Medicaid Provider Spending

$1.09 trillion in Medicaid claims data, 2018–2024 · 617K+ providers

PROSPECT CT MEDICAL FOUNDATION, INC.

NPI: 1144677568 · MANCHESTER, CT 06040 · Clinical Social Worker · NPI assigned 05/16/2016

Billing Flags · Automated signals — not evidence of fraud
Entity Proliferation

Authorized official ELDERS, ROBERT controls 20+ related entities in our dataset. Read more

$34.07M
Total Medicaid Paid
1,348,275
Total Claims
1,131,128
Beneficiaries
256
Codes Billed
2018-01
First Month
2024-12
Last Month

Provider Details

Authorized OfficialELDERS, ROBERT (SECRETARY)
NPI Enumeration Date05/16/2016

Related Entities

Other providers sharing the same authorized official: ELDERS, ROBERT

ProviderCityStateTotal 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

Monthly Spending Trend

Yearly Breakdown

YearClaimsTotal 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
2024 191,919 $4.33M

Billing Codes

CodeDescriptionClaimsBeneficiariesTotal Paid
99214 Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity 196,695 164,513 $10.31M
99213 Office or other outpatient visit for the evaluation and management of an established patient, low complexity 196,798 169,268 $8.12M
J0585 Injection, onabotulinumtoxina, 1 unit 3,620 1,653 $1.52M
99232 Subsequent hospital care, per day, moderate complexity 49,356 18,609 $973K
99391 Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) 8,238 7,341 $929K
90460 Immunization administration through 18 years of age via any route, first or only component 25,074 23,043 $898K
99392 Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) 7,291 6,954 $840K
99284 Emergency department visit for the evaluation and management, high severity 15,281 14,052 $739K
99285 Emergency department visit for the evaluation and management, high severity with immediate threat to life 10,793 9,952 $724K
99393 Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) 4,227 4,058 $464K
99233 Prolong inpt eval add15 m 17,626 8,953 $452K
99215 Prolong outpt/office vis 7,373 6,237 $428K
90791 Psychiatric diagnostic evaluation 13,721 9,282 $412K
99308 Subsequent nursing facility care, per day, straightforward 15,898 13,951 $378K
99231 Subsequent hospital care, per day, straightforward or low complexity 24,809 9,211 $362K
99394 Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) 3,023 2,840 $323K
99239 Hospital discharge day management, more than 30 minutes 10,436 9,436 $320K
93306 Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete 6,077 5,395 $278K
99223 Prolong inpt eval add15 m 5,744 5,009 $262K
93010 Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only 73,206 60,084 $258K
99395 Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years 3,865 3,388 $245K
99305 3,757 3,353 $238K
99283 Emergency department visit for the evaluation and management, moderate severity 8,981 8,289 $235K
96110 Developmental screening, with scoring and documentation, per standardized instrument 9,407 9,026 $210K
99204 Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity 2,383 2,079 $193K
99244 Office or other outpatient consultation, moderate to high complexity 1,626 1,509 $186K
99309 Subsequent nursing facility care, per day, low to moderate complexity 3,952 3,591 $147K
96127 8,633 8,027 $147K
76805 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation 1,116 1,043 $144K
99396 Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years 1,634 1,448 $127K
95810 Polysomnography; sleep staging with 4 or more additional parameters 1,417 1,332 $113K
90853 Group psychotherapy (other than of a multiple-family group) 7,903 3,267 $112K
99442 5,792 4,945 $106K
43239 Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple 2,117 1,929 $99K
99173 13,617 12,869 $92K
99238 Hospital discharge day management, 30 minutes or less 3,642 3,307 $89K
99460 2,524 2,318 $87K
99222 Initial hospital care, per day, moderate complexity 2,104 1,857 $87K
94010 10,137 8,004 $84K
87635 Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe 2,541 2,400 $84K
