Physician
San Lucas Pediatric Clinic, INC.
San Lucas Pediatric Clinic, INC. was paid $529K by Medicaid between Jan 2018 and Dec 2024, across 68 billing codes. Its largest line is 96110, Developmental screening, with scoring and documentation, per standardized instrument — 25% of everything it billed.
33Billing provider infoSAN LUCAS PEDIATRIC CLINIC, INC.
SACRAMENTO, CA 95834
SACRAMENTO, CA 95834
33aNPI1073870283assigned 04/12/2012
33bProvider typePediatrics Physician
28Total paid$529K
24GClaims353,443
24DCodes billed68
24AFirst – last monthJan 2018 – Dec 2024
Compared with peers
Next to other Pediatrics Physician providers in California
Rank by total paid#215 of 1,490
Median peer was paid$15K
This provider vs. median35×
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 | 38,474 | $163K | |
| 2019 | 67,517 | $8K | |
| 2020 | 52,305 | $242.84 | |
| 2021 | 66,587 | $70.00 | |
| 2022 | 65,552 | $31K | |
| 2023 | 31,882 | $215K | |
| 2024incomplete | 31,126 | $112K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| 96110 | Developmental screening, with scoring and documentation, per standardized instrument | 25% | 32,544 | 31,690 | $134K |
| 96156 | 17% | 18,225 | 18,116 | $91K | |
| 99393 | Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) | 13% | 9,708 | 9,437 | $67K |
| G9920 | Screening performed and negative | 11% | 5,479 | 5,471 | $59K |
| 99392 | Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) | 9.2% | 8,709 | 8,531 | $49K |
| 99394 | Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) | 3.9% | 5,973 | 5,846 | $21K |
| 99391 | Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) | 2.9% | 3,618 | 3,481 | $15K |
| 92551 | 2.4% | 20,006 | 19,441 | $13K | |
| G0447 | Face-to-face behavioral counseling for obesity, 15 minutes | 1.4% | 25,606 | 24,773 | $8K |
| 99383 | 1.3% | 550 | 497 | $7K | |
| 97802 | 1.2% | 23,917 | 23,224 | $6K | |
| 99213 | Doctor's office visit, returning patient (routine)Office or other outpatient visit for the evaluation and management of an established patient, low complexity | 1.1% | 16,148 | 15,404 | $6K |
56 more codes
| 99401 | 1.1% | 28,893 | $6K | |
| 99188 | 1.0% | 1,621 | $6K | |
| 86580 | <1% | 9,349 | $4K | |
| 85018 | <1% | 13,788 | $4K | |
| D0120 | Dental checkup, returning patient | <1% | 22,639 | $4K |
| 90686 | <1% | 8,667 | $4K | |
| 99173 | <1% | 20,403 | $3K | |
| 99211 | Office or other outpatient visit for the evaluation and management of an established patient, minimal severity | <1% | 4,114 | $3K |
| 90460 | Immunization administration through 18 years of age via any route, first or only component | <1% | 6,522 | $2K |
| 90651 | <1% | 2,857 | $2K | |
| 90471 | Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine | <1% | 8,123 | $2K |
| G9919 | Screening performed and positive and provision of recommendations | <1% | 159 | $2K |
| 97803 | <1% | 6,072 | $2K | |
| 90472 | Immunization administration, each additional vaccine (list separately) | <1% | 1,744 | $1K |
| 99382 | <1% | 182 | $1K | |
| 90716 | <1% | 2,680 | $737.84 | |
| 90733 | <1% | 523 | $692.53 | |
| 99212 | Office or other outpatient visit for the evaluation and management of an established patient, straightforward | <1% | 5,194 | $651.41 |
| 90670 | <1% | 3,526 | $576.92 | |
| 90461 | <1% | 5,925 | $548.27 | |
| 90744 | <1% | 1,931 | $480.03 | |
| 90707 | <1% | 2,576 | $452.35 | |
| 90633 | <1% | 3,019 | $411.30 | |
| 90700 | <1% | 2,051 | $319.43 | |
| 99384 | <1% | 197 | $318.53 | |
| 90710 | <1% | 55 | $275.20 | |
| 90619 | <1% | 403 | $267.00 | |
| 90620 | <1% | 1,337 | $200.00 | |
| 90680 | <1% | 1,934 | $188.72 | |
| 87502 | Infectious agent detection by nucleic acid, influenza virus, for multiple types or subtypes, includes all targets | <1% | 78 | $160.00 |
| 90697 | <1% | 215 | $157.08 | |
| 90685 | <1% | 610 | $153.24 | |
| 99214 | Doctor's office visit, returning patient (more involved) | <1% | 3,046 | $135.82 |
| D1206 | Topical application of fluoride varnish | <1% | 2,413 | $118.12 |
| 90696 | <1% | 1,139 | $116.40 | |
| 90713 | <1% | 792 | $111.35 | |
| 90715 | <1% | 1,282 | $95.27 | |
| 90698 | <1% | 1,553 | $89.86 | |
| 87880 | Infectious agent antigen detection by immunoassay; Streptococcus, group A | <1% | 374 | $55.36 |
| 90647 | <1% | 1,696 | $54.00 | |
| 90671 | <1% | 362 | $36.27 | |
| 90734 | <1% | 1,809 | $18.00 | |
| 90650 | 0% | 536 | $0.00 | |
| 94760 | 0% | 63 | $0.00 | |
| 86403 | 0% | 101 | $0.00 | |
| 90480 | 0% | 13 | $0.00 | |
| 0081A | 0% | 14 | $0.00 | |
| 99381 | 0% | 14 | $0.00 | |
| 91307 | 0% | 41 | $0.00 | |
| 99395 | Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years | 0% | 156 | $0.00 |
| 87631 | 0% | 61 | $0.00 | |
| 90681 | 0% | 32 | $0.00 | |
| 91308 | 0% | 32 | $0.00 | |
| 91312 | 0% | 15 | $0.00 | |
| 99204 | Doctor's office visit, new patient (more involved) | 0% | 13 | $0.00 |
| 91320 | 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 officialAREVALO, MANUEL (PRESIDENT)