NP / PA
South Polk Medical Clinic LLC
South Polk Medical Clinic LLC was paid $665K by Medicaid between Jun 2018 and Dec 2024, across 47 billing codes. Its largest line is 99091, — 21% of everything it billed.
33Billing provider infoSOUTH POLK MEDICAL CLINIC LLC
DALLAS, TX 75224
DALLAS, TX 75224
33aNPI1043351760assigned 02/08/2007
33bProvider typeNurse Practitioner
28Total paid$665K
24GClaims29,838
24DCodes billed47
24AFirst – last monthJun 2018 – Dec 2024
Compared with peers
Next to other Nurse Practitioner providers in Texas
Rank by total paid#18 of 142
Median peer was paid$25K
This provider vs. median26×
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 | 12 | $259.88 | |
| 2019 | 17 | $298.59 | |
| 2020 | 2,198 | $35K | |
| 2021 | 6,453 | $100K | |
| 2022 | 6,591 | $140K | |
| 2023 | 5,346 | $156K | |
| 2024incomplete | 9,221 | $234K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| 99091 | 21% | 1,070 | 1,024 | $142K | |
| 99213 | Doctor's office visit, returning patient (routine)Office or other outpatient visit for the evaluation and management of an established patient, low complexity | 20% | 4,587 | 4,076 | $130K |
| 99394 | Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) | 15% | 1,360 | 1,222 | $98K |
| 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 | 11% | 1,902 | 1,708 | $72K |
| 99393 | Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) | 8.5% | 809 | 745 | $56K |
| 90460 | Immunization administration through 18 years of age via any route, first or only component | 5.1% | 3,999 | 1,430 | $34K |
| 99000 | 3.5% | 2,981 | 2,649 | $24K | |
| 99392 | Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) | 2.4% | 266 | 226 | $16K |
| 87635 | Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe | 2.0% | 315 | 281 | $13K |
| 99395 | Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years | 1.7% | 192 | 175 | $11K |
| 87804 | Infectious agent antigen detection by immunoassay; Influenza, each type | 1.3% | 718 | 333 | $9K |
| 87880 | Infectious agent antigen detection by immunoassay; Streptococcus, group A | 1.1% | 639 | 556 | $7K |
35 more codes
| 87426 | Infectious agent antigen detection, SARS-CoV-2 (COVID-19) | 1.0% | 171 | $7K |
| J1050 | Injection, medroxyprogesterone acetate, 1 mg | <1% | 116 | $6K |
| 81003 | <1% | 2,826 | $5K | |
| 81025 | <1% | 826 | $5K | |
| 99212 | Office or other outpatient visit for the evaluation and management of an established patient, straightforward | <1% | 206 | $4K |
| 90471 | Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine | <1% | 359 | $4K |
| 94010 | <1% | 212 | $3K | |
| 96372 | Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular | <1% | 380 | $3K |
| 92551 | <1% | 455 | $3K | |
| 90472 | Immunization administration, each additional vaccine (list separately) | <1% | 252 | $3K |
| 90461 | <1% | 435 | $2K | |
| 96160 | <1% | 1,384 | $2K | |
| 93000 | <1% | 153 | $1K | |
| G2023 | Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source | <1% | 96 | $1K |
| G0444 | Annual depression screening, 5 to 15 minutes | <1% | 249 | $1K |
| 96110 | Developmental screening, with scoring and documentation, per standardized instrument | <1% | 86 | $576.22 |
| 94640 | Pressurized or nonpressurized inhalation treatment for acute airway obstruction | <1% | 55 | $513.07 |
| 90619 | <1% | 71 | $335.40 | |
| 90715 | <1% | 91 | $100.74 | |
| 90658 | <1% | 286 | $93.28 | |
| A7003 | Administration set, with small volume nonfiltered pneumatic nebulizer, disposable | <1% | 94 | $52.85 |
| 90651 | <1% | 238 | $15.27 | |
| J7611 | Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, 1 mg | <1% | 48 | $8.26 |
| 90734 | <1% | 97 | $0.28 | |
| 90620 | <1% | 141 | $0.25 | |
| 90677 | <1% | 12 | $0.07 | |
| 90656 | <1% | 18 | $0.04 | |
| 90710 | 0% | 17 | $0.00 | |
| 99173 | 0% | 593 | $0.00 | |
| 90700 | 0% | 89 | $0.00 | |
| 90649 | 0% | 16 | $0.00 | |
| G8510 | Screening for depression is documented as negative, a follow-up plan is not required | 0% | 117 | $0.00 |
| 96127 | 0% | 753 | $0.00 | |
| 99459 | 0% | 42 | $0.00 | |
| 90696 | 0% | 16 | $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 officialROBERTS, EL GRECO (VICE PRESIDENT OF BUSINESS AFFAIRS)