99203 Office or other outpatient visit for the evaluation and management of a new patient, low complexity 1,685 1,500 $83K
92551 13,618 12,857 $79K
45380 Colonoscopy, flexible; with biopsy, single or multiple 958 873 $76K
64615 1,781 1,580 $75K
76775 2,421 2,080 $72K
99443 1,927 1,616 $72K
99220 1,280 1,172 $68K
36416 24,677 23,245 $66K
98926 3,906 3,370 $64K
90960 End-stage renal disease related services monthly, for patients 20 years and older, with 4 or more face-to-face visits 854 702 $59K
90792 Psychiatric diagnostic evaluation with medical services 798 710 $56K
87804 Infectious agent antigen detection by immunoassay; Influenza, each type 3,342 2,740 $55K
76830 Ultrasound, transvaginal 935 857 $52K
99318 1,304 1,203 $52K
99464 1,113 1,015 $51K
87651 Infectious agent detection by nucleic acid; Streptococcus, group A, amplified probe 1,772 1,653 $51K
90686 11,590 10,952 $50K
99307 6,653 4,407 $48K
83036 Hemoglobin; glycosylated (A1C) 9,278 8,578 $46K
99051 6,256 5,829 $45K
99291 Critical care, evaluation and management of the critically ill patient, first 30-74 minutes 686 414 $44K
99212 Office or other outpatient visit for the evaluation and management of an established patient, straightforward 2,371 1,938 $43K
87880 Infectious agent antigen detection by immunoassay; Streptococcus, group A 4,031 3,696 $40K
99417 Prolong home eval add 15m 584 534 $39K
98927 1,848 1,611 $37K
76817 Ultrasound, pregnant uterus, real time with image documentation, transvaginal 461 397 $33K
90832 Psychotherapy, 30 minutes with patient 1,497 543 $33K
99462 1,699 1,467 $33K
36415 Collection of venous blood by venipuncture 11,483 9,620 $32K
94729 2,181 1,730 $30K
51798 6,625 5,552 $30K
96372 Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular 2,461 2,019 $30K
93000 3,718 3,078 $28K
95251 1,888 1,735 $26K
99243 304 293 $25K
99254 348 280 $24K
99253 551 429 $22K
97597 2,022 1,109 $22K
81025 4,379 3,647 $21K
94060 870 744 $18K
45385 Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) 162 145 $18K
20610 970 675 $14K
99219 382 349 $14K
96160 989 882 $14K
99217 559 524 $13K
95811 157 146 $13K
99349 902 648 $12K
99306 Prolong nursin fac eval 15m 244 200 $12K
95816 662 549 $12K
77067 Screening mammography, bilateral, including computer-aided detection 156 151 $11K
G8510 Screening for depression is documented as negative, a follow-up plan is not required 2,067 1,943 $11K
95886 183 166 $11K
51700 316 188 $11K
73564 868 556 $11K
76801 102 96 $10K
93923 134 119 $10K
73110 847 524 $10K
94726 529 447 $9K
98925 676 611 $8K
99221 216 192 $8K
11042 Debridement, subcutaneous tissue (includes epidermis, dermis, and subcutaneous tissue); first 20 sq cm 789 411 $8K
76813 96 92 $7K
90471 Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine 6,084 5,441 $7K
99497 529 332 $7K
59025 Fetal non-stress test 142 112 $7K
95004 Percutaneous tests with allergenic extracts, immediate type reaction 47 46 $6K
98967 177 89 $6K
73030 729 486 $6K
93356 524 472 $6K
95117 516 183 $5K
99385 51 42 $5K
95923 103 89 $4K
99205 Prolong outpt/office vis 47 40 $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) 1,132 987 $4K
99202 Office or other outpatient visit for the evaluation and management of a new patient, straightforward 85 72 $4K
87210 1,232 1,087 $4K
45378 Colonoscopy, flexible; diagnostic, including collection of specimen(s) 45 42 $4K
73130 362 223 $3K
99374 117 103 $3K
95806 67 64 $3K
J1040 Injection, methylprednisolone acetate, 80 mg 614 424 $3K
99356 283 217 $3K
95911 29 25 $3K
99335 124 102 $3K
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit 100 68 $3K
95921 120 103 $3K
99383 36 29 $3K
98968 64 29 $3K
90688 366 312 $2K
93016 289 267 $2K
46600 58 54 $2K
94640 Pressurized or nonpressurized inhalation treatment for acute airway obstruction 257 241 $2K
90662 372 345 $2K
76816 Ultrasound, pregnant uterus, real time with image documentation, follow-up 31 25 $2K
99245 14 12 $2K
99402 42 32 $2K
99384 17 16 $2K
99386 14 12 $2K
