1104913813

1104913813 was paid $483K by Medicaid between Jan 2018 and Dec 2020, across 5 billing codes. Its largest line is 90876, — 89% of everything it billed.

33Billing provider info1104913813

33aNPI1104913813

33bProvider type—

28Total paid$483K

24GClaims7,021

24DCodes billed5

24AFirst – last monthJan 2018 – Dec 2020

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	1,071	$68K
2019	2,277	$196K
2020	3,673	$219K

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
90876		89%	4,791	413	$428K
Q3014	Telehealth originating site facility fee	7.8%	1,641	132	$38K
99213	Doctor's office visit, returning patient (routine)Office or other outpatient visit for the evaluation and management of an established patient, low complexity	2.4%	452	283	$12K
90792	Psychiatric diagnostic evaluation with medical services	<1%	59	51	$3K
99308	Subsequent nursing facility care, per day, straightforward	<1%	78	49	$2K

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.