Physician
Balboa Nephrology Medical Group, INC.
Balboa Nephrology Medical Group, INC. was paid $25.86M by Medicaid between Jan 2018 and Dec 2024, across 54 billing codes. Its largest line is 90960, End-stage renal disease related services monthly, for patients 20 years and older, with 4 or more face-to-face visits — 49% of everything it billed.
33Billing provider infoBALBOA NEPHROLOGY MEDICAL GROUP, INC.
SAN DIEGO, CA 92123
SAN DIEGO, CA 92123
33aNPI1316997505assigned 05/11/2006
33bProvider typeSurgery Physician
28Total paid$25.86M
24GClaims402,139
24DCodes billed54
24AFirst – last monthJan 2018 – Dec 2024
Compared with peers
Next to other Surgery Physician providers in California
Rank by total paid#4 of 437
Median peer was paid$23K
This provider vs. median1,131×
Peers share this provider's primary NPPES type and state. Size alone says nothing about billing quality: a big agency or a hospital system is expected to sit far above the median.
Box 24A · Dates of service
Paid by month
Paid that monthNov–Dec 2024: claims still arriving when the file was cut, so these months run low for every provider
By year, as a table
| Year | Claims | Paid | |
|---|---|---|---|
| 2018 | 43,981 | $2.95M | |
| 2019 | 52,063 | $3.20M | |
| 2020 | 57,441 | $3.50M | |
| 2021 | 61,601 | $4.03M | |
| 2022 | 61,487 | $3.84M | |
| 2023 | 68,535 | $4.23M | |
| 2024incomplete | 57,031 | $4.12M |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| 90960 | End-stage renal disease related services monthly, for patients 20 years and older, with 4 or more face-to-face visits | 49% | 112,085 | 111,703 | $12.70M |
| 99232 | Hospital visit by a doctor, follow-up daySubsequent hospital care, per day, moderate complexity | 11% | 111,094 | 37,623 | $2.73M |
| 36902 | 10% | 5,219 | 5,159 | $2.64M | |
| 99214 | Doctor's office visit, returning patient (more involved)Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity | 8.3% | 68,324 | 65,947 | $2.16M |
| 99233 | Hospital visit by a doctor, follow-up day (complex)Prolong inpt eval add15 m | 4.2% | 38,598 | 15,444 | $1.08M |
| 36905 | 3.8% | 891 | 835 | $971K | |
| 90961 | 3.5% | 9,237 | 9,198 | $904K | |
| 90966 | 2.8% | 6,291 | 6,276 | $732K | |
| 99223 | Prolong inpt eval add15 m | 1.9% | 8,985 | 8,671 | $483K |
| 99213 | Doctor's office visit, returning patient (routine)Office or other outpatient visit for the evaluation and management of an established patient, low complexity | <1% | 9,517 | 9,397 | $211K |
| 90935 | Hemodialysis procedure with single evaluation by a physician | <1% | 5,935 | 3,108 | $192K |
| 36901 | <1% | 575 | 571 | $156K |
42 more codes
| 36215 | <1% | 1,404 | $155K | |
| 75710 | <1% | 1,638 | $144K | |
| 99152 | <1% | 6,124 | $122K | |
| 99222 | Initial hospital care, per day, moderate complexity | <1% | 1,716 | $81K |
| 93985 | <1% | 500 | $77K | |
| 99204 | Doctor's office visit, new patient (more involved) | <1% | 1,154 | $73K |
| 36589 | <1% | 535 | $50K | |
| 36907 | <1% | 320 | $39K | |
| 99215 | Doctor's office visit, returning patient (complex) | <1% | 651 | $23K |
| 99231 | Subsequent hospital care, per day, straightforward or low complexity | <1% | 1,939 | $23K |
| 90962 | <1% | 309 | $16K | |
| 99457 | <1% | 1,447 | $13K | |
| 99458 | <1% | 1,001 | $13K | |
| 37225 | <1% | 12 | $11K | |
| 77001 | <1% | 250 | $9K | |
| G2211 | Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient's single, serious condition or a complex condition. (add-on code, list separately in addition to office/outpatient evaluation and management visit, new or established) | <1% | 2,513 | $7K |
| 99205 | Prolong outpt/office vis | <1% | 92 | $7K |
| 36821 | <1% | 37 | $7K | |
| 99454 | <1% | 525 | $6K | |
| 99442 | <1% | 280 | $5K | |
| 99153 | Mod sedat endo service >5yrs | <1% | 338 | $3K |
| 90970 | <1% | 304 | $2K | |
| 36558 | <1% | 12 | $1K | |
| 99203 | Doctor's office visit, new patient (routine) | <1% | 26 | $1K |
| 93925 | <1% | 40 | $1K | |
| J0885 | Injection, epoetin alfa, (for non-esrd use), 1000 units | <1% | 73 | $1K |
| Q9967 | Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml | <1% | 299 | $918.96 |
| 96372 | Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular | <1% | 244 | $774.02 |
| 99497 | <1% | 62 | $673.37 | |
| 76937 | <1% | 52 | $577.55 | |
| 75625 | <1% | 12 | $546.23 | |
| 99212 | Office or other outpatient visit for the evaluation and management of an established patient, straightforward | <1% | 30 | $454.25 |
| 99349 | <1% | 25 | $378.67 | |
| J2250 | Injection, midazolam hydrochloride, per 1 mg | <1% | 189 | $346.08 |
| 99453 | <1% | 129 | $325.78 | |
| 93923 | <1% | 13 | $301.33 | |
| 0061U | <1% | 127 | $110.44 | |
| J3010 | Injection, fentanyl citrate, 0.1 mg | <1% | 82 | $86.54 |
| G9500 | Radiation exposure indices documented in final report for procedure using fluoroscopy | 0% | 537 | $0.00 |
| G8427 | Eligible clinician attests to documenting in the medical record they obtained, updated, or reviewed the patient's current medications | 0% | 311 | $0.00 |
| 90756 | 0% | 19 | $0.00 | |
| 99443 | 0% | 17 | $0.00 |
Claims and beneficiary counts add up across code × month rows, so one patient seen every month counts many times. Rows with fewer than 12 claims are suppressed by HHS, so small lines can be missing.
From NPPES
Who's on the registration
Authorized officialEDELSTEIN, SHAUN (CFO)