With over 70% of the world population projected to live in urban areas by 2030, the role of cities in sustainable development is gaining greater momentum. Creating healthy and livable communities have become a priority in many regions, giving birth to several neighborhood sustainability assessment tools. Yet, these tools largely fail to consider and integrate the four pillars of sustainability namely, environmental, social, economic, and institutional dimensions in a balanced, equitable manner. Without a detailed analysis of the most recent versions of widely used NSA tools, the impact of these tools toward sustainability may be inaccurately measured and reported. Besides, it is crucial to understand the various credits implemented and/or ignored by stakeholders using such tools. With a balanced approach in mind, this paper examines five NSA tools and addresses four objectives namely, (1) to fill the gap in current literature by using the most up-to-date versions of NSA tools in the analysis; (2) to examine the current rating systems’ ability to define the goals of sustainability and to measure their progress; (3) to identify which sustainability criteria are applied most frequently by stakeholders and which ones are ignored; and (4) to offer timely and imminent issues relevant to current NSA tools. The first three objectives listed above are dealt with using actual projects implemented, i.e., data from 115 projects, one of the largest dataset used in any study at this time. Using the results from the analysis, this paper concludes with a series of recommendations for a balanced approach to NSA.