Clinic
Big Sandy Health Care INC
Big Sandy Health Care INC was paid $1.74M by Medicaid between Jan 2018 and Dec 2024, across 80 billing codes. Its largest line is 99213, doctor's office visit, returning patient (routine) — 43% of everything it billed.
33Billing provider infoBIG SANDY HEALTH CARE INC
GRETHEL, KY 41631
GRETHEL, KY 41631
33aNPI1154367191assigned 06/20/2006
33bProvider typeFederally Qualified Health Center (FQHC)
28Total paid$1.74M
24GClaims92,307
24DCodes billed80
24AFirst – last monthJan 2018 – Dec 2024
Compared with peers
Next to other Federally Qualified Health Center (FQHC) providers in Kentucky
Rank by total paid#17 of 37
Median peer was paid$1.29M
This provider vs. median1.4×
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 | 13,444 | $227K | |
| 2019 | 13,335 | $238K | |
| 2020 | 12,059 | $233K | |
| 2021 | 14,289 | $270K | |
| 2022 | 14,305 | $279K | |
| 2023 | 14,284 | $286K | |
| 2024incomplete | 10,591 | $212K |
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 | 43% | 22,672 | 20,295 | $757K |
| 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 | 6.1% | 1,870 | 1,762 | $107K |
| 87804 | Infectious agent antigen detection by immunoassay; Influenza, each type | 5.1% | 6,153 | 3,057 | $89K |
| D7140 | Extraction, erupted tooth or exposed root | 4.3% | 1,364 | 587 | $75K |
| 87811 | Infectious agent antigen detection by immunoassay; SARS-CoV-2 (COVID-19) | 3.8% | 1,926 | 1,788 | $66K |
| 99232 | Hospital visit by a doctor, follow-up daySubsequent hospital care, per day, moderate complexity | 3.8% | 2,384 | 879 | $66K |
| G0467 | Community health center visit, returning patientFederally qualified health center (fqhc) visit, established patient; a medically-necessary, face-to-face encounter (one-on-one) between an established patient and a fqhc practitioner during which time one or more fqhc services are rendered and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving a fqhc visit | 3.6% | 8,342 | 2,883 | $63K |
| 87880 | Infectious agent antigen detection by immunoassay; Streptococcus, group A | 3.4% | 4,353 | 3,968 | $59K |
| D0330 | Panoramic radiographic image | 2.5% | 1,007 | 978 | $44K |
| 87635 | Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe | 1.9% | 831 | 749 | $34K |
| 85025 | Blood count; complete (CBC), automated, and automated differential WBC count | 1.9% | 6,022 | 5,692 | $33K |
| D0150 | Comprehensive oral evaluation - new or established patient | 1.7% | 1,072 | 1,057 | $30K |
68 more codes
| 99202 | Office or other outpatient visit for the evaluation and management of a new patient, straightforward | 1.5% | 781 | $27K |
| 99238 | Hospital discharge day management, 30 minutes or less | 1.5% | 717 | $26K |
| D1110 | Prophylaxis - adult | 1.2% | 430 | $21K |
| 36415 | Collection of venous blood by venipuncture | 1.2% | 8,397 | $21K |
| D0140 | Limited oral evaluation - problem focused | 1.1% | 504 | $19K |
| 99173 | 1.0% | 696 | $18K | |
| 99212 | Office or other outpatient visit for the evaluation and management of an established patient, straightforward | 1.0% | 780 | $18K |
| 83036 | Hemoglobin; glycosylated (A1C) | <1% | 2,603 | $17K |
| 99222 | Initial hospital care, per day, moderate complexity | <1% | 207 | $13K |
| D0274 | Bitewings - four radiographic images | <1% | 486 | $13K |
| 92014 | Ophthalmological services: medical examination and evaluation, comprehensive, established patient | <1% | 180 | $11K |
| 99223 | Prolong inpt eval add15 m | <1% | 162 | $11K |
| 87633 | Infectious agent detection by nucleic acid, respiratory virus, 12-25 targets | <1% | 31 | $11K |
| 90837 | Psychotherapy session, about an hour | <1% | 156 | $10K |
| 90460 | Immunization administration through 18 years of age via any route, first or only component | <1% | 984 | $10K |
| D1120 | Dental cleaning, child | <1% | 231 | $9K |
| D0220 | Intraoral - periapical first radiographic image | <1% | 870 | $7K |
| 99393 | Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) | <1% | 71 | $5K |
| 90834 | Psychotherapy session, about 45 minutes | <1% | 121 | $5K |
| 99203 | Doctor's office visit, new patient (routine) | <1% | 93 | $5K |
