SOUTHERN ILLINOIS REGIONAL WELLNESS CENTER
NPI: 1336258540
· EAST SAINT LOUIS, IL 62204
· Federally Qualified Health Center (FQHC)
· NPI assigned 08/30/2006
$297K
Total Medicaid Paid
Provider Details
| Authorized Official | FREELAND, MARK (EXECUTIVE DIRECTOR) |
| NPI Enumeration Date | 08/30/2006 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
3,914 |
$189K |
| 2019 |
2,060 |
$108K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
2,768 |
2,303 |
$296K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,028 |
1,734 |
$935.55 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
532 |
474 |
$127.50 |
| 99406 |
|
85 |
81 |
$50.33 |
| 3077F |
|
64 |
54 |
$0.00 |
| 1159F |
|
136 |
115 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
15 |
15 |
$0.00 |
| 4050F |
|
144 |
117 |
$0.00 |
| 97802 |
|
99 |
81 |
$0.00 |
| 4010F |
|
17 |
14 |
$0.00 |
| 3080F |
|
55 |
45 |
$0.00 |
| 82962 |
|
14 |
14 |
$0.00 |
| G0447 |
Face-to-face behavioral counseling for obesity, 15 minutes |
17 |
16 |
$0.00 |