1063431195

1063431195 was paid $988K by Medicaid between Jan 2018 and Feb 2019, across 3 billing codes. Its largest line is 90378, — 71% of everything it billed.

33Billing provider info1063431195

33aNPI1063431195

33bProvider type—

28Total paid$988K

24GClaims399

24DCodes billed3

24AFirst – last monthJan 2018 – Feb 2019

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	334	$833K
2019	65	$155K

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
90378		71%	282	159	$703K
J2357	Injection, omalizumab, 5 mg	15%	44	27	$148K
J1729	Injection, hydroxyprogesterone caproate, not otherwise specified, 10 mg	14%	73	68	$138K

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.