Behavioral
Prospect CT Medical Foundation, INC.
Prospect CT Medical Foundation, INC. was paid $34.07M by Medicaid between Jan 2018 and Dec 2024, across 256 billing codes. Its largest line is 99214, doctor's office visit, returning patient (more involved) — 30% of everything it billed.
33Billing provider infoPROSPECT CT MEDICAL FOUNDATION, INC.
MANCHESTER, CT 06040
MANCHESTER, CT 06040
33aNPI1144677568assigned 05/16/2016
33bProvider typeClinical Social Worker
28Total paid$34.07M
24GClaims1,348,275
24DCodes billed256
24AFirst – last monthJan 2018 – Dec 2024
Compared with peers
Next to other Clinical Social Worker providers in Connecticut
Rank by total paid#2 of 647
Median peer was paid$67K
This provider vs. median507×
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.
Auditor's notes
Automated statistical signals. Not evidence of fraud — how these are computed.
Entity ProliferationAuthorized official ELDERS, ROBERT controls 20+ related entities in our dataset. Read more
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 | 167,437 | $5.09M | |
| 2019 | 188,735 | $5.54M | |
| 2020 | 162,075 | $4.32M | |
| 2021 | 201,668 | $4.89M | |
| 2022 | 227,087 | $5.15M | |
| 2023 | 209,354 | $4.75M | |
| 2024incomplete | 191,919 | $4.33M |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| 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 | 30% | 196,695 | 164,513 | $10.31M |
| 99213 | Doctor's office visit, returning patient (routine)Office or other outpatient visit for the evaluation and management of an established patient, low complexity | 24% | 196,798 | 169,268 | $8.12M |
| J0585 | Injection, onabotulinumtoxina, 1 unit | 4.5% | 3,620 | 1,653 | $1.52M |
| 99232 | Hospital visit by a doctor, follow-up daySubsequent hospital care, per day, moderate complexity | 2.9% | 49,356 | 18,609 | $973K |
| 99391 | Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) | 2.7% | 8,238 | 7,341 | $929K |
| 90460 | Immunization administration through 18 years of age via any route, first or only component | 2.6% | 25,074 | 23,043 | $898K |
| 99392 | Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) | 2.5% | 7,291 | 6,954 | $840K |
| 99284 | Emergency room visit (serious)Emergency department visit for the evaluation and management, high severity | 2.2% | 15,281 | 14,052 | $739K |
| 99285 | Emergency room visit (most serious)Emergency department visit for the evaluation and management, high severity with immediate threat to life | 2.1% | 10,793 | 9,952 | $724K |
| 99393 | Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) | 1.4% | 4,227 | 4,058 | $464K |
| 99233 | Hospital visit by a doctor, follow-up day (complex)Prolong inpt eval add15 m | 1.3% | 17,626 | 8,953 | $452K |
| 99215 | Doctor's office visit, returning patient (complex)Prolong outpt/office vis | 1.3% | 7,373 | 6,237 | $428K |
244 more codes
| 90791 | Psychiatric diagnostic evaluation | 1.2% | 13,721 | $412K |
| 99308 | Subsequent nursing facility care, per day, straightforward | 1.1% | 15,898 | $378K |
| 99231 | Subsequent hospital care, per day, straightforward or low complexity | 1.1% | 24,809 | $362K |
| 99394 | Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) | <1% | 3,023 | $323K |
| 99239 | Hospital discharge day management, more than 30 minutes | <1% | 10,436 | $320K |
| 93306 | Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete | <1% | 6,077 | $278K |
| 99223 | Prolong inpt eval add15 m | <1% | 5,744 | $262K |
| 93010 | Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only | <1% | 73,206 | $258K |
| 99395 | Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years | <1% | 3,865 | $245K |
