SHOPKO STORES OPERATING CO. LLC
NPI: 1174576748
· MISSOULA, MT 59801
· 156FX1800X
$134K
Total Medicaid Paid
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
2,015 |
$104K |
| 2019 |
626 |
$30K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
|
926 |
906 |
$73K |
| 92340 |
|
1,171 |
1,157 |
$30K |
| 92014 |
|
307 |
305 |
$25K |
| 92250 |
|
225 |
217 |
$5K |
| 92341 |
|
12 |
12 |
$350.50 |