NPI: 1235533662 · AMORY, MS 38821 · Durable Medical Equipment & Medical Supplies · NPI assigned 10/14/2014
| Authorized Official | CARSON, KIMBERLY (MANAGING MEMBER) |
| NPI Enumeration Date | 10/14/2014 |
Other providers sharing the same authorized official: CARSON, KIMBERLY
| Provider | City | State | Total Paid |
|---|---|---|---|
| PREMIER CHOICE BEHAVIORAL HEALTH AND WELLNESS CLINIC, LLC | JACKSON | MS | $1K |
| Year | Claims | Total Paid |
|---|---|---|
| 2018 | 24 | $636.50 |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| A5500 | For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe | 12 | 12 | $636.50 |
| A5512 | For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees fahrenheit or higher, total contact with patient's foot, including arch, base layer minimum of 1/4 inch material of shore a 35 durometer or 3/16 inch material of shore a 40 durometer (or higher), prefabricated, each | 12 | 12 | $0.00 |