Martinez, Sergio

Martinez, Sergio was paid $464K by Medicaid between Jan 2018 and Nov 2024, across 66 billing codes. Its largest line is 99213, doctor's office visit, returning patient (routine) — 49% of everything it billed.

33Billing provider infoMARTINEZ, SERGIO
JACKSON HEIGHTS, NY 11372

33aNPI1336171040assigned 07/06/2006

33bProvider typePulmonary Disease Physician

28Total paid$464K

24GClaims52,915

24DCodes billed66

24AFirst – last monthJan 2018 – Nov 2024

Compared with peers

Next to other Pulmonary Disease Physician providers in New York

Rank by total paid#25 of 413

Median peer was paid$8K

This provider vs. median59×

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	3,643	$45K
2019	8,953	$63K
2020	9,245	$73K
2021	11,282	$78K
2022	8,790	$76K
2023	9,420	$78K
2024incomplete	1,582	$51K

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	49%	7,783	7,013	$228K
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	13%	1,247	1,208	$59K
95004	Percutaneous tests with allergenic extracts, immediate type reaction	8.3%	228	199	$38K
99397		8.1%	2,301	2,103	$38K
99401		5.4%	7,364	6,689	$25K
99232	Hospital visit by a doctor, follow-up daySubsequent hospital care, per day, moderate complexity	3.8%	303	134	$17K
99396	Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years	3.4%	434	405	$16K
99222	Initial hospital care, per day, moderate complexity	3.1%	222	214	$14K
G0447	Face-to-face behavioral counseling for obesity, 15 minutes	1.5%	2,803	2,531	$7K
99204	Doctor's office visit, new patient (more involved)Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity	<1%	75	74	$4K
99203	Doctor's office visit, new patient (routine)Office or other outpatient visit for the evaluation and management of a new patient, low complexity	<1%	105	104	$3K
99402		<1%	455	395	$3K

54 more codes

94621		<1%	19	$2K
97802		<1%	4,114	$2K
99443		<1%	62	$2K
94729		<1%	19	$823.99
94726		<1%	19	$767.64
99212	Office or other outpatient visit for the evaluation and management of an established patient, straightforward	<1%	26	$615.34
94060		<1%	19	$606.06
99407		<1%	112	$443.12
99442		<1%	34	$422.43
99406		<1%	179	$421.63
3078F		<1%	506	$290.00
3074F		<1%	437	$290.00
36415	Collection of venous blood by venipuncture	<1%	750	$185.00
94640	Pressurized or nonpressurized inhalation treatment for acute airway obstruction	<1%	19	$169.00
99395	Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years	<1%	20	$150.00
99491	Ccm add 20min	<1%	21	$140.67
94664		<1%	39	$101.91
96372	Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular	<1%	12	$100.66
G8427	Eligible clinician attests to documenting in the medical record they obtained, updated, or reviewed the patient's current medications	<1%	4,549	$55.36
1160F		<1%	277	$45.00
1126F		<1%	306	$40.00
1159F		<1%	461	$35.00
94010		<1%	19	$33.55
3016F		<1%	2,865	$17.00
1125F		<1%	74	$10.00
H0001	Alcohol and/or drug assessment	<1%	1,100	$7.04
94760		<1%	30	$0.78
90658		<1%	12	$0.07
80047		<1%	57	$0.04
80061	Lipid panel	<1%	268	$0.02
80053	Comprehensive metabolic panel	<1%	267	$0.02
G8510	Screening for depression is documented as negative, a follow-up plan is not required	<1%	767	$0.02
G8417	Bmi is documented above normal parameters and a follow-up plan is documented	0%	1,409	$0.00
1090F		0%	2,462	$0.00
1158F		0%	231	$0.00
3725F		0%	581	$0.00
G8752	Most recent systolic blood pressure < 140 mmhg	0%	364	$0.00
4551F		0%	29	$0.00
0521F		0%	80	$0.00
G0438	Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit	0%	367	$0.00
G9507	Documentation that the patient is on a statin medication or has documentation of a valid contraindication or exception to statin medications; contraindications/exceptions that can be defined by diagnosis codes include pregnancy during the measurement period, active liver disease, rhabdomyolysis, end stage renal disease on dialysis and heart failure; provider documented contraindications/exceptions include breastfeeding during the measurement period, woman of child-bearing age not actively taking birth control, allergy to statin, drug interaction (hiv protease inhibitors, nefazodone, cyclosporine, gemfibrozil, and danazol) and intolerance (with supporting documentation of trying a statin at least once within the last 5 years or diagnosis codes for myostitis or toxic myopathy related to drugs)	0%	150	$0.00
G8431	Screening for depression is documented as being positive and a follow-up plan is documented	0%	27	$0.00
G8754	Most recent diastolic blood pressure < 90 mmhg	0%	372	$0.00
G8420	Bmi is documented within normal parameters and no follow-up plan is required	0%	1,909	$0.00
3008F		0%	2,130	$0.00
G9275	Documentation that patient is a current non-tobacco user	0%	223	$0.00
3011F		0%	82	$0.00
1000F		0%	109	$0.00
G9788	Most recent bp is less than or equal to 130/80 mm hg	0%	445	$0.00
1036F		0%	766	$0.00
1157F		0%	233	$0.00
G0439	Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	0%	99	$0.00
G8418	Bmi is documented below normal parameters and a follow-up plan is documented	0%	15	$0.00
0001F		0%	53	$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.