NPI: 1285962001 · SANTO DOMINGO PUEBLO, NM 87052 · 261QE0700X
| Year | Claims | Total Paid |
|---|---|---|
| 2018 | 5,869 | $200K |
| 2019 | 4,743 | $267K |
| 2020 | 2,085 | $155K |
| 2021 | 1,848 | $125K |
| 2022 | 567 | $43K |
| 2023 | 278 | $16K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| 90999 | 11,821 | 1,059 | $777K | |
| J0887 | Epoetin beta esrd use | 203 | 124 | $9K |
| J0882 | Darbepoetin alfa, esrd use | 572 | 184 | $9K |
| A4657 | Syringe w/wo needle | 1,430 | 339 | $6K |
| 83970 | 123 | 120 | $1K | |
| 82728 | 358 | 351 | $812.92 | |
| J2916 | Na ferric gluconate complex | 143 | 29 | $612.64 |
| 84466 | 357 | 351 | $510.69 | |
| 83540 | 357 | 351 | $263.03 | |
| 90662 | 13 | 13 | $42.60 | |
| G0008 | Admin influenza virus vac | 13 | 13 | $6.82 |