Paloma Medical Group INC
Paloma Medical Group INC was paid $812K by Medicaid between Jan 2018 and Nov 2024, across 35 billing codes. Its largest line is 99215, doctor's office visit, returning patient (complex) — 26% of everything it billed.
33Billing provider infoPALOMA MEDICAL GROUP INC
SAN JUAN CAPISTRANO, CA 92675
SAN JUAN CAPISTRANO, CA 92675
33aNPI1346331725assigned 09/28/2006
33bProvider typeSpecialist
28Total paid$812K
24GClaims26,352
24DCodes billed35
24AFirst – last monthJan 2018 – Nov 2024
Compared with peers
Next to other Specialist providers in California
Rank by total paid#213 of 1,230
Median peer was paid$51K
This provider vs. median16×
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 | 2,539 | $20K | |
| 2019 | 914 | $11K | |
| 2020 | 3,638 | $34K | |
| 2021 | 3,037 | $31K | |
| 2022 | 3,305 | $47K | |
| 2023 | 7,690 | $306K | |
| 2024incomplete | 5,229 | $364K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| 99215 | Doctor's office visit, returning patient (complex)Prolong outpt/office vis | 26% | 2,798 | 2,378 | $214K |
| 99310 | Prolong nursin fac eval 15m | 13% | 4,630 | 1,421 | $110K |
| 99233 | Hospital visit by a doctor, follow-up day (complex)Prolong inpt eval add15 m | 13% | 8,574 | 1,331 | $102K |
| 99205 | Prolong outpt/office vis | 10% | 686 | 521 | $84K |
| 99291 | Critical care, evaluation and management of the critically ill patient, first 30-74 minutes | 10% | 1,880 | 352 | $82K |
| 94729 | 5.2% | 730 | 727 | $42K | |
| 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 | 4.1% | 1,442 | 1,376 | $34K |
| 94060 | 4.0% | 657 | 654 | $33K | |
| 94727 | 3.4% | 600 | 600 | $28K | |
| 99418 | Prolong nursin fac eval 15m | 2.6% | 395 | 149 | $21K |
| 99497 | 1.4% | 310 | 265 | $11K | |
| 99223 | Prolong inpt eval add15 m | 1.4% | 612 | 546 | $11K |
23 more codes
| G0317 | Prolonged nursing facility evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using time on the date of the primary service); each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (list separately in addition to cpt codes 99306, 99310 for nursing facility evaluation and management services). (do not report g0317 on the same date of service as other prolonged services for evaluation and management 99358, 99359, 99418). (do not report g0317 for any time unit less than 15 minutes) | <1% | 182 | $6K |
| 94664 | <1% | 525 | $6K | |
| 99292 | <1% | 183 | $4K | |
| 99451 | <1% | 681 | $4K | |
| 99417 | Prolong home eval add 15m | <1% | 80 | $3K |
| 94618 | <1% | 83 | $3K | |
| 99306 | Prolong nursin fac eval 15m | <1% | 90 | $3K |
| 94375 | <1% | 74 | $2K | |
| 99358 | Prolong nursin fac eval 15m | <1% | 286 | $2K |
| 99356 | <1% | 183 | $1K | |
| 94010 | <1% | 47 | $1K | |
| 99239 | Hospital discharge day management, more than 30 minutes | <1% | 108 | $1K |
| 99308 | Subsequent nursing facility care, per day, straightforward | <1% | 21 | $990.19 |
| 95012 | <1% | 37 | $973.54 | |
| 99222 | Initial hospital care, per day, moderate complexity | <1% | 12 | $421.70 |
| 94760 | <1% | 330 | $322.87 | |
| 99213 | Doctor's office visit, returning patient (routine) | <1% | 12 | $238.80 |
| 99407 | <1% | 12 | $219.69 | |
| G0316 | Prolonged hospital inpatient or observation care evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using time on the date of the primary service); each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (list separately in addition to cpt codes 99223, 99233, and 99236 for hospital inpatient or observation care evaluation and management services). (do not report g0316 on the same date of service as other prolonged services for evaluation and management 99358, 99359, 99418, 99415, 99416). (do not report g0316 for any time unit less than 15 minutes) | <1% | 12 | $200.90 |
| 94726 | <1% | 14 | $48.26 | |
| 94016 | <1% | 15 | $5.56 | |
| 94762 | 0% | 38 | $0.00 | |
| G2211 | Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient's single, serious condition or a complex condition. (add-on code, list separately in addition to office/outpatient evaluation and management visit, new or established) | 0% | 13 | $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 officialROVZAR, MICHAEL (PRESIDENT)
| Provider | Location | Paid |
|---|---|---|
| Pacific Private Practice Network INC | San Juan Capistrano, CA | $14K |
| Paloma Incare | San Juan Capistrano, CA | $6K |
Matched on the authorized-official name exactly as entered in NPPES. A common name can match unrelated people.