Physician
Pinelake Physician Practice, LLC
Pinelake Physician Practice, LLC was paid $2.26M by Medicaid between Jan 2018 and Dec 2024, across 63 billing codes. Its largest line is 99213, doctor's office visit, returning patient (routine) — 47% of everything it billed.
33Billing provider infoPINELAKE PHYSICIAN PRACTICE, LLC
MAYFIELD, KY 42066
MAYFIELD, KY 42066
33aNPI1295960532assigned 05/15/2009
33bProvider typeFamily Medicine Physician
28Total paid$2.26M
24GClaims151,870
24DCodes billed63
24AFirst – last monthJan 2018 – Dec 2024
Compared with peers
Next to other Family Medicine Physician providers in Kentucky
Rank by total paid#33 of 352
Median peer was paid$90K
This provider vs. median25×
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.
Auditor's notes
Automated statistical signals. Not evidence of fraud — how these are computed.
Entity ProliferationAuthorized official BOWMAN, MONICA controls 20+ related entities in our dataset. Read more
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 | 14,845 | $424K | |
| 2019 | 11,576 | $353K | |
| 2020 | 7,708 | $260K | |
| 2021 | 10,767 | $353K | |
| 2022 | 21,696 | $320K | |
| 2023 | 54,166 | $301K | |
| 2024incomplete | 31,112 | $250K |
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 | 47% | 31,902 | 24,035 | $1.06M |
| 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% | 13,779 | 11,732 | $612K |
| 99212 | Office or other outpatient visit for the evaluation and management of an established patient, straightforward | 9.0% | 6,825 | 4,321 | $204K |
| 99391 | Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) | 4.0% | 1,573 | 1,348 | $91K |
| 99392 | Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) | 2.4% | 811 | 742 | $54K |
| 90460 | Immunization administration through 18 years of age via any route, first or only component | 1.9% | 1,708 | 1,567 | $42K |
| 99395 | Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years | 1.9% | 683 | 519 | $42K |
| 90461 | <1% | 1,101 | 1,018 | $21K | |
| 87804 | Infectious agent antigen detection by immunoassay; Influenza, each type | <1% | 1,065 | 635 | $15K |
| 99307 | <1% | 613 | 611 | $14K | |
| 76805 | Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation | <1% | 160 | 149 | $13K |
| 90670 | <1% | 717 | 664 | $12K |
51 more codes
| 87428 | <1% | 288 | $11K | |
| 99396 | Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years | <1% | 130 | $11K |
| 99203 | Doctor's office visit, new patient (routine) | <1% | 200 | $10K |
| 96372 | Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular | <1% | 518 | $7K |
| 76801 | <1% | 118 | $7K | |
| 76816 | Ultrasound, pregnant uterus, real time with image documentation, follow-up | <1% | 112 | $5K |
| 99204 | Doctor's office visit, new patient (more involved) | <1% | 45 | $5K |
| 81025 | <1% | 878 | $5K | |
| 87880 | Infectious agent antigen detection by immunoassay; Streptococcus, group A | <1% | 281 | $4K |
| 87807 | <1% | 184 | $2K | |
| 99393 | Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) | <1% | 28 | $2K |
| 93306 | Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete | <1% | 12 | $1K |
| 90723 | <1% | 532 | $1K | |
| 90686 | <1% | 244 | $878.97 | |
| 90681 | <1% | 220 | $783.76 | |
| 81002 | <1% | 1,532 | $780.06 | |
| 90647 | <1% | 455 | $630.75 | |
| 99462 | <1% | 32 | $595.37 | |
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | <1% | 54 | $586.43 |
| 87400 | <1% | 105 | $573.56 | |
| 99460 | <1% | 14 | $556.02 | |
| G2025 | Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only | <1% | 14 | $534.73 |
| 99238 | Hospital discharge day management, 30 minutes or less | <1% | 12 | $377.26 |
| 97597 | <1% | 29 | $341.51 | |
| 87426 | Infectious agent antigen detection, SARS-CoV-2 (COVID-19) | <1% | 20 | $323.86 |
| G0071 | Payment for communication technology-based services for 5 minutes or more of a virtual (non-face-to-face) communication between an rural health clinic (rhc) or federally qualified health center (fqhc) practitioner and rhc or fqhc patient, or 5 minutes or more of remote evaluation of recorded video and/or images by an rhc or fqhc practitioner, occurring in lieu of an office visit; rhc or fqhc only | <1% | 35 | $246.98 |
| 87430 | <1% | 12 | $183.73 | |
| 90633 | <1% | 111 | $183.22 | |
| 87210 | <1% | 30 | $165.01 | |
| 81003 | <1% | 376 | $134.57 | |
| 85018 | <1% | 16 | $37.29 | |
| 3074F | <1% | 12,501 | $34.77 | |
| 3078F | <1% | 12,034 | $33.63 | |
| 3008F | <1% | 16,306 | $15.24 | |
| 3079F | <1% | 2,787 | $8.14 | |
| 3075F | <1% | 1,470 | $5.01 | |
| 1159F | <1% | 10,938 | $4.13 | |
| 1160F | <1% | 10,939 | $4.13 | |
| 3077F | <1% | 963 | $2.67 | |
| 1036F | <1% | 10,078 | $2.07 | |
| 1034F | <1% | 4,279 | $1.02 | |
| 3080F | <1% | 394 | $0.91 | |
| 1035F | <1% | 99 | $0.03 | |
| 3725F | 0% | 1,218 | $0.00 | |
| 0502F | 0% | 48 | $0.00 | |
| T1015 | A visit at a community health center or clinic (one all-in rate) | 0% | 19 | $0.00 |
| 90671 | 0% | 30 | $0.00 | |
| 99024 | 0% | 142 | $0.00 | |
| 90688 | 0% | 24 | $0.00 | |
| 90698 | 0% | 15 | $0.00 | |
| 90744 | 0% | 12 | $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.
From NPPES
Who's on the registration
Authorized officialBOWMAN, MONICA (SR. DIRECTOR)
Matched on the authorized-official name exactly as entered in NPPES. A common name can match unrelated people.