Clinic
Prisma Health-Upstate
Prisma Health-Upstate was paid $1.07M by Medicaid between Sep 2018 and Dec 2024, across 37 billing codes. Its largest line is 99211, Office or other outpatient visit for the evaluation and management of an established patient, minimal severity — 44% of everything it billed.
33Billing provider infoPRISMA HEALTH-UPSTATE
SENECA, SC 29672
SENECA, SC 29672
33aNPI1407345846assigned 05/01/2018
33bProvider typeClinic/Center
28Total paid$1.07M
24GClaims17,987
24DCodes billed37
24AFirst – last monthSep 2018 – Dec 2024
Compared with peers
Next to other Clinic/Center providers in South Carolina
Rank by total paid#7 of 33
Median peer was paid$154K
This provider vs. median6.9×
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 MILLER, POLLY 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 | 100 | $6K | |
| 2019 | 790 | $58K | |
| 2020 | 1,586 | $101K | |
| 2021 | 2,450 | $143K | |
| 2022 | 3,741 | $244K | |
| 2023 | 5,133 | $281K | |
| 2024incomplete | 4,187 | $236K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| 99211 | Office or other outpatient visit for the evaluation and management of an established patient, minimal severity | 44% | 6,506 | 5,525 | $469K |
| 36415 | Collection of venous blood by venipuncture | 26% | 2,347 | 2,162 | $279K |
| 99212 | Office or other outpatient visit for the evaluation and management of an established patient, straightforward | 23% | 3,818 | 3,510 | $247K |
| C9803 | Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source | 2.6% | 166 | 161 | $27K |
| 99213 | Doctor's office visit, returning patient (routine)Office or other outpatient visit for the evaluation and management of an established patient, low complexity | 2.0% | 430 | 398 | $21K |
| 87804 | Infectious agent antigen detection by immunoassay; Influenza, each type | <1% | 94 | 93 | $5K |
| G0463 | Hospital outpatient clinic visit for assessment and management of a patient | <1% | 79 | 75 | $5K |
| 81003 | <1% | 114 | 99 | $3K | |
| 83036 | Hemoglobin; glycosylated (A1C) | <1% | 241 | 225 | $3K |
| 83655 | <1% | 36 | 36 | $2K | |
| T1015 | A visit at a community health center or clinic (one all-in rate)Clinic visit/encounter, all-inclusive | <1% | 15 | 15 | $1K |
| 85018 | <1% | 53 | 53 | $1K |
25 more codes
| 90686 | <1% | 468 | $838.25 | |
| U0003 | Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high throughput technologies as described by cms-2020-01-r | <1% | 105 | $735.00 |
| 80053 | Comprehensive metabolic panel | <1% | 473 | $683.96 |
| 90460 | Immunization administration through 18 years of age via any route, first or only component | <1% | 1,178 | $655.21 |
| 80048 | Basic metabolic panel (calcium, ionized) | <1% | 25 | $542.82 |
| 85025 | Blood count; complete (CBC), automated, and automated differential WBC count | <1% | 371 | $418.37 |
| 87661 | Infectious agent detection by nucleic acid; Trichomonas vaginalis, amplified probe | <1% | 37 | $392.83 |
| 90670 | <1% | 281 | $329.89 | |
| 87591 | Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe | <1% | 20 | $219.32 |
| 90656 | <1% | 87 | $191.62 | |
| 87086 | Culture, bacterial; quantitative colony count, urine | <1% | 14 | $128.11 |
| 84443 | Thyroid stimulating hormone (TSH) | <1% | 242 | $104.82 |
| 86803 | <1% | 49 | $71.04 | |
| 90471 | Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine | <1% | 143 | $60.90 |
| 90461 | <1% | 81 | $22.70 | |
| 90677 | <1% | 84 | $0.02 | |
| 87491 | Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe | 0% | 35 | $0.00 |
| 80061 | Lipid panel | 0% | 161 | $0.00 |
| 90633 | 0% | 39 | $0.00 | |
| 90697 | 0% | 58 | $0.00 | |
| 90698 | 0% | 27 | $0.00 | |
| 90680 | 0% | 38 | $0.00 | |
| U0005 | Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, cdc or non-cdc, making use of high throughput technologies, completed within 2 calendar days from date of specimen collection (list separately in addition to either hcpcs code u0003 or u0004) as described by cms-2020-01-r2 | 0% | 42 | $0.00 |
| 87389 | Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies | 0% | 17 | $0.00 |
| 87635 | Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe | 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 officialMILLER, POLLY (VP PAYOR STRATEGIES & ALIGNMENT)
| Provider | Location | Paid |
|---|---|---|
| Prisma Health-Midlands | Columbia, SC | $74.58M |
| Prisma Health-Midlands | Columbia, SC | $68.26M |
| Prisma Health-Upstate | Greenville, SC | $25.04M |
| Prisma Health-Upstate | Greenville, SC | $21.98M |
| Prisma Health-Upstate | Greenville, SC | $19.69M |
| Prisma Health-Upstate | Seneca, SC | $15.64M |
| Prisma Health-Midlands | Columbia, SC | $11.77M |
| Prisma Health-Upstate | Greenville, SC | $10.74M |
| Greenville Health Corporation | Greenville, SC | $8.90M |
| Prisma Health-Upstate | Greenville, SC | $8.32M |
| Prisma Health-Upstate | Greenville, SC | $7.45M |
| Prisma Health University Medical Group | Greenville, SC | $7.44M |
| Prisma Health-Midlands | Coulmbia, SC | $7.43M |
| Prisma Health-Midlands | Columbia, SC | $6.88M |
| Prisma Health Tuomey | Sumter, SC | $6.84M |
| Prisma Health-Midlands | Columbia, SC | $6.77M |
| Prisma Health-Upstate | Greenville, SC | $6.37M |
| Prisma Health-Upstate