Individual provider Active NPI

Carlos Daniel Martinez Balzano, M.D.

  • Pulmonary Disease Physician
  • Syracuse, NY
National Provider Identifier
1497073555
Registry record updated Oct 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
281662 Issued in NY
Practice address
750 E Adams St
Suny Upstate Medical University
Syracuse, NY 13210-2306
Phone
(315) 464-5540
NPI assigned
May 13, 2010
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 27, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 281662 NY
Pulmonary Disease Physician 207RP1001X 281662 NY Primary

Addresses

Primary practice location

750 E Adams St
Suny Upstate Medical University
Syracuse, NY 13210-2306

Mailing address

750 E Adams St
Syracuse, NY 13210-2306

Other identifiers 1

IdentifierTypeStateIssuer
04427083MedicaidNY

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, CA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20160819000128 NY Practitioner - Pulmonary DiseasePractitioner - Internal Medicine 1355574526 Reassigns benefits to 2 organizations
I20230922001979 CA Practitioner - Internal Medicine 1355574526 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southern California Permanente Medical GroupGroup PAC ID 6002729175, 11,250 clinicians

Practice addresses (Care Compare)

9961 Sierra Ave
Fontana, CA 92335-6720
Phone (909) 427-5000

Hospital & facility affiliations

  • Sequoia Hospital Hospital, Redwood City, CA, CCN 050197
  • Kaiser Foundation Hospital Fontana/Ontario Hospital, Fontana, CA, CCN 050140

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Upstate Community Medical, PC CurrentSince Jun 1, 2019 Accepting new patients
Southern California Permanente Medical Group CurrentSince Aug 11, 2023 Accepting new patients
Southern California Permanente Medical Group CurrentSince Aug 11, 2023 Accepting new patients
Southern California Permanente Medical Group Current Accepting new patients
Department of Medicine Medical Serv GRP at Suny HLTH Sci Ctr Syr in Internal Medicine CurrentSince Jul 1, 2016 Accepting new patients
H Lee Moffitt Cancer Ctr & Res Inst Life Time Cancer SCRN Ctr Inc Current Accepting new patients
Department of Medicine Medical Service Group CurrentSince Jul 1, 2016 Accepting new patients

Locations

9961 Sierra Ave
Fontana, CA 92335
Phone (909) 427-3910

393 E Walnut St
Fl 3
Pasadena, CA 91188
Phone (626) 405-7914

17 Lansing St
Sennett, NY 13021
Phone (315) 255-7011

750 E Adams St
Syracuse, NY 13210
Phone (315) 464-4363

4900 Broad Rd
Syracuse, NY 13215
Phone (315) 492-5011

251 Salina Meadows Pkwy
Ste 100
Syracuse, NY 13212
Phone (315) 464-2000

4900 Broad Rd
Ste 4H
Syracuse, NY 13215
Phone (315) 492-5678

1001 W Fayette St
Ste 400
Syracuse, NY 13204
Phone (315) 472-1488

Networks

  • Freedom Health HMO Network

Interoperability endpoints

  • Direct secure messaging: carlos.martinezbalzano@direct.moffitt.org

Organizations & group practices 7

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 2

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": "1273708800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698364800000",
    "number": "1497073555",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "750 E ADAMS ST",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132102306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 E ADAMS ST",
            "address_2": "SUNY UPSTATE MEDICAL UNIVERSITY",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132102306",
            "telephone_number": "315-464-5540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTINEZ BALZANO",
        "first_name": "CARLOS",
        "middle_name": "DANIEL",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-05-13",
        "last_updated": "2023-10-27",
        "certification_date": "2020-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "281662",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "NY",
            "license": "281662",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04427083",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "9961 Sierra Ave",
            "city": "Fontana",
            "state": "CA",
            "country_code": "US",
            "postal_code": "923356720",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Syracuse, NY

Sources for this page

Verify at the official NPI Registry.