| 99305 | <1% | 3,757 | $238K | |
| 99283 | Emergency room visit (moderate) | <1% | 8,981 | $235K |
| 96110 | Developmental screening, with scoring and documentation, per standardized instrument | <1% | 9,407 | $210K |
| 99204 | Doctor's office visit, new patient (more involved) | <1% | 2,383 | $193K |
| 99244 | Office or other outpatient consultation, moderate to high complexity | <1% | 1,626 | $186K |
| 99309 | Subsequent nursing facility care, per day, low to moderate complexity | <1% | 3,952 | $147K |
| 96127 | <1% | 8,633 | $147K | |
| 76805 | Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation | <1% | 1,116 | $144K |
| 99396 | Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years | <1% | 1,634 | $127K |
| 95810 | Polysomnography; sleep staging with 4 or more additional parameters | <1% | 1,417 | $113K |
| 90853 | Group psychotherapy (other than of a multiple-family group) | <1% | 7,903 | $112K |
| 99442 | <1% | 5,792 | $106K | |
| 43239 | Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple | <1% | 2,117 | $99K |
| 99173 | <1% | 13,617 | $92K | |
| 99238 | Hospital discharge day management, 30 minutes or less | <1% | 3,642 | $89K |
| 99460 | <1% | 2,524 | $87K | |
| 99222 | Initial hospital care, per day, moderate complexity | <1% | 2,104 | $87K |
| 94010 | <1% | 10,137 | $84K | |
| 87635 | Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe | <1% | 2,541 | $84K |
| 99203 | Doctor's office visit, new patient (routine) | <1% | 1,685 | $83K |
| 92551 | <1% | 13,618 | $79K | |
| 45380 | Colonoscopy, flexible; with biopsy, single or multiple | <1% | 958 | $76K |
| 64615 | <1% | 1,781 | $75K | |
| 76775 | <1% | 2,421 | $72K | |
| 99443 | <1% | 1,927 | $72K | |
| 99220 | <1% | 1,280 | $68K | |
| 36416 | <1% | 24,677 | $66K | |
| 98926 | <1% | 3,906 | $64K | |
| 90960 | End-stage renal disease related services monthly, for patients 20 years and older, with 4 or more face-to-face visits | <1% | 854 | $59K |
| 90792 | Psychiatric diagnostic evaluation with medical services | <1% | 798 | $56K |
| 87804 | Infectious agent antigen detection by immunoassay; Influenza, each type | <1% | 3,342 | $55K |
| 76830 | Ultrasound, transvaginal | <1% | 935 | $52K |
| 99318 | <1% | 1,304 | $52K | |
| 99464 | <1% | 1,113 | $51K | |
| 87651 | Infectious agent detection by nucleic acid; Streptococcus, group A, amplified probe | <1% | 1,772 | $51K |
| 90686 | <1% | 11,590 | $50K | |
| 99307 | <1% | 6,653 | $48K | |
| 83036 | Hemoglobin; glycosylated (A1C) | <1% | 9,278 | $46K |
| 99051 | <1% | 6,256 | $45K | |
| 99291 | Critical care, evaluation and management of the critically ill patient, first 30-74 minutes | <1% | 686 | $44K |
| 99212 | Office or other outpatient visit for the evaluation and management of an established patient, straightforward | <1% | 2,371 | $43K |
| 87880 | Infectious agent antigen detection by immunoassay; Streptococcus, group A | <1% | 4,031 | $40K |
| 99417 | Prolong home eval add 15m | <1% | 584 | $39K |
| 98927 | <1% | 1,848 | $37K | |
| 76817 | Ultrasound, pregnant uterus, real time with image documentation, transvaginal | <1% | 461 | $33K |
| 90832 | Psychotherapy session, about 30 minutes | <1% | 1,497 | $33K |
| 99462 | <1% | 1,699 | $33K | |
| 36415 | Collection of venous blood by venipuncture | <1% | 11,483 | $32K |
| 94729 | <1% | 2,181 | $30K | |
| 51798 | <1% | 6,625 | $30K | |
| 96372 | Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular | <1% | 2,461 | $30K |
| 93000 | <1% | 3,718 | $28K | |
| 95251 | <1% | 1,888 | $26K | |
| 99243 | <1% | 304 | $25K | |
