NPI: 1124461363 · COUNCIL BLUFFS, IA 51501 · Community/Retail Pharmacy · NPI assigned 04/08/2013
| Authorized Official | PEREGOY, JACQUIE (EXECUTIVE DIRECTOR) |
| NPI Enumeration Date | 04/08/2013 |
| Year | Claims | Total Paid |
|---|---|---|
| 2021 | 586 | $9K |
| 2022 | 54 | $276.17 |
| 2023 | 34 | $2K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| 0011A | 139 | 139 | $5K | |
| 91322 | 17 | 17 | $2K | |
| 0012A | 42 | 42 | $1K | |
| 0001A | 74 | 64 | $1K | |
| 0031A | 30 | 30 | $1K | |
| 0002A | 33 | 33 | $320.00 | |
| 90686 | 14 | 14 | $210.00 | |
| 90480 | 17 | 17 | $144.00 | |
| 90471 | Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine | 13 | 13 | $66.17 |
| 91303 | 29 | 29 | $0.02 | |
| 91301 | 218 | 215 | $0.00 | |
| 91300 | 48 | 48 | $0.00 |