LITTLE RIVER BAND OF OTTAWA INDIANS
NPI: 1154590917
· MANISTEE, MI 49660
· Federally Qualified Health Center (FQHC)
· NPI assigned 02/26/2008
$380K
Total Medicaid Paid
Provider Details
| Authorized Official | GRANT, JANICE (HEALTH SERVICES SUPERVISOR) |
| NPI Enumeration Date | 02/26/2008 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
417 |
$94K |
| 2019 |
176 |
$54K |
| 2020 |
110 |
$37K |
| 2021 |
75 |
$37K |
| 2022 |
195 |
$61K |
| 2023 |
262 |
$80K |
| 2024 |
26 |
$16K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| G0467 |
Federally 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 |
840 |
750 |
$379K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
166 |
152 |
$301.50 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
173 |
158 |
$40.81 |
| 94760 |
|
82 |
79 |
$0.00 |