93244 166 151 $2K
94727 121 111 $2K
95885 27 27 $2K
J1010 Injection, methylprednisolone acetate, 1 mg 547 386 $1K
99252 79 43 $1K
81003 13,746 11,845 $1K
93018 267 251 $1K
81002 24,734 22,586 $1K
99441 278 232 $1K
90620 265 247 $1K
99188 52 49 $1K
73140 136 98 $1K
93242 165 151 $1K
85018 15,384 14,512 $1K
J1030 Injection, methylprednisolone acetate, 40 mg 277 194 $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 60 55 $924.14
99397 44 31 $897.28
98928 30 28 $872.64
99408 48 43 $801.06
87807 77 73 $800.41
J1580 Injection, garamycin, gentamicin, up to 80 mg 441 256 $682.68
99348 26 25 $678.75
99350 Prolong home eval add 15m 14 13 $658.99
82270 275 241 $635.43
72110 33 27 $629.22
20550 32 27 $609.58
82962 502 450 $599.39
D0145 Oral evaluation for a patient under three years of age 20 18 $558.00
52000 15 13 $547.82
90961 17 13 $531.39
J1644 Injection, heparin sodium, per 1000 units 362 209 $497.93
D1206 Topical application of fluoride varnish 20 18 $446.40
96161 51 46 $440.00
72040 28 27 $439.10
76536 13 12 $419.86
51702 40 29 $406.07
72050 13 13 $398.64
82947 122 108 $390.82
90715 46 40 $388.08
99211 Office or other outpatient visit for the evaluation and management of an established patient, minimal severity 86 59 $349.60
73502 21 14 $343.07
93005 Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report 140 125 $299.45
95249 13 12 $259.20
90651 271 257 $252.85
99406 61 51 $246.06
90734 418 392 $244.02
43450 15 12 $232.10
80305 44 37 $229.54
94761 107 101 $229.12
J1020 Injection, methylprednisolone acetate, 20 mg 47 26 $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) 144 123 $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 38 30 $116.62
0296T 31 27 $115.73
0298T 31 27 $109.33
90656 835 811 $89.40
J3420 Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg 125 101 $89.21
90472 Immunization administration, each additional vaccine (list separately) 12 12 $70.95
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg 14 13 $57.10
99058 96 88 $52.31
G0008 Administration of influenza virus vaccine 242 240 $45.87
94618 17 13 $43.02
J7613 Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg 1,068 930 $37.78
11721 13 12 $29.20
A7003 Administration set, with small volume nonfiltered pneumatic nebulizer, disposable 606 532 $21.85
99000 18,853 16,311 $17.73
93040 130 114 $16.45
J1050 Injection, medroxyprogesterone acetate, 1 mg 574 537 $4.56
3008F 121,808 110,261 $0.63
1160F 80,932 73,407 $0.44
90671 592 579 $0.32
G8431 Screening for depression is documented as being positive and a follow-up plan is documented 113 103 $0.21
1126F 22,061 20,288 $0.16
J2357 Injection, omalizumab, 5 mg 12 12 $0.12
90685 383 349 $0.07
1125F 13,859 12,464 $0.04
90680 2,371 2,274 $0.02
90670 3,895 3,704 $0.02
3074F 2,078 1,935 $0.01
1000F 311 285 $0.01
1159F 23,311 21,528 $0.01
2028F 2,482 2,376 $0.01
3078F 2,129 1,995 $0.01
90723 1,775 1,704 $0.00
1036F 187 169 $0.00
90697 541 523 $0.00
3079F 671 621 $0.00
1101F 663 607 $0.00
3075F 54 51 $0.00
A4270 Disposable endoscope sheath, each 341 202 $0.00
90694 150 115 $0.00
1170F 43 33 $0.00
90696 12 12 $0.00
3017F 34 29 $0.00
1111F 27 26 $0.00
97802 12 12 $0.00
90732 13 12 $0.00
3080F 13 13 $0.00
4000F 15 12 $0.00
A7015 Aerosol mask, used with dme nebulizer 19 14 $0.00
90619 38 38 $0.00
G8952 Elevated or hypertensive blood pressure reading documented, indicated follow-up not documented, reason not given 13 12 $0.00
3077F 183 164 $0.00
90461 10,090 9,637 $0.00
G8482 Influenza immunization administered or previously received 670 597 $0.00
90648 3,014 2,881 $0.00
3288F 1,018 919 $0.00
90633 1,186 1,130 $0.00
G8417 Bmi is documented above normal parameters and a follow-up plan is documented 1,132 1,004 $0.00
90710 550 529 $0.00
97803 574 568 $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) 41 41 $0.00
3725F 393 354 $0.00
2014F 249 234 $0.00
90672 36 36 $0.00
G9744 Patient not eligible due to active diagnosis of hypertension 31 31 $0.00
1100F 13 12 $0.00
90700 67 63 $0.00
1158F 31 24 $0.00