Medicaid Provider Spending

$1.09 trillion in Medicaid claims data, 2018–2024 · 617K+ providers

MERCY PHYSICIAN NETWORK

NPI: 1023056744 · MUSKEGON, MI 49445 · Internal Medicine Physician · NPI assigned 06/03/2006

Billing Flags · Automated signals — not evidence of fraud
Entity Proliferation

Authorized official GUSHO, MICHAEL controls 20+ related entities in our dataset. Read more

$11.14M
Total Medicaid Paid
345,652
Total Claims
325,092
Beneficiaries
87
Codes Billed
2018-01
First Month
2024-12
Last Month

Provider Details

Authorized OfficialGUSHO, MICHAEL (CHIEF FINANCIAL OFFICER)
Parent OrganizationMERCY HEALTH PARTNERS
NPI Enumeration Date06/03/2006

Related Entities

Other providers sharing the same authorized official: GUSHO, MICHAEL

ProviderCityStateTotal Paid
ST JOSEPH MERCY HOSPITAL YPSILANTI MI $65.22M
ST JOSEPH MERCY HOSPITAL-SMHC PONTIAC MI $51.85M
TRINITY HEALTH-MICHIGAN ST MARY MERCY HOSPITAL DIVISION LIVONIA MI $27.75M
SAINT JOSEPH MERCY LIVINGSTON HOSPITAL HOWELL MI $18.28M
ST JOSEPH MERCY CHELSEA INC CHELSEA MI $6.89M
MERCY HEALTH PARTNERS - PHYSICIAN SPECIALIST MUSKEGON MI $5.34M
MERCY SPECIALTY SERVICES MUSKEGON MI $5.27M
MERCY HEALTH PARTNERS-OBSTETRICS AND GYNECOLOGY SPECIALIST MUSKEGON MI $1.67M
MERCY HEALTH WESTSHORE CARDIOLOGY SERVICES MUSKEGON MI $1.56M
MERCY HEALTH PARTNERS SUB-SPECIALTY SERVICES MUSKEGON MI $1.38M
SAINT MARY'S HEALTH SERVICES GRAND RAPIDS MI $1.22M
MERCY WOMEN'S HEALTH SERVICES MUSKEGON MI $1.08M
ST JOSEPH MERCY HOSPITAL YPSILANTI MI $653K
CHELSEA COMMUNITY HOSPITAL CHELSEA MI $597K
ST JOSEPH MERCY HOSPITAL CANTON MI $474K
SJMHS ANESTHESIA SERVICES YPSILANTI MI $459K
LAKES OBGYN SPECIALIST NORTON SHORES MI $425K
CHELSEA COMMUNITY HOSPITAL CHELSEA MI $223K
JOHNSON FAMILY CENTER FOR CANCER CARE MUSKEGON MI $156K
ST MARY MERCY HOSPITAL CRNA LIVONIA MI $102K

Monthly Spending Trend

Yearly Breakdown

YearClaimsTotal Paid
2018 45,020 $1.52M
2019 47,094 $1.51M
2020 30,454 $1.09M
2021 46,681 $1.51M
2022 52,316 $1.76M
2023 60,422 $2.09M
2024 63,665 $1.65M

