1174860423

1174860423 was paid $62K by Medicaid between Nov 2019 and Nov 2019, across 1 billing code. Its largest line is 0658, — 100% of everything it billed.

33Billing provider info1174860423

33aNPI1174860423

33bProvider type—

28Total paid$62K

24GClaims13

24DCodes billed1

24AFirst – last monthNov 2019 – Nov 2019

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
2019	13	$62K

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
0658		100%	13	12	$62K

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.