federal source.
Prescribing volume
1K
Medicare Part D claims · 345 beneficiaries · Specialist avg: 1K
Generic prescribing
85%
generic claims · 15% brand-name · higher generic rates reduce patient out-of-pocket costs
MIPS score
80.826/100
▼ 2 pts below national avg 83.1 · [object Object]
Industry payments
$101.15
4 payments · CMS Open Payments (Sunshine Act)

What the federal data shows

DAVID BALABAN, MD reported a CMS MIPS final score of 80.826/100 — below the 83.1 national average — and filed 1,130 Medicare Part D claims in 2023.

80.826/100
MIPS score · -2 vs avg
1K
Part D claims, 2023
85%
generic prescribing
$101.15
industry payments (Sunshine Act)

Every figure on this page comes straight from federal CMS records (NPPES, Medicare Part D, MIPS, Open Payments) — no proprietary rating or editorial opinion is applied.

DAVID BALABAN, MD's MIPS score vs every scored U.S. clinician

CMS Merit-based Incentive Payment System (MIPS) final score, 2023 — the federal quality measure

81 33rd percentile higher than 33% of 477,587 scored providers

0–10: 8,684 scored providers (2%). Below this entry. 10–20: 3,008 scored providers (1%). Below this entry. 20–30: 3,069 scored providers (1%). Below this entry. 30–40: 2,746 scored providers (1%). Below this entry. 40–50: 2,928 scored providers (1%). Below this entry. 50–60: 5,882 scored providers (1%). Below this entry. 60–70: 13,906 scored providers (3%). Below this entry. 70–80: 118,074 scored providers (25%). Below this entry. 80–90: 129,887 scored providers (27%). This entry sits in this band. 90–100: 189,403 scored providers (40%). Above this entry. This provider 0 100 every MIPS-scored clinician, bucketed by value

Each bar is a band; taller bars hold more scored providers. The dashed line + filled bar mark this entry. Hover or tap any bar for its full count, share, and where it sits relative to this entry.

Source CMS Merit-based Incentive Payment System (MIPS) · 2023

What does the federal data show about DAVID BALABAN, MD?

Near national average

NPI registry status

Active

Issued 07/07/2005

NPI 1225035959

Primary specialty

Specialist

High-volume

69,658 US NPIs in this specialty

Medicare Part D claims

1,130 23% vs specialty avg

2023 prescription claims

Specialty avg: 1,474

MIPS final score

80.826/100 2.274000000000001% pts

Above neutral band

vs 83.1 national avg

Specialty distribution in Virginia

How Specialist compares to other specialties among Virginia providers

Virginia providers

Specialist share within Virginia

1. Specialist42%2. Internal medicine21%3. Family medicine17%4. Surgical12%5. Pediatric8%
Specialist share within Virginia

Medicare quality performance — MIPS

DAVID BALABAN, MD's 2023 MIPS final score plotted against the Specialist national average

Near national average
MIPS Final Score
80.826/100
vs 83.1 national avg · 2023 performance year

MIPS final score (Specialist) — 80.826/100 vs national avg 83.1

0%100%National avg83%80.8%
MIPS final score (Specialist) — 80.826/100 vs national avg 83.1

The Merit-based Incentive Payment System (MIPS) scores providers 0–100 across four performance categories: Quality, Cost, Promoting Interoperability, and Improvement Activities, weighted under 42 CFR §414.1380. Reporting is voluntary for many small practices, so absence of a MIPS score is not a quality signal.

Board certification through an ABMS or AOA member board signals voluntary post-licensure examination plus continuous Maintenance of Certification cycles. Verify any individual provider's status through certificationmatters.org (ABMS) or osteopathic.org (AOA).

DAVID BALABAN, MD appears in the CMS NPPES registry as a Specialist provider holding MD credentials at 1139 E HIGH ST, CHARLOTTESVILLE, VA, 22902, with a listed phone of (434) 817-8484. NPI 1225035959 was issued on 07/07/2005. Because NPPES data is self-reported by the provider and refreshed monthly, the address, phone, and specialty reflect what BALABAN most recently submitted to CMS rather than a vetted directory listing, which is why patients should always confirm the practice is still at this location before scheduling.

