Risk scores are statistical indicators based on prescribing patterns compared to specialty peers. They are NOT allegations of fraud, misconduct, or improper care. Many legitimate medical reasons can explain outlier prescribing.
Read our methodology →Edward Albert BalbasM.D.
Physical Medicine and Rehabilitation · Colton, CA 92324
NPI: 1629062435
38
🟠 Elevated
🚫 This provider appears on the OIG List of Excluded Individuals/Entities (LEIE)
Exclusion type: 1128a3 · Date: 04/18/2024 · State: CA
Risk Flags
Risk indicators are statistical patterns, not allegations. Learn more
216
Total Claims
$24K
Drug Cost
19
Beneficiaries
$1,254
Cost/Patient
Risk Score Breakdown 38/100
Score components are additive. Read full methodology
Peer Comparison vs. 7,404 Physical Medicine and Rehabilitation providers
+147%
Opioid rate vs peers
50.0% vs 20.2% avg
+175%
Cost per patient vs peers
$1,254 vs $455 avg
🔎 Data Overview
This provider appears on the federal OIG exclusion list, meaning they have been formally barred from participating in federal healthcare programs due to fraud, patient abuse, licensing issues, or other misconduct. The fact that they still appear in active prescribing data is a significant concern.
Insights generated from CMS data analysis. Statistical patterns are not accusations — always consider clinical context.
Opioid Prescribing
50.0%
Opioid Rate
108
Opioid Claims
$18K
Opioid Cost
41.7%
Long-Acting Rate
This provider's opioid prescribing rate of 50.0% is above the 20% threshold that CMS considers elevated.
Brand vs Generic
Brand: 0 claims · $0
Generic: 206 claims · $20K
Patient Profile
63
Avg Age
—
Female
1.67
Avg Risk Score
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Data from CMS Medicare Part D Prescriber Public Use File, 2023. Risk scores are statistical indicators, not allegations of wrongdoing.Methodology · About · Dispute this data