Medicaid Provider Spending

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

SUMMIT PHARMACY OF IOWA, INC

NPI: 1154941870 · FAIRFIELD, IA 52556 · Community/Retail Pharmacy · NPI assigned 04/22/2020

$2K
Total Medicaid Paid
120
Total Claims
103
Beneficiaries
3
Codes Billed
2021-03
First Month
2022-10
Last Month

Provider Details

Authorized OfficialVANDER LINDEN, BRYAN (OWNER)
NPI Enumeration Date04/22/2020

Monthly Spending Trend

Yearly Breakdown

YearClaimsTotal Paid
2021 79 $2K
2022 41 $55.99

Billing Codes

CodeDescriptionClaimsBeneficiariesTotal Paid
0011A 52 46 $1K
0012A 27 25 $761.00
90471 Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine 41 32 $55.99