Medicare Part D records for calendar year 2023 show 1,130 prescription claims written by this provider, covering 345 Medicare beneficiaries and totaling roughly $376K in drug spend, split 15% brand-name and 85% generic by claim count. These figures capture only Medicare Part D — commercial insurance, Medicaid, and cash-pay prescriptions are not included, and any drug-beneficiary cell under 11 is suppressed by CMS for patient privacy. On the CMS Merit-based Incentive Payment System, this provider earned a Final Score of 80.826/100 for the 2023 performance year (Quality 61.6323, Cost 74.4545), compared with the national average of 83.1.

Specialist is a high-volume specialty nationwide, with 69,658 enrolled providers across 55 states and an average of 1,474 Part D claims per prescriber, so the context for interpreting these metrics differs meaningfully from a primary-care baseline. Important: PlainDoctor is a directory of publicly available government data, not medical advice, a malpractice database, or a quality rating. Inclusion here does not imply a recommendation, and absence of complaints or sanctions on this page does not mean none exist — always verify credentials through the NPPES NPI Registry, your state medical board, and the ABMS or AOA before making healthcare decisions.

Practice Address

1139 E HIGH ST
CHARLOTTESVILLE, VA 22902

Provider Details

NPI 1225035959
Specialty Specialist
Credentials MD
Gender Male
NPI Issued 07/07/2005

CMS Quality Score (MIPS)

Merit-based Incentive Payment System (MIPS) scores from CMS, 2023 performance year.

80.826
Final Score
Avg: 83.1
61.6323
Quality
74.4545
Cost
100
Promoting Interoperability

Reporting: Group practice

Hospital and facility affiliations

Facilities where DAVID BALABAN, MD bills Medicare from. Star ratings (1-5) are CMS Hospital Compare's "Hospital overall rating" — a composite of mortality, readmission, patient experience, safety, timely care, and efficient use of medical imaging measures. Source: CMS Care Compare.

CHARLOTTESVILLE GASTROENTEROLOGY ASSOCIATES PC
CHARLOTTESVILLE, VA
GASTROENTEROLOGY ASSOCIATES OF NORTHERN VIRGINIA, LLC
CHARLOTTESVILLE, VA

Affiliations sourced from CMS Doctors and Clinicians National Downloadable File; hospital ratings from CMS Hospital General Information dataset (cross-referenced by facility name + state).

Industry payments received (2024) — CMS Open Payments transparency data

The federal Physician Payments Sunshine Act (part of the Affordable Care Act) requires drug and medical-device manufacturers + group purchasing organizations to publicly report payments and other transfers of value to physicians and teaching hospitals. The data below covers 2024 for DAVID BALABAN, MD. Source: openpaymentsdata.cms.gov.

Total received

$101

Largest payer

ABBVIE INC.

Most common payment type

Food and Beverage

Industry payments are not necessarily indicators of bias — they include research funding, consulting fees for evidence-based work, royalties for inventions, food at conferences, and similar items. The disclosure exists for transparency. Read our methodology for how we interpret this data.

Brand vs generic prescribing mix · Typical

DAVID BALABAN, MD — brand share 15.0%
Specialty average (est.)

15% brand-name claims vs 85% generic, on 1,130 2023 Medicare Part D claims.

The federal Medicare Part D Generic Dispensing Rate national benchmark sits near 90% generic / 10% brand for primary-care prescribers, per CMS Office of the Actuary 2024 estimates. Higher brand share is common in specialty prescribing where generic equivalents are not available.

Medicare Part D Prescribing Data

CMS Medicare Part D prescriber-level data for calendar year 2023.

1,130
Total Claims
$376K
Total Drug Cost
345
Medicare Beneficiaries

Prescribing Breakdown

30-Day Fills
1,790
Total Day Supply
47,288
Brand vs Generic
15% brand / 85% generic
Brand Drug Cost
$231K
Generic Drug Cost
$145K
Antibiotic Claims
24

Patient Demographics

Average Patient Age
73.2 years
Avg HCC Risk Score
0.99
Gender Split
57% female / 43% male
Age Distribution
<65: 20, 65-74: 195, 75-84: 102, 85+: 28

Top Prescribed Drugs (Medicare Part D)

Top drugs by claim count for calendar year 2023. Based on Medicare Part D data only.