| D1208 | Topical application of fluoride, excluding varnish | <1% | 335 | $4K |
| D0120 | Dental checkup, returning patient | <1% | 141 | $4K |
| V2020 | Frames, purchases | <1% | 159 | $3K |
| 90461 | <1% | 202 | $3K | |
| G2025 | Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only | <1% | 325 | $2K |
| 99233 | Hospital visit by a doctor, follow-up day (complex) | <1% | 42 | $2K |
| 99392 | Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) | <1% | 27 | $2K |
| 90471 | Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine | <1% | 154 | $2K |
| 99460 | <1% | 44 | $2K | |
| 87420 | <1% | 162 | $2K | |
| 92015 | Determination of refractive state | <1% | 394 | $2K |
| D0272 | Bitewings - two radiographic images | <1% | 107 | $2K |
| 99391 | Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) | <1% | 26 | $2K |
| D2392 | Resin-based composite - two surfaces, posterior, primary or permanent | <1% | 27 | $2K |
| 90686 | <1% | 276 | $1K | |
| 99394 | Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) | <1% | 14 | $1K |
| 92551 | <1% | 110 | $1K | |
| D1351 | Sealant - per tooth | <1% | 68 | $1K |
| D1206 | Topical application of fluoride varnish | <1% | 49 | $900.00 |
| G2012 | Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, 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; 5-10 minutes of medical discussion | <1% | 78 | $654.55 |
| 99217 | <1% | 15 | $641.28 | |
| 99211 | Office or other outpatient visit for the evaluation and management of an established patient, minimal severity | <1% | 33 | $550.23 |
| 96372 | Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular | <1% | 26 | $495.66 |
| D0230 | Intraoral - periapical each additional radiographic image | <1% | 58 | $352.05 |
| 90674 | <1% | 15 | $295.64 | |
| 80305 | <1% | 41 | $292.68 | |
| 90633 | <1% | 121 | $272.79 | |
| 90756 | <1% | 17 | $216.00 | |
| 71046 | Radiologic examination, chest; 2 views | <1% | 19 | $148.60 |
| G0071 | Payment for communication technology-based services for 5 minutes or more of a virtual (non-face-to-face) communication between an rural health clinic (rhc) or federally qualified health center (fqhc) practitioner and rhc or fqhc patient, or 5 minutes or more of remote evaluation of recorded video and/or images by an rhc or fqhc practitioner, occurring in lieu of an office visit; rhc or fqhc only | <1% | 85 | $123.93 |
| 81001 | <1% | 49 | $36.12 | |
| 81003 | <1% | 114 | $33.00 | |
| 36416 | <1% | 16 | $13.08 | |
| 3074F | <1% | 214 | $1.18 | |
| 3044F | <1% | 270 | $1.14 | |
| 3078F | <1% | 131 | $0.61 | |
| D0999 | Unspecified diagnostic procedure, by report | <1% | 861 | $0.21 |
| 1036F | <1% | 1,351 | $0.19 | |
| 3079F | <1% | 27 | $0.12 | |
| 90648 | <1% | 12 | $0.01 | |
| 4004F | <1% | 3,995 | $0.01 | |
| 90670 | <1% | 12 | $0.01 | |
| G8510 | Screening for depression is documented as negative, a follow-up plan is not required | <1% | 3,050 | $0.01 |
| G8417 | Bmi is documented above normal parameters and a follow-up plan is documented | 0% | 2,220 | $0.00 |
| G8431 | Screening for depression is documented as being positive and a follow-up plan is documented | 0% | 99 | $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% | 28 | $0.00 |
| T1015 | A visit at a community health center or clinic (one all-in rate) | 0% | 147 | $0.00 |
| G8420 | Bmi is documented within normal parameters and no follow-up plan is required | 0% | 45 | $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 officialHERALD, JAMES (CEO)
| Provider | Location | Paid |
|---|---|---|
| Big Sandy Health Care INC | Auxier, KY | $4.57M |
| Big Sandy Health Care, INC | Inez, KY | $2.30M |
| Big Sandy Health Care INC | Salyersville, KY | $1.99M |
| Big Sandy Health Care INC | Pikeville, KY | $1.73M |
| Big Sandy Health Care INC | Salyersville, KY | $1.01M |
| Big Sandy Health Care INC | Pikeville, KY | $530K |
| Big Sandy Health Care INC | Harold, KY | $416K |
| The Pathology Group PC | Memphis, TN | $380K |
| Big Sandy Health Care INC | Freeburn, KY | $114K |
| Big Sandy Health Care INC | Paintsville, KY | $48K |
Matched on the authorized-official name exactly as entered in NPPES. A common name can match unrelated people.