NPI: 1376189407 · EDGERTON, WI 53534 · Community/Retail Pharmacy · NPI assigned 11/25/2019
| Authorized Official | APPALANENI, SAIBABU (PRESIDENT) |
| NPI Enumeration Date | 11/25/2019 |
Other providers sharing the same authorized official: APPALANENI, SAIBABU
| Provider | City | State | Total Paid |
|---|---|---|---|
| WAGNER CHEMISTS, INC. | CLINTON | IA | $7K |
| MEDICINE SHOPPE OF SOMERSET INC | SOMERSET | KY | $5K |
| STOUGHTON CHEMISTS INC | STOUGHTON | WI | $2K |
| RIPON DRUG MANAGEMENT ENTERPRISES INC | RIPON | WI | $2K |
| MARSHLAND CHEMISTS, INC. | HORICON | WI | $2K |
| HEALTH FIRST PHARMACY, LLC | GREENSBURG | KY | $734.76 |
| Year | Claims | Total Paid |
|---|---|---|
| 2021 | 555 | $7K |
| 2022 | 197 | $1K |
| 2023 | 48 | $2K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| 0001A | 43 | 43 | $2K | |
| 91320 | 13 | 12 | $2K | |
| 0012A | 33 | 33 | $1K | |
| 0004A | 29 | 27 | $992.16 | |
| 0064A | 41 | 29 | $992.16 | |
| 0011A | 25 | 25 | $907.68 | |
| 90686 | 65 | 31 | $710.96 | |
| 0071A | 33 | 17 | $648.72 | |
| 0072A | 27 | 13 | $534.24 | |
| 0002A | 13 | 13 | $496.08 | |
| 0054A | 24 | 12 | $419.76 | |
| 0031A | 14 | 13 | $395.28 | |
| 90656 | 17 | 16 | $278.28 | |
| 91300 | 132 | 126 | $0.00 | |
| 91307 | 104 | 63 | $0.00 | |
| 91306 | 32 | 29 | $0.00 | |
| 91301 | 82 | 82 | $0.00 | |
| 91305 | 59 | 29 | $0.00 | |
| 91303 | 14 | 13 | $0.00 |