1114989787

1114989787 was paid $508K by Medicaid between Jan 2018 and May 2021, across 23 billing codes. Its largest line is 99213, doctor's office visit, returning patient (routine) — 90% of everything it billed.

33Billing provider info1114989787

33aNPI1114989787

33bProvider type—

28Total paid$508K

24GClaims18,607

24DCodes billed23

24AFirst – last monthJan 2018 – May 2021

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	6,803	$165K
2019	7,645	$161K
2020	3,234	$140K
2021	925	$43K

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
99213	Doctor's office visit, returning patient (routine)Office or other outpatient visit for the evaluation and management of an established patient, low complexity	90%	6,812	5,245	$455K
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	5.2%	547	473	$27K
99203	Doctor's office visit, new patient (routine)Office or other outpatient visit for the evaluation and management of a new patient, low complexity	2.5%	199	154	$13K
99394	Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years)	1.4%	91	80	$7K
99393	Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years)	<1%	48	41	$4K
99212	Office or other outpatient visit for the evaluation and management of an established patient, straightforward	<1%	17	12	$1K
36416		<1%	2,590	1,945	$297.85
36415	Collection of venous blood by venipuncture	<1%	1,217	1,018	$285.23
85025	Blood count; complete (CBC), automated, and automated differential WBC count	<1%	3,358	2,537	$217.83
96372	Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular	<1%	432	333	$93.78
99173		<1%	99	84	$93.78
87804	Infectious agent antigen detection by immunoassay; Influenza, each type	<1%	298	225	$89.88

11 more codes

J0702	Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg	<1%	73	$67.82
87880	Infectious agent antigen detection by immunoassay; Streptococcus, group A	<1%	1,505	$34.01
99000		<1%	221	$4.45
90471	Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine	0%	247	$0.00
92551		0%	93	$0.00
J1100	Injection, dexamethasone sodium phosphate, 1 mg	0%	37	$0.00
90686		0%	20	$0.00
J0696	Injection, ceftriaxone sodium, per 250 mg	0%	14	$0.00
81003		0%	635	$0.00
J0945	Injection, brompheniramine maleate, per 10 mg	0%	37	$0.00
90472	Immunization administration, each additional vaccine (list separately)	0%	17	$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.