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NPI 1215000633
NPI deactivated
1215000633
1215000633 was paid $101K by Medicaid between Jan 2018 and Jan 2019, across 34 billing codes. Its largest line is 92081, — 32% of everything it billed.
33Billing provider info1215000633
33aNPI1215000633
33bProvider type—
28Total paid$101K
24GClaims8,447
24DCodes billed34
24AFirst – last monthJan 2018 – Jan 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 | |
|---|---|---|---|
| 2018 | 8,383 | $100K | |
| 2019 | 64 | $615.00 |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| 92081 | 32% | 893 | 891 | $32K | |
| 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 | 27% | 1,324 | 1,160 | $27K |
| 97802 | 18% | 541 | 539 | $18K | |
| 96110 | Developmental screening, with scoring and documentation, per standardized instrument | 6.7% | 107 | 103 | $7K |
| 99391 | Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) | 5.0% | 168 | 155 | $5K |
| 90680 | 4.4% | 303 | 297 | $4K | |
| D1206 | Topical application of fluoride varnish | 3.8% | 169 | 166 | $4K |
| 81000 | 1.8% | 776 | 773 | $2K | |
| 99393 | Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) | 1.1% | 399 | 397 | $1K |
| 99392 | Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) | <1% | 120 | 117 | $649.18 |
| 92552 | <1% | 925 | 923 | $429.52 | |
| 99394 | Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) | <1% | 93 | 93 | $180.56 |
22 more codes
| 90686 | <1% | 186 | $140.94 | |
| 90688 | <1% | 217 | $89.20 | |
| 90630 | <1% | 71 | $49.60 | |
| 90723 | 0% | 156 | $0.00 | |
| 90716 | 0% | 70 | $0.00 | |
| 85018 | 0% | 58 | $0.00 | |
| 90696 | 0% | 45 | $0.00 | |
| 90647 | 0% | 38 | $0.00 | |
| 90698 | 0% | 21 | $0.00 | |
| 90715 | 0% | 29 | $0.00 | |
| 90460 | Immunization administration through 18 years of age via any route, first or only component | 0% | 148 | $0.00 |
| 90670 | 0% | 387 | $0.00 | |
| 90648 | 0% | 325 | $0.00 | |
| 90707 | 0% | 65 | $0.00 | |
| 90633 | 0% | 286 | $0.00 | |
| 90710 | 0% | 33 | $0.00 | |
| 90700 | 0% | 160 | $0.00 | |
| 90713 | 0% | 29 | $0.00 | |
| 90649 | 0% | 168 | $0.00 | |
| 90621 | 0% | 28 | $0.00 | |
| 90461 | 0% | 12 | $0.00 | |
| 90734 | 0% | 97 | $0.00 |
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.