What DAVID BALABAN, MD prescribes most

Top Medicare Part D drugs by claim count, 2023

claims
Source CMS Medicare Part D Prescriber Public Use File As of 2023
Drug Claims
Pantoprazole Sodium
160
Omeprazole
148
Mesalamine
130
Peg 3350-Electrolyte
Sodium Chloride/Nahco3/Kcl/Peg
98
Dicyclomine Hcl
80
Famotidine
52
Esomeprazole Magnesium
31
Ondansetron Odt
Ondansetron
29
Budesonide Ec
Budesonide
26
Creon
Lipase/Protease/Amylase
26

* Counts below 11 are suppressed by CMS for patient privacy. Generic names shown where available from CMS Part D data.

Specialist Overview

How DAVID BALABAN, MD fits within the Specialist landscape nationally.

69,658
Specialist Providers in US
55
States with Specialist
1,474
Avg Claims per Provider

DAVID BALABAN, MD's 1,130 claims are below the specialty average of 1,474.

Nearby Specialist Providers in Virginia

Other clinicians with the same primary specialty enrolled in Virginia, drawn from the same CMS NPPES roster as BALABAN.

Compare Specialist nationally: see state-by-state distribution →

Frequently Asked Questions

What is DAVID BALABAN, MD's specialty?
DAVID BALABAN, MD specializes in Specialist and practices in CHARLOTTESVILLE, Virginia. Credentials: MD.
How much does DAVID BALABAN, MD prescribe under Medicare Part D?
In 2023, DAVID BALABAN, MD wrote 1,130 Medicare Part D claims totaling $376K in drug costs for 345 beneficiaries.
What is DAVID BALABAN, MD's Medicare quality score?
DAVID BALABAN, MD has a CMS MIPS Final Score of 80.826/100 (Quality: 61.6323, Cost: 74.4545). The national average MIPS Final Score is 83.1. Source: CMS Merit-based Incentive Payment System (MIPS) 2023.
Where is DAVID BALABAN, MD located?
DAVID BALABAN, MD is located at 1139 E HIGH ST, CHARLOTTESVILLE, VA, 22902. Phone: (434) 817-8484.
What is DAVID BALABAN, MD's NPI number?
DAVID BALABAN, MD's National Provider Identifier (NPI) is 1225035959, issued on 07/07/2005.
Does DAVID BALABAN, MD prescribe more brand-name or generic drugs?
DAVID BALABAN, MD's prescribing is 15% brand-name and 85% generic drugs by claim count, with $231K in brand drug costs.
How many Specialist providers are there in the US?
There are 69,658 Specialist providers across 55 states in the US. The average Specialist provider writes 1,474 Medicare Part D claims per year.
What drugs does DAVID BALABAN, MD prescribe most often?
Based on 2023 Medicare Part D data, DAVID BALABAN, MD's most frequently prescribed drugs include Pantoprazole Sodium, Omeprazole, Mesalamine. This reflects Medicare Part D prescriptions only and does not include commercial insurance or other payer types.
Does DAVID BALABAN, MD accept Medicare?
DAVID BALABAN, MD appears in CMS Medicare data with 1,130 Part D claims and 345 Medicare beneficiaries in 2023. Contact the provider's office directly to confirm current Medicare enrollment and accepted plans.
How can I verify DAVID BALABAN, MD's credentials?
DAVID BALABAN, MD's NPI is 1225035959 with credentials MD. You can verify this through the NPPES NPI Registry, check state medical board records, and confirm board certification through the ABMS or AOA.

Data Sources

Provider Directory
CMS National Plan and Provider Enumeration System (NPPES), download.cms.gov/nppes, updated monthly. Contains NPI, specialty, credentials, and practice location.
Specialty Classification
NUCC Health Care Provider Taxonomy (nucc.org), the industry standard for classifying provider specialties in Medicare and Medicaid billing.
Prescribing Data
CMS Medicare Part D Prescriber Public Use File (2023). Includes claims, drug costs, beneficiaries, and opioid prescribing rates.
Quality Performance
CMS Merit-based Incentive Payment System (MIPS) — 2023 performance year.
Limitations
Provider data is self-reported to CMS. Prescribing data reflects Medicare Part D only and does not include commercial insurance, Medicaid, or cash prescriptions. Claims below 11 beneficiaries are suppressed by CMS for privacy.

See our complete data methodology for details on how we collect and process government data.

Data as of April 2026 (NPPES) / 2023 (Medicare Part D). Source: Centers for Medicare & Medicaid Services (CMS).

Disclaimer: Data from CMS NPPES and Medicare Part D. PlainDoctor does not rate or rank providers. Provider information is self-reported and may not be current. Always verify information directly with the provider. About · Methodology