CRYSTAL LAKE CLINIC P.C.

NPI: 1386028769 · WILLIAMSBURG, MI 49690 · Family Medicine Physician · NPI assigned 07/15/2015

Billing Flags · Automated signals — not evidence of fraud

Entity Proliferation

Authorized official NIELSEN, RICHARD controls 12+ related entities in our dataset. Read more

$51K

Total Medicaid Paid

1,034

Total Claims

933

Beneficiaries

Codes Billed

2018-01

First Month

2019-08

Last Month

Provider Details

Authorized Official	NIELSEN, RICHARD (PRESIDENT)
NPI Enumeration Date	07/15/2015

Other providers sharing the same authorized official: NIELSEN, RICHARD

Provider	City	State	Total Paid
CRYSTAL LAKE CLINIC P.C.	BENZONIA	MI	$2.10M
CRYSTAL LAKE CLINIC P.C.	INTERLOCHEN	MI	$1.47M
CRYSTAL LAKE CLINIC, PC	TRAVERSE CITY	MI	$1.30M
CRYSTAL LAKE CLINIC PC	MANISTEE	MI	$1.02M
CRYSTAL LAKE CLINIC, PC	MANTON	MI	$725K
CRYSTAL LAKE CLINIC P.C.	TRAVERSE CITY	MI	$706K
CRYSTAL LAKE CLINIC, P.C.	KINGSLEY	MI	$669K
INTERIM HEALTHCARE OF OHIO	GAHANNA	OH	$341K
CRYSTAL LAKE CLINIC, P.C.	BEAR LAKE	MI	$336K
CRYSTAL LAKE CLINIC P.C.	SUTTONS BAY	MI	$253K
CRYSTAL LAKE CLINIC P.C.	ELK RAPIDS	MI	$240K
CRYSTAL LAKE CLINIC P.C.	FRANKFORT	MI	$234K

Year	Claims	Total Paid
2018	634	$30K
2019	400	$21K

Code	Description	Claims	Beneficiaries	Total Paid
99213	Office or other outpatient visit for the evaluation and management of an established patient, low complexity	785	703	$36K
99214	Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity	217	198	$14K
90688		17	17	$214.08
90471	Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine	15	15	$91.00