Physician
Splain, James
Splain, James was paid $15K by Medicaid between Jan 2018 and Feb 2018, across 7 billing codes. Its largest line is 99213, doctor's office visit, returning patient (routine) — 54% of everything it billed.
33Billing provider infoSPLAIN, JAMES
AGAWAM, MA 01001
AGAWAM, MA 01001
33aNPI1184613630assigned 10/18/2005
33bProvider typePediatrics Physician
28Total paid$15K
24GClaims309
24DCodes billed7
24AFirst – last monthJan 2018 – Feb 2018
Compared with peers
Next to other Pediatrics Physician providers in Massachusetts
Rank by total paid#727 of 1,273
Median peer was paid$24K
This provider vs. median0.6×
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 | 309 | $15K |
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 | 54% | 110 | 105 | $8K |
| 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 | 15% | 22 | 22 | $2K |
| 90460 | Immunization administration through 18 years of age via any route, first or only component | 14% | 43 | 43 | $2K |
| 99392 | Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) | 8.6% | 13 | 13 | $1K |
| 96110 | Developmental screening, with scoring and documentation, per standardized instrument | 3.9% | 53 | 53 | $584.62 |
| S0302 | Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) | 3.3% | 56 | 56 | $492.48 |
| 87880 | Infectious agent antigen detection by immunoassay; Streptococcus, group A | 1.0% | 12 | 12 | $153.52 |
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.