Managed care
Prospect Professional Care Medical Group, INC.
Prospect Professional Care Medical Group, INC. was paid $10K by Medicaid between Jan 2018 and Sep 2018, across 44 billing codes. Its largest line is 99213, doctor's office visit, returning patient (routine) — 23% of everything it billed.
33Billing provider infoPROSPECT PROFESSIONAL CARE MEDICAL GROUP, INC.
SANTA ANA, CA 92705
SANTA ANA, CA 92705
33aNPI1043331614assigned 04/02/2007
33bProvider typeHealth Maintenance Organization
28Total paid$10K
24GClaims6,166
24DCodes billed44
24AFirst – last monthJan 2018 – Sep 2018
Compared with peers
Next to other Health Maintenance Organization providers in California
Rank by total paid#100 of 151
Median peer was paid$59K
This provider vs. median0.2×
Peers share this provider's primary NPPES type and state. Size alone says nothing about billing quality: a big agency or a hospital system is expected to sit far above the median.
Box 24A · Dates of service
Paid by month
Paid that monthNov–Dec 2024: claims still arriving when the file was cut, so these months run low for every provider
By year, as a table
| Year | Claims | Paid | |
|---|---|---|---|
| 2018 | 6,166 | $10K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| 99213 | Doctor's office visit, returning patient (routine)Office or other outpatient visit for the evaluation and management of an established patient, low complexity | 23% | 166 | 149 | $2K |
| 99214 | Doctor's office visit, returning patient (more involved)Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity | 20% | 64 | 62 | $2K |
| A0429 | Emergency ambulance ride, basic life supportAmbulance service, basic life support, emergency transport (bls-emergency) | 17% | 14 | 12 | $2K |
| 87491 | Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe | 16% | 186 | 184 | $2K |
| 83036 | Hemoglobin; glycosylated (A1C) | 11% | 469 | 467 | $1K |
| 85025 | Blood count; complete (CBC), automated, and automated differential WBC count | 7.8% | 671 | 640 | $812.45 |
| 84443 | Thyroid stimulating hormone (TSH) | 2.1% | 504 | 500 | $217.70 |
| 80053 | Comprehensive metabolic panel | 1.1% | 642 | 620 | $116.11 |
| 83540 | <1% | 13 | 13 | $78.55 | |
| 85652 | <1% | 52 | 49 | $75.33 | |
| 87340 | <1% | 26 | 26 | $59.62 | |
| 88175 | Cytopathology, cervical or vaginal, any reporting system; collected in preservative fluid, automated thin layer | <1% | 12 | 12 | $23.50 |
32 more codes
| 84439 | <1% | 139 | $22.67 | |
| 86592 | <1% | 152 | $19.20 | |
| 87086 | Culture, bacterial; quantitative colony count, urine | <1% | 109 | $9.76 |
| 81003 | <1% | 305 | $1.74 | |
| 99211 | Office or other outpatient visit for the evaluation and management of an established patient, minimal severity | 0% | 32 | $0.00 |
| A0425 | Ground mileage, per statute mile | 0% | 124 | $0.00 |
| 80061 | Lipid panel | 0% | 525 | $0.00 |
| 1159F | 0% | 27 | $0.00 | |
| 80076 | 0% | 12 | $0.00 | |
| 84550 | 0% | 46 | $0.00 | |
| 82570 | 0% | 12 | $0.00 | |
| 77067 | Screening mammography, bilateral, including computer-aided detection | 0% | 12 | $0.00 |
| 87186 | 0% | 12 | $0.00 | |
| 84436 | 0% | 169 | $0.00 | |
| 2001F | 0% | 57 | $0.00 | |
| 82306 | Vitamin D; 25 hydroxy, includes fraction(s), if performed | 0% | 254 | $0.00 |
| 86803 | 0% | 27 | $0.00 | |
| 84153 | 0% | 35 | $0.00 | |
| 3008F | 0% | 113 | $0.00 | |
| 84479 | 0% | 135 | $0.00 | |
| 85027 | 0% | 57 | $0.00 | |
| 83550 | 0% | 12 | $0.00 | |
| 84480 | 0% | 40 | $0.00 | |
| 81001 | 0% | 31 | $0.00 | |
| 87389 | Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies | 0% | 107 | $0.00 |
| 36415 | Collection of venous blood by venipuncture | 0% | 436 | $0.00 |
| 82043 | 0% | 26 | $0.00 | |
| 0001F | 0% | 56 | $0.00 | |
| 87591 | Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe | 0% | 187 | $0.00 |
| 82607 | 0% | 50 | $0.00 | |
| 82746 | 0% | 35 | $0.00 | |
| 86140 | 0% | 13 | $0.00 |
Claims and beneficiary counts add up across code × month rows, so one patient seen every month counts many times. Rows with fewer than 12 claims are suppressed by HHS, so small lines can be missing.
From NPPES
Who's on the registration
Authorized officialKAM, LILY (CFO)
| Provider | Location | Paid |
|---|---|---|
| Prospect Medical Group, INC. | Orange, CA | $209K |
| Prospect Healthsource Medical Group INC | Orange, CA | $571.69 |
| Nuestra Familia Medical Group INC | Orange, CA | $71.72 |
Matched on the authorized-official name exactly as entered in NPPES. A common name can match unrelated people.