Billing Codes

CodeDescriptionClaimsBeneficiariesTotal Paid
99214 Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity 85,287 80,593 $4.97M
99213 Office or other outpatient visit for the evaluation and management of an established patient, low complexity 65,910 61,306 $2.62M
99396 Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years 8,600 8,498 $607K
99215 Prolong outpt/office vis 6,402 6,194 $556K
99395 Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years 8,394 8,333 $537K
99204 Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity 3,753 3,730 $329K
99394 Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) 3,772 3,722 $238K
99393 Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) 4,197 4,172 $236K
99392 Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) 4,205 4,153 $234K
99391 Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) 4,513 4,170 $218K
99203 Office or other outpatient visit for the evaluation and management of a new patient, low complexity 2,423 2,397 $126K
93010 Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only 16,748 14,710 $71K
99308 Subsequent nursing facility care, per day, straightforward 1,836 1,302 $39K
99309 Subsequent nursing facility care, per day, low to moderate complexity 964 874 $36K
G9002 Coordinated care fee, maintenance rate 2,675 2,332 $34K
17110 735 652 $29K
99385 399 398 $28K
98967 3,787 3,028 $21K
98966 8,348 6,682 $20K
99406 3,448 3,334 $19K
99495 258 253 $17K
99212 Office or other outpatient visit for the evaluation and management of an established patient, straightforward 878 804 $17K
G9007 Coordinated care fee, scheduled team conference 1,440 1,116 $16K
99205 Prolong outpt/office vis 122 122 $16K
99238 Hospital discharge day management, 30 minutes or less 255 252 $13K
99307 960 623 $10K
99496 109 107 $10K
99460 171 170 $10K
99381 141 140 $8K
98968 1,201 967 $7K
20610 274 257 $7K
99383 88 88 $5K
99442 273 268 $5K
93016 412 405 $4K
98926 182 167 $4K
99356 123 110 $3K
93018 413 406 $3K
99350 Prolong home eval add 15m 27 25 $2K
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) 491 478 $2K
99310 Prolong nursin fac eval 15m 20 20 $1K
99202 Office or other outpatient visit for the evaluation and management of a new patient, straightforward 44 44 $1K
98925 98 94 $1K
99349 18 15 $1K
90837 Psychotherapy, 53 minutes with patient 16 13 $1K
90471 Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine 501 490 $1K
99386 13 13 $1K
90686 326 319 $1K
99443 70 67 $955.70
98928 29 27 $923.34
90834 Psychotherapy, 45 minutes with patient 14 12 $493.86
99417 Prolong home eval add 15m 13 12 $493.64
G2212 Prolonged office or other outpatient evaluation and management service(s) beyond the maximum required time of the primary procedure which has been selected using total time on the date of the primary service; each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (list separately in addition to cpt codes 99205, 99215, 99483 for office or other outpatient evaluation and management services) (do not report g2212 on the same date of service as 99358, 99359, 99415, 99416). (do not report g2212 for any time unit less than 15 minutes) 17 15 $440.14
Q0091 Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory 39 38 $381.75
93272 38 37 $370.76
99441 60 58 $341.17
98927 13 12 $336.16
99305 13 12 $312.02
87880 Infectious agent antigen detection by immunoassay; Streptococcus, group A 15 14 $108.26
99211 Office or other outpatient visit for the evaluation and management of an established patient, minimal severity 14 14 $67.74
36415 Collection of venous blood by venipuncture 26 25 $51.60
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit 13 13 $46.25
3074F 29,739 28,486 $25.01
81002 12 12 $11.08
3008F 5,504 5,301 $0.01
3079F 10,632 10,393 $0.01
3075F 5,996 5,896 $0.01
3078F 26,035 25,061 $0.01
3080F 2,029 1,966 $0.00
3052F 388 370 $0.00
S0250 Comprehensive geriatric assessment and treatment planning performed by assessment team 3,365 3,342 $0.00
3044F 5,458 5,171 $0.00
G8510 Screening for depression is documented as negative, a follow-up plan is not required 1,341 1,240 $0.00
G8754 Most recent diastolic blood pressure < 90 mmhg 1,288 1,228 $0.00
1111F 42 41 $0.00
4000F 63 52 $0.00
G8755 Most recent diastolic blood pressure >= 90 mmhg 14 14 $0.00
G9920 Screening performed and negative 1,379 1,374 $0.00
G8431 Screening for depression is documented as being positive and a follow-up plan is documented 165 150 $0.00
G8417 Bmi is documented above normal parameters and a follow-up plan is documented 1,251 1,186 $0.00
3288F 16 15 $0.00
3051F 819 775 $0.00
3077F 2,929 2,840 $0.00
3046F 521 483 $0.00
G8752 Most recent systolic blood pressure < 140 mmhg 922 879 $0.00
99001 13 13 $0.00
3045F 27 24 $0.00
G8753 Most recent systolic blood pressure >= 140 mmhg 80 78 $0.00