Pulmonary & Critical Care Associates, PC
Pulmonary & Critical Care Associates, PC was paid $798K by Medicaid between Jan 2018 and Sep 2022, across 15 billing codes. Its largest line is 99233, hospital visit by a doctor, follow-up day (complex) — 36% of everything it billed.
33Billing provider infoPULMONARY & CRITICAL CARE ASSOCIATES, PC
SOUTH BEND, IN 46601
SOUTH BEND, IN 46601
33aNPI1124141346assigned 04/10/2007
33bProvider typeSpecialist
28Total paid$798K
24GClaims23,393
24DCodes billed15
24AFirst – last monthJan 2018 – Sep 2022
Compared with peers
Next to other Specialist providers in Indiana
Rank by total paid#19 of 90
Median peer was paid$98K
This provider vs. median8.2×
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 | 3,994 | $41K | |
| 2019 | 4,290 | $127K | |
| 2020 | 4,512 | $176K | |
| 2021 | 6,299 | $266K | |
| 2022 | 4,298 | $187K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| 99233 | Hospital visit by a doctor, follow-up day (complex)Prolong inpt eval add15 m | 36% | 6,520 | 2,220 | $291K |
| 99232 | Hospital visit by a doctor, follow-up daySubsequent hospital care, per day, moderate complexity | 20% | 5,756 | 2,147 | $160K |
| 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 | 20% | 3,436 | 3,001 | $156K |
| 99223 | Prolong inpt eval add15 m | 6.9% | 736 | 644 | $55K |
| 99291 | Critical care, evaluation and management of the critically ill patient, first 30-74 minutes | 4.2% | 297 | 134 | $34K |
| 94060 | 3.4% | 2,201 | 2,008 | $27K | |
| 94726 | 2.9% | 1,949 | 1,779 | $23K | |
| 94729 | 2.8% | 2,048 | 1,868 | $23K | |
| 99215 | Doctor's office visit, returning patient (complex)Prolong outpt/office vis | 1.8% | 206 | 181 | $15K |
| 31624 | 1.0% | 108 | 82 | $8K | |
| 99205 | Prolong outpt/office vis | <1% | 29 | 28 | $4K |
| 99204 | Doctor's office visit, new patient (more involved)Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity | <1% | 13 | 12 | $823.71 |
3 more codes
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 officialKOSCIELSKI, MATTHEW (PRESIDENT)