NPI: 1003453119 · PRAIRIE DU CHIEN, WI 53821 · Rural Health Clinic/Center · NPI assigned 12/09/2019
Authorized official BORTNEM, MARK controls 20+ related entities in our dataset. Read more
| Authorized Official | BORTNEM, MARK (CHIEF FINANCIAL OFFICER) |
| Parent Organization | MAYO CLINIC HEALTH SYSTEM-SOUTHWEST WISCONSIN REGION, INC. |
| NPI Enumeration Date | 12/09/2019 |
Other providers sharing the same authorized official: BORTNEM, MARK
| Year | Claims | Total Paid |
|---|---|---|
| 2021 | 705 | $26K |
| 2022 | 1,390 | $60K |
| 2023 | 1,299 | $57K |
| 2024 | 745 | $34K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| 99214 | Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity | 1,942 | 1,639 | $106K |
| 99213 | Office or other outpatient visit for the evaluation and management of an established patient, low complexity | 1,612 | 1,443 | $46K |
| 90834 | Psychotherapy, 45 minutes with patient | 426 | 299 | $23K |
| 99394 | Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) | 16 | 15 | $960.45 |
| G2025 | Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only | 30 | 14 | $617.95 |
| G2211 | Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient's single, serious condition or a complex condition. (add-on code, list separately in addition to office/outpatient evaluation and management visit, new or established) | 49 | 45 | $85.09 |
| 90734 | 15 | 14 | $48.38 | |
| 36415 | Collection of venous blood by venipuncture | 49 | 42 | $0.00 |