| 99254 | <1% | 348 | $24K | |
| 99253 | <1% | 551 | $22K | |
| 97597 | <1% | 2,022 | $22K | |
| 81025 | <1% | 4,379 | $21K | |
| 94060 | <1% | 870 | $18K | |
| 45385 | Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) | <1% | 162 | $18K |
| 20610 | <1% | 970 | $14K | |
| 99219 | <1% | 382 | $14K | |
| 96160 | <1% | 989 | $14K | |
| 99217 | <1% | 559 | $13K | |
| 95811 | <1% | 157 | $13K | |
| 99349 | <1% | 902 | $12K | |
| 99306 | Prolong nursin fac eval 15m | <1% | 244 | $12K |
| 95816 | <1% | 662 | $12K | |
| 77067 | Screening mammography, bilateral, including computer-aided detection | <1% | 156 | $11K |
| G8510 | Screening for depression is documented as negative, a follow-up plan is not required | <1% | 2,067 | $11K |
| 95886 | <1% | 183 | $11K | |
| 51700 | <1% | 316 | $11K | |
| 73564 | <1% | 868 | $11K | |
| 76801 | <1% | 102 | $10K | |
| 93923 | <1% | 134 | $10K | |
| 73110 | <1% | 847 | $10K | |
| 94726 | <1% | 529 | $9K | |
| 98925 | <1% | 676 | $8K | |
| 99221 | <1% | 216 | $8K | |
| 11042 | Debridement, subcutaneous tissue (includes epidermis, dermis, and subcutaneous tissue); first 20 sq cm | <1% | 789 | $8K |
| 76813 | <1% | 96 | $7K | |
| 90471 | Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine | <1% | 6,084 | $7K |
| 99497 | <1% | 529 | $7K | |
| 59025 | Fetal non-stress test | <1% | 142 | $7K |
| 95004 | Percutaneous tests with allergenic extracts, immediate type reaction | <1% | 47 | $6K |
| 98967 | <1% | 177 | $6K | |
| 73030 | <1% | 729 | $6K | |
| 93356 | <1% | 524 | $6K | |
| 95117 | <1% | 516 | $5K | |
| 99385 | <1% | 51 | $5K | |
| 95923 | <1% | 103 | $4K | |
| 99205 | Prolong outpt/office vis | <1% | 47 | $4K |
| G2211 | Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient's single, serious condition or a complex condition. (add-on code, list separately in addition to office/outpatient evaluation and management visit, new or established) | <1% | 1,132 | $4K |
| 99202 | Office or other outpatient visit for the evaluation and management of a new patient, straightforward | <1% | 85 | $4K |
| 87210 | <1% | 1,232 | $4K | |
| 45378 | Colonoscopy, flexible; diagnostic, including collection of specimen(s) | <1% | 45 | $4K |
| 73130 | <1% | 362 | $3K | |
| 99374 | <1% | 117 | $3K | |
| 95806 | <1% | 67 | $3K | |
| J1040 | Injection, methylprednisolone acetate, 80 mg | <1% | 614 | $3K |
| 99356 | <1% | 283 | $3K | |
| 95911 | <1% | 29 | $3K | |
| 99335 | <1% | 124 | $3K | |
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | <1% | 100 | $3K |
| 95921 | <1% | 120 | $3K | |
| 99383 | <1% | 36 | $3K | |
| 98968 | <1% | 64 | $3K | |
| 90688 | <1% | 366 | $2K | |
| 93016 | <1% | 289 | $2K | |
| 46600 | <1% | 58 | $2K | |
| 94640 | Pressurized or nonpressurized inhalation treatment for acute airway obstruction | <1% | 257 | $2K |
| 90662 | <1% | 372 | $2K | |
| 76816 | Ultrasound, pregnant uterus, real time with image documentation, follow-up | <1% | 31 | $2K |
| 99245 | <1% | 14 | $2K | |
| 99402 | <1% | 42 | $2K | |
| 99384 | <1% | 17 | $2K | |
| 99386 | <1% | 14 | $2K | |
| 93244 | <1% | 166 | $2K | |
| 94727 | <1% | 121 | $2K | |
| 95885 | <1% | 27 | $2K | |
| J1010 | Injection, methylprednisolone acetate, 1 mg | <1% | 547 | $1K |
| 99252 | <1% | 79 | $1K | |
| 81003 | <1% | 13,746 | $1K | |
| 93018 | <1% | 267 | $1K | |
| 81002 | <1% | 24,734 | $1K | |
| 99441 | <1% | 278 | $1K | |
| 90620 | <1% | 265 | $1K | |
| 99188 | <1% | 52 | $1K | |
| 73140 | <1% | 136 | $1K | |
| 93242 | <1% | 165 | $1K | |
| 85018 | <1% | 15,384 | $1K | |
| J1030 | Injection, methylprednisolone acetate, 40 mg | <1% | 277 | $978.21 |
