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NPI 1043869340
NPI deactivated
1043869340
1043869340 was paid $40K by Medicaid between Jul 2020 and Nov 2024, across 13 billing codes. Its largest line is 90686, — 33% of everything it billed.
33Billing provider info1043869340
33aNPI1043869340
33bProvider type—
28Total paid$40K
24GClaims2,755
24DCodes billed13
24AFirst – last monthJul 2020 – Nov 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 | |
|---|---|---|---|
| 2020 | 2,136 | $22K | |
| 2021 | 297 | $8K | |
| 2022 | 172 | $4K | |
| 2023 | 69 | $2K | |
| 2024incomplete | 81 | $3K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| 90686 | 33% | 937 | 873 | $13K | |
| 90471 | Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine | 29% | 1,071 | 1,050 | $12K |
| 0064A | 9.2% | 95 | 95 | $4K | |
| 91322 | 8.4% | 25 | 25 | $3K | |
| 0134A | 4.8% | 46 | 46 | $2K | |
| 90674 | 4.4% | 71 | 71 | $2K | |
| 0012A | 3.7% | 35 | 35 | $1K | |
| 0011A | 3.2% | 32 | 32 | $1K | |
| 90480 | 2.6% | 26 | 26 | $1K | |
| 90661 | <1% | 15 | 15 | $384.01 | |
| 90654 | 0% | 28 | 28 | $0.00 | |
| K1034 | Provision of covid-19 test, nonprescription self-administered and self-collected use, fda approved, authorized or cleared, one test count | 0% | 12 | 12 | $0.00 |
1 more codes
| S9430 | Pharmacy compounding and dispensing services | 0% | 362 | $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.