Home ›
NPI 1043389042
NPI deactivated
1043389042
1043389042 was paid $1.42M by Medicaid between Jan 2018 and Jun 2024, across 33 billing codes. Its largest line is 99394, Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) — 22% of everything it billed.
33Billing provider info1043389042
33aNPI1043389042
33bProvider type—
28Total paid$1.42M
24GClaims51,935
24DCodes billed33
24AFirst – last monthJan 2018 – Jun 2024
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 | 103 | $2K | |
| 2019 | 43 | $337.12 | |
| 2020 | 2,922 | $73K | |
| 2021 | 15,848 | $390K | |
| 2022 | 15,814 | $417K | |
| 2023 | 12,054 | $375K | |
| 2024incomplete | 5,151 | $161K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| 99394 | Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) | 22% | 3,318 | 3,192 | $310K |
| 99393 | Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) | 19% | 3,209 | 3,101 | $277K |
| 99392 | Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) | 13% | 2,213 | 2,159 | $181K |
| 99212 | Office or other outpatient visit for the evaluation and management of an established patient, straightforward | 12% | 6,381 | 5,904 | $167K |
| 99213 | Doctor's office visit, returning patient (routine)Office or other outpatient visit for the evaluation and management of an established patient, low complexity | 10% | 3,690 | 3,537 | $146K |
| 90460 | Immunization administration through 18 years of age via any route, first or only component | 8.4% | 11,849 | 5,534 | $119K |
| 99391 | Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) | 4.3% | 754 | 738 | $61K |
| 99395 | Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years | 3.0% | 484 | 469 | $42K |
| 99211 | Office or other outpatient visit for the evaluation and management of an established patient, minimal severity | 2.3% | 2,095 | 2,028 | $33K |
| 86580 | 2.1% | 3,726 | 3,606 | $30K | |
| 87880 | Infectious agent antigen detection by immunoassay; Streptococcus, group A | 1.2% | 1,144 | 1,102 | $16K |
| 96110 | Developmental screening, with scoring and documentation, per standardized instrument | <1% | 1,095 | 911 | $10K |
21 more codes
| 90620 | <1% | 1,118 | $7K | |
| 90461 | <1% | 1,290 | $6K | |
| 99381 | <1% | 66 | $6K | |
| 99000 | <1% | 253 | $3K | |
| 99382 | <1% | 28 | $3K | |
| 87804 | Infectious agent antigen detection by immunoassay; Influenza, each type | <1% | 136 | $2K |
| 90651 | <1% | 1,928 | $2K | |
| 90471 | Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine | <1% | 61 | $509.95 |
| 90658 | <1% | 986 | $347.67 | |
| 96161 | <1% | 17 | $41.56 | |
| 90734 | <1% | 1,015 | $0.12 | |
| 90715 | <1% | 327 | $0.02 | |
| 90716 | 0% | 505 | $0.00 | |
| 90723 | 0% | 195 | $0.00 | |
| 90680 | 0% | 446 | $0.00 | |
| 90633 | 0% | 495 | $0.00 | |
| 90670 | 0% | 1,004 | $0.00 | |
| 90700 | 0% | 671 | $0.00 | |
| 90707 | 0% | 467 | $0.00 | |
| 90648 | 0% | 808 | $0.00 | |
| 90713 | 0% | 161 | $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.