Physician
Southeastern Nephrology Associates, PLLC
Southeastern Nephrology Associates, PLLC was paid $255K by Medicaid between Jan 2018 and May 2019, across 11 billing codes. Its largest line is 90960, End-stage renal disease related services monthly, for patients 20 years and older, with 4 or more face-to-face visits — 61% of everything it billed.
33Billing provider infoSOUTHEASTERN NEPHROLOGY ASSOCIATES, PLLC
WILMINGTON, NC 28401
WILMINGTON, NC 28401
33aNPI1104878347assigned 05/16/2006
33bProvider typeNephrology Physician
28Total paid$255K
24GClaims8,605
24DCodes billed11
24AFirst – last monthJan 2018 – May 2019
Compared with peers
Next to other Nephrology Physician providers in North Carolina
Rank by total paid#16 of 41
Median peer was paid$168K
This provider vs. median1.5×
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 | 5,712 | $165K | |
| 2019 | 2,893 | $89K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| 90960 | End-stage renal disease related services monthly, for patients 20 years and older, with 4 or more face-to-face visits | 61% | 4,050 | 3,712 | $157K |
| 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 | 17% | 1,337 | 1,292 | $44K |
| 99232 | Hospital visit by a doctor, follow-up daySubsequent hospital care, per day, moderate complexity | 12% | 1,455 | 791 | $31K |
| 90935 | Hemodialysis procedure with single evaluation by a physician | 5.7% | 1,057 | 609 | $14K |
| 90961 | 1.6% | 115 | 106 | $4K | |
| 99233 | Hospital visit by a doctor, follow-up day (complex)Prolong inpt eval add15 m | <1% | 63 | 39 | $2K |
| 99231 | Subsequent hospital care, per day, straightforward or low complexity | <1% | 121 | 73 | $1K |
| 80048 | Basic metabolic panel (calcium, ionized) | <1% | 162 | 145 | $657.48 |
| 90966 | <1% | 12 | 12 | $323.61 | |
| 36415 | Collection of venous blood by venipuncture | <1% | 221 | 196 | $286.20 |
| 85027 | <1% | 12 | 12 | $47.88 |
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 officialHERION, JOHN (MANAGING PARTNER)