Physician
Duke University Health System, INC.
Duke University Health System, INC. was paid $7.61M by Medicaid between Jan 2018 and Dec 2024, across 32 billing codes. Its largest line is 99285, emergency room visit (most serious) — 35% of everything it billed.
33Billing provider infoDUKE UNIVERSITY HEALTH SYSTEM, INC.
DURHAM, NC 27704
DURHAM, NC 27704
33aNPI1376574798assigned 07/05/2006
33bProvider typeCardiovascular Disease Physician
28Total paid$7.61M
24GClaims128,963
24DCodes billed32
24AFirst – last monthJan 2018 – Dec 2024
Compared with peers
Next to other Cardiovascular Disease Physician providers in North Carolina
Rank by total paid#2 of 109
Median peer was paid$58K
This provider vs. median130×
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 SMITH, JOHN 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 | 6,170 | $226K | |
| 2019 | 18,530 | $1.17M | |
| 2020 | 14,182 | $950K | |
| 2021 | 16,319 | $1.08M | |
| 2022 | 16,435 | $1.06M | |
| 2023 | 23,610 | $1.29M | |
| 2024incomplete | 33,717 | $1.84M |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| 99285 | Emergency room visit (most serious)Emergency department visit for the evaluation and management, high severity with immediate threat to life | 35% | 35,721 | 30,873 | $2.68M |
| 99284 | Emergency room visit (serious)Emergency department visit for the evaluation and management, high severity | 33% | 34,574 | 31,096 | $2.50M |
| 99233 | Hospital visit by a doctor, follow-up day (complex)Prolong inpt eval add15 m | 14% | 24,849 | 9,617 | $1.08M |
| 99232 | Hospital visit by a doctor, follow-up daySubsequent hospital care, per day, moderate complexity | 7.7% | 17,345 | 6,690 | $584K |
| 99223 | Prolong inpt eval add15 m | 3.4% | 3,244 | 2,924 | $262K |
| 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 | 2.6% | 4,487 | 3,414 | $196K |
| 99283 | Emergency room visit (moderate)Emergency department visit for the evaluation and management, moderate severity | 1.4% | 2,585 | 2,344 | $105K |
| 99239 | Hospital discharge day management, more than 30 minutes | <1% | 1,232 | 1,092 | $58K |
| 99238 | Hospital discharge day management, 30 minutes or less | <1% | 858 | 769 | $43K |
| 99213 | Doctor's office visit, returning patient (routine)Office or other outpatient visit for the evaluation and management of an established patient, low complexity | <1% | 835 | 574 | $21K |
| 90837 | Psychotherapy session, about an hourPsychotherapy, 53 minutes with patient | <1% | 220 | 147 | $17K |
| 99282 | Emergency department visit for the evaluation and management, low to moderate severity | <1% | 394 | 341 | $13K |
20 more codes
| 99460 | <1% | 113 | $8K | |
| 99215 | Doctor's office visit, returning patient (complex) | <1% | 108 | $8K |
| 99222 | Initial hospital care, per day, moderate complexity | <1% | 51 | $5K |
| D0160 | <1% | 71 | $4K | |
| 90792 | Psychiatric diagnostic evaluation with medical services | <1% | 39 | $4K |
| 96127 | <1% | 1,175 | $3K | |
| 99443 | <1% | 80 | $3K | |
| 99255 | <1% | 16 | $2K | |
| 90832 | Psychotherapy session, about 30 minutes | <1% | 59 | $2K |
| 99199 | Unlisted special service, procedure or report | <1% | 401 | $2K |
| 90791 | Psychiatric diagnostic evaluation | <1% | 39 | $2K |
| 99291 | Critical care, evaluation and management of the critically ill patient, first 30-74 minutes | <1% | 17 | $2K |
| 99203 | Doctor's office visit, new patient (routine) | <1% | 30 | $1K |
| 99220 | <1% | 26 | $891.10 | |
| 90834 | Psychotherapy session, about 45 minutes | <1% | 18 | $764.70 |
| 99212 | Office or other outpatient visit for the evaluation and management of an established patient, straightforward | <1% | 27 | $748.62 |
| 99231 | Subsequent hospital care, per day, straightforward or low complexity | <1% | 70 | $442.08 |
| 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) | <1% | 223 | $192.98 |
| 11042 | Debridement, subcutaneous tissue (includes epidermis, dermis, and subcutaneous tissue); first 20 sq cm | <1% | 35 | $123.39 |
| 99497 | <1% | 21 | $106.42 |
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 officialSMITH, JOHN (VP, FINANCE)
Parent organizationDUKE UNIVERSITY HEALTH SYSTEM, INC.
| Provider | Location | Paid |
|---|---|---|
| Prestige Healthcare Resources INC. | Bladensburg, MD | $55.74M |
| Duke University Health System, INC. | Durham, NC | $44.35M |
| Duke University Health System, INC. | Durham, NC | $11.62M |
| Proact Dental, INC. | Birmingham, AL | $9.47M |
| Duke University Health System, INC. | Durham, NC | $8.33M |
| Duke University Health System INC | Raleigh, NC | $7.84M |
| Wishon Radiological Medical Group, INC. | Fresno, CA | $5.11M |
| Duke University Health System, INC. | Durham, NC | $5.01M |
| Duke University Health System, INC. | Raleigh, NC | $4.15M |
| Lighthouse Systems, LLC | Pharr, TX | $3.54M |
| Duke University Health System, INC. | Durham, NC | $1.59M |
| Old School LLC | Lakewood, OH | $800K |
| Gateway Medical Group LC | Okeechobee, FL | $447K |
| Triangle Geriatric and Memory Clinic, PLLC | Cary, NC | $437K |
| Duke University Health System, INC. | Durham, NC | $289K |
| Duke University Health System, INC. | Durham, NC | $118K |
| Associated Health Services, INC. | Durham, NC | $102K |
| Duke Health Integrated Practice, INC. | Durham, NC | $64K |
| Duke University Health System, INC. | Durham, NC | $49K |
| Women's Imaging Specialists in Healthcare | Fresno, CA | $36K |
Matched on the authorized-official name exactly as entered in NPPES. A common name can match unrelated people.