Physician

Gautam Balakrishnan, MD

According to 2025 Medicare claims, Gautam Balakrishnan, MD (NPI: 1609214519) practices pulmonary disease in the St. Joseph, MO-KS market, with the plurality of this provider's patient population coming from Buchanan, MO. This provider's primary affiliated billing organization is HEARTLAND REGIONAL MEDICAL CENTER (NPI: 1538200357; TIN: 440545289) and primary practice location at 64506-3488. Balakrishnan is affiliated with the Main Street Rural Health Maple ACO LLC (ACO ID: A5401), participating under the MSSP model.

Balakrishnan's data goes back to 2015 and runs through 2024. For example, in 2024, this provider had 645 traditional Medicare patients, billed 2,292 HCPCS/CPT codes, and received $147,610 in Medicare payments. The top billing code was 99214 (Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more). Part D data shows 1,605 prescription claims across 302 beneficiaries totaling $766,637 in drug costs, led by Ofev (Nintedanib Esylate). DME data shows 927 claims. Open Payments data shows 15 records totaling $2,753. You can download detailed data with all billing codes (2015-2024). For more recent data, please contact us.

Over the past 10 years, this provider's Medicare Part B carrier billing did not follow a clear longitudinal pattern. Concurrently, Part D prescription costs have risen steadily, from $3,588 to $766,637. For DME billing, reported payments did not follow a clear longitudinal pattern.

Part B Carrier Billing Trend

Medicare payment trend, with N of patients and claim lines in the table.

Year	Patients	Clm Lines	Payment
2015	N/R	N/R	N/R
2016	N/R	N/R	N/R
2017	N/R	N/R	N/R
2018	N/R	N/R	N/R
2019	195	866	$59,603
2020	523	2,604	$179,161
2021	542	2,359	$170,870
2022	529	2,104	$125,991
2023	578	2,111	$139,064
2024	645	2,292	$147,610

Part D Events Trend

Drug cost trend, with N of patients and prescription claims in the table.

Year	Patients	Claims	Drug Cost
2015	N/R	78	$3,588
2016	11	79	$3,917
2017	18	70	$21,362
2018	N/R	25	$7,128
2019	58	181	$38,340
2020	145	772	$153,593
2021	178	838	$359,570
2022	195	938	$551,770
2023	248	1,369	$616,077
2024	302	1,605	$766,637

DME Billing Trend

Medicare payment trend, with N of patients and DME claim records in the table.

Year	Patients	Claims	Payment
2015	N/R	N/R	N/R
2016	N/R	N/R	N/R
2017	N/R	N/R	N/R
2018	N/R	N/R	N/R
2019	N/R	N/R	N/R
2020	66	701	$95,825
2021	110	909	$130,822
2022	160	850	$97,314
2023	150	879	$87,648
2024	190	927	$90,074

* / # = suppressed by CMS; 0 = reported zero; N/R = not reported or blank.

Top 5 Part B carrier billing codes in 2024

By total payments.

Code	Description	Patients	Clm Lines	Total Payment
99214	Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	253	401	$69
99232	Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	210	540	$59
94726	Test to determine lung volumes using sensors	122	126	$8
94060	Test to measure expiratory airflow and volume changes before and after medication administration	117	120	$7
94729	Test to examine how well the lungs exchange gases	121	125	$6

Top 5 Part D drugs in 2024

By total drug costs.

Drug	Generic	Claims	Total Day Supply	Total Drug Cost
Ofev	Nintedanib Esylate	14	420	$182,043
Dupixent Pen	Dupilumab	15	560	$81,137
Trelegy Ellipta	Fluticasone/Umeclidin/Vilanter	49	2,190	$47,290
Spiriva Respimat	Tiotropium Bromide	60	2,460	$43,827
Breztri Aerosphere	Budesonide/Glycopyr/Formoterol	35	1,950	$40,584

Top 5 DME services in 2024

By Total Medicare Payment Amount.

HCPCS Code	HCPCS Description	Supplier Rental Indicator	Total Supplier Beneficiaries	Total Supplier Claims	Total Medicare Payment Amount
E0466	Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell)	Y	N/R	49	$46,076
E1390	Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate	Y	34	215	$16,313
J7606	Formoterol fumarate, inhalation solution, fda approved final product, non-compounded, administered through dme, unit dose form, 20 micrograms	N	N/R	33	$4,596
A7030	Full face mask used with positive airway pressure device, each	N	13	27	$2,498
A7031	Face mask interface, replacement for full face mask, each	N	12	31	$2,449

Open Payments Summary in 2024

Category	Definition	Records	Total Reported Amount	Top Related Entity
General Payments	Reported payment or transfer-of-value amount.	15	$2,753	Noah Medical Corporation
Research Payments	Reported research-related payment or transfer-of-value amount.	0	$0	N/R
Ownership / Investment Interests	Reported value of ownership or investment interests.	0	$0	N/R

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FAQ

What Medicare data is available for Gautam Balakrishnan, MD?

Tedicare shows public-source Medicare data for Gautam Balakrishnan, MD (NPI 1609214519), including provider identity, specialty, market context, Medicare Part B activity, Part D prescribing, DME records, Open Payments where available, billing organization details, and ACO affiliation signals where available. Profile data covers 2015-2024, with current attribution based on 2025 claims where available.

Does Gautam Balakrishnan, MD have ACO affiliation data?

Gautam Balakrishnan, MD is shown with ACO affiliation data for Main Street Rural Health Maple ACO LLC (MSSP, ACO ID A5401).

What billing organization is linked to Gautam Balakrishnan, MD?

Gautam Balakrishnan, MD is linked to HEARTLAND REGIONAL MEDICAL CENTER (billing NPI 1538200357) in the available physician profile data.

Does Gautam Balakrishnan, MD have Open Payments data?

Gautam Balakrishnan, MD has 15 connected Open Payments records in the available 2024 summary data.

Can I download physician-level Medicare data from Tedicare?

Yes. Tedicare provides sample physician export data and paid custom physician data exports for research, planning, outreach, and market analysis. Exports can include physician profile fields, market and specialty context, billing organization details, ACO affiliation signals where available, and Medicare utilization data.