| G0179 | Physician or allowed practitioner re-certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians and allowed practitioners to affirm the initial implementation of the plan of care | <1% | 60 | $924.14 |
| 99397 | <1% | 44 | $897.28 | |
| 98928 | <1% | 30 | $872.64 | |
| 99408 | <1% | 48 | $801.06 | |
| 87807 | <1% | 77 | $800.41 | |
| J1580 | Injection, garamycin, gentamicin, up to 80 mg | <1% | 441 | $682.68 |
| 99348 | <1% | 26 | $678.75 | |
| 99350 | Prolong home eval add 15m | <1% | 14 | $658.99 |
| 82270 | <1% | 275 | $635.43 | |
| 72110 | <1% | 33 | $629.22 | |
| 20550 | <1% | 32 | $609.58 | |
| 82962 | <1% | 502 | $599.39 | |
| D0145 | Oral evaluation for a patient under three years of age | <1% | 20 | $558.00 |
| 52000 | <1% | 15 | $547.82 | |
| 90961 | <1% | 17 | $531.39 | |
| J1644 | Injection, heparin sodium, per 1000 units | <1% | 362 | $497.93 |
| D1206 | Topical application of fluoride varnish | <1% | 20 | $446.40 |
| 96161 | <1% | 51 | $440.00 | |
| 72040 | <1% | 28 | $439.10 | |
| 76536 | <1% | 13 | $419.86 | |
| 51702 | <1% | 40 | $406.07 | |
| 72050 | <1% | 13 | $398.64 | |
| 82947 | <1% | 122 | $390.82 | |
| 90715 | <1% | 46 | $388.08 | |
| 99211 | Office or other outpatient visit for the evaluation and management of an established patient, minimal severity | <1% | 86 | $349.60 |
| 73502 | <1% | 21 | $343.07 | |
| 93005 | Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report | <1% | 140 | $299.45 |
| 95249 | <1% | 13 | $259.20 | |
| 90651 | <1% | 271 | $252.85 | |
| 99406 | <1% | 61 | $246.06 | |
| 90734 | <1% | 418 | $244.02 | |
| 43450 | <1% | 15 | $232.10 | |
| 80305 | <1% | 44 | $229.54 | |
| 94761 | <1% | 107 | $229.12 | |
| J1020 | Injection, methylprednisolone acetate, 20 mg | <1% | 47 | $182.76 |
| G2212 | Prolonged office or other outpatient evaluation and management service(s) beyond the maximum required time of the primary procedure which has been selected using total time on the date of the primary service; each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (list separately in addition to cpt codes 99205, 99215, 99483 for office or other outpatient evaluation and management services) (do not report g2212 on the same date of service as 99358, 99359, 99415, 99416). (do not report g2212 for any time unit less than 15 minutes) | <1% | 144 | $133.10 |
| G2010 | Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment | <1% | 38 | $116.62 |
| 0296T | <1% | 31 | $115.73 | |
| 0298T | <1% | 31 | $109.33 | |
| 90656 | <1% | 835 | $89.40 | |
| J3420 | Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg | <1% | 125 | $89.21 |
| 90472 | Immunization administration, each additional vaccine (list separately) | <1% | 12 | $70.95 |
| J3301 | Injection, triamcinolone acetonide, not otherwise specified, 10 mg | <1% | 14 | $57.10 |
| 99058 | <1% | 96 | $52.31 | |
| G0008 | Administration of influenza virus vaccine | <1% | 242 | $45.87 |
| 94618 | <1% | 17 | $43.02 | |
| J7613 | Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg | <1% | 1,068 | $37.78 |
| 11721 | <1% | 13 | $29.20 | |
| A7003 | Administration set, with small volume nonfiltered pneumatic nebulizer, disposable | <1% | 606 | $21.85 |
| 99000 | <1% | 18,853 | $17.73 | |
| 93040 | <1% | 130 | $16.45 | |
| J1050 | Injection, medroxyprogesterone acetate, 1 mg | <1% | 574 | $4.56 |
| 3008F | <1% | 121,808 | $0.63 | |
| 1160F | <1% | 80,932 | $0.44 | |
| 90671 | <1% | 592 | $0.32 | |
| G8431 | Screening for depression is documented as being positive and a follow-up plan is documented | <1% | 113 | $0.21 |
