Individual provider Active NPI

Brian J Niedbalski, MD

  • Family Medicine Physician
  • Columbus, IN
National Provider Identifier
1124040589
Registry record updated Sep 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
01050916A Issued in IN
Practice address
4001 W Goeller Blvd Ste a
Columbus, IN 47201-8309
Phone
(812) 375-3330
Fax
(812) 375-3329
NPI assigned
Jul 24, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 01050916A IN Primary

Addresses

Primary practice location

4001 W Goeller Blvd Ste a
Columbus, IN 47201-8309

Mailing address

PO Box 775383
Chicago, IL 60677-5383
Phone (812) 376-5315

Other identifiers 3

IdentifierTypeStateIssuer
000000983450OtherINANTHEM PIN
200317250MedicaidIN
080170664OtherMEDICARE RR

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address bniedbalski7773@edirect.crh.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100726000774 IN Practitioner - Family Practice 1759414857 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Indiana University School of Medicine, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Columbus Regional Health Physicians LLCGroup PAC ID 1052612314, 216 clinicians

Practice addresses (Care Compare)

2400 17TH St
Columbus, IN 47201-5351
Phone (812) 376-5974

4001 W Goeller Blvd
Suite a
Columbus, IN 47201-8309
Phone (812) 375-3330

Hospital & facility affiliations

  • American Nursing Care LLC Home health agency, Columbus, IN, CCN 157077
  • Our Hospice of South Central Indiana Inc Hospice, Columbus, IN, CCN 151502
  • Columbus Regional Hospital Hospital, Columbus, IN, CCN 150112

Merit-based Incentive Payment System (MIPS)

Final score
93.97 of 100Reported as apm
Quality
85.1
Promoting interoperability
94.69
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
01050916AINMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Columbus Regional Health Physicians, LLC CurrentSince Jan 1, 2016 Accepting new patients
Bartholomew County Auditor CurrentSince Jul 1, 2012 Accepting new patients
Columbus Regional Health Physicians, LLC Family Medicine CurrentSince Jan 1, 2016 Accepting new patients
Columbus Regional Health Physicians, LLC Family Medicine Current Accepting new patients
Major Hospital Past Accepting new patients
Columbus Regional Health Physicians, LLC Family Medicine Past Accepting new patients

Locations

2625 Fox Pointe Dr
Columbus, IN 47203
Phone (812) 314-2378

3201 Middle Rd
Columbus, IN 47203
Phone (812) 372-4956

2400 17th St
Columbus, IN 47201
Phone (812) 373-3025

4001 W Goeller Blvd
Ste A
Columbus, IN 47201
Phone (812) 342-2100

Interoperability endpoints

  • Direct secure messaging: bniedbalski7773@edirect.crh.org

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725840000000",
    "number": "1124040589",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 775383",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606775383",
            "telephone_number": "812-376-5315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4001 W GOELLER BLVD STE A",
            "city": "COLUMBUS",
            "state": "IN",
            "postal_code": "472018309",
            "telephone_number": "812-375-3330",
            "fax_number": "812-375-3329"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIEDBALSKI",
        "first_name": "BRIAN",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-24",
        "last_updated": "2024-09-09",
        "certification_date": "2024-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01050916A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM PIN",
            "identifier": "000000983450",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200317250",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RR",
            "identifier": "080170664",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bniedbalski7773@edirect.crh.org",
            "affiliation": "N",
            "endpointDescription": "Direct Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Direct Address",
            "address_1": "4001 W Goeller Blvd Ste A",
            "city": "Columbus",
            "state": "IN",
            "country_code": "US",
            "postal_code": "472018309",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Columbus, IN

Sources for this page

Verify at the official NPI Registry.