| 1126F | <1% | 22,061 | $0.16 | |
| J2357 | Injection, omalizumab, 5 mg | <1% | 12 | $0.12 |
| 90685 | <1% | 383 | $0.07 | |
| 1125F | <1% | 13,859 | $0.04 | |
| 90680 | <1% | 2,371 | $0.02 | |
| 90670 | <1% | 3,895 | $0.02 | |
| 3074F | <1% | 2,078 | $0.01 | |
| 1000F | <1% | 311 | $0.01 | |
| 1159F | <1% | 23,311 | $0.01 | |
| 2028F | <1% | 2,482 | $0.01 | |
| 3078F | <1% | 2,129 | $0.01 | |
| 90723 | 0% | 1,775 | $0.00 | |
| 1036F | 0% | 187 | $0.00 | |
| 90697 | 0% | 541 | $0.00 | |
| 3079F | 0% | 671 | $0.00 | |
| 1101F | 0% | 663 | $0.00 | |
| 3075F | 0% | 54 | $0.00 | |
| A4270 | Disposable endoscope sheath, each | 0% | 341 | $0.00 |
| 90694 | 0% | 150 | $0.00 | |
| 1170F | 0% | 43 | $0.00 | |
| 90696 | 0% | 12 | $0.00 | |
| 3017F | 0% | 34 | $0.00 | |
| 1111F | 0% | 27 | $0.00 | |
| 97802 | 0% | 12 | $0.00 | |
| 90732 | 0% | 13 | $0.00 | |
| 3080F | 0% | 13 | $0.00 | |
| 4000F | 0% | 15 | $0.00 | |
| A7015 | Aerosol mask, used with dme nebulizer | 0% | 19 | $0.00 |
| 90619 | 0% | 38 | $0.00 | |
| G8952 | Elevated or hypertensive blood pressure reading documented, indicated follow-up not documented, reason not given | 0% | 13 | $0.00 |
| 3077F | 0% | 183 | $0.00 | |
| 90461 | 0% | 10,090 | $0.00 | |
| G8482 | Influenza immunization administered or previously received | 0% | 670 | $0.00 |
| 90648 | 0% | 3,014 | $0.00 | |
| 3288F | 0% | 1,018 | $0.00 | |
| 90633 | 0% | 1,186 | $0.00 | |
| G8417 | Bmi is documented above normal parameters and a follow-up plan is documented | 0% | 1,132 | $0.00 |
| 90710 | 0% | 550 | $0.00 | |
| 97803 | 0% | 574 | $0.00 | |
| G8483 | Influenza immunization was not administered for reasons documented by clinician (e.g., patient allergy or other medical reasons, patient declined or other patient reasons, vaccine not available or other system reasons) | 0% | 41 | $0.00 |
| 3725F | 0% | 393 | $0.00 | |
| 2014F | 0% | 249 | $0.00 | |
| 90672 | 0% | 36 | $0.00 | |
| G9744 | Patient not eligible due to active diagnosis of hypertension | 0% | 31 | $0.00 |
| 1100F | 0% | 13 | $0.00 | |
| 90700 | 0% | 67 | $0.00 | |
| 1158F | 0% | 31 | $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.
From NPPES
Who's on the registration
Authorized officialELDERS, ROBERT (SECRETARY)
| Provider | Location | Paid |
|---|---|---|
| Prospect Waterbury, INC. | Waterbury, CT | $84.62M |
| Prospect Manchester Hospital, INC. | Manchester, CT | $69.20M |
| Prospect Chartercare RWMC, LLC | Providence, RI | $57.10M |
| Prospect CCMC, LLC | Chester, PA | $40.89M |
| Prospect Rockville Hospital, INC. | Vernon, CT | $30.06M |
| Prospect Chartercare Sjhsri, LLC | North Providence, RI | $10.94M |
| Prospect DCMH, LLC | Drexel Hill, PA | $10.37M |
| Prospect CCMC, LLC | Chester, PA | $5.46M |
| Alta Los Angeles Hospitals, INC. | Los Angeles, CA | $5.42M |
| Prospect CCMC, LLC | Chester, PA | $5.03M |
| Prospect CCMC, LLC | Chester, PA | $3.71M |
| Prospect Chartercare Physicians, LLC | Cranston, RI | $2.31M |
| Prospect Echn Home Health, INC. | Vernon, CT | $1.75M |
| Prospect Waterbury Home Health, INC. | Watertown, CT | $1.30M |
| Prospect Health Access Network, INC. | Chester, PA | $1.22M |
| Alta Newport Hospital, LLC | Tustin, CA | $1.16M |
| Prospect Health Access Network, INC. | Crum Lynne, PA | $924K |
| Prospect Health Access Network, INC. | Chester, PA | $872K |
| Prospect Chartercare Sjhsri, LLC | North Providence, RI | $858K |
| Prospect Health Access Network, INC. | Drexel Hill, PA | $815K |
Matched on the authorized-official name exactly as entered in NPPES. A common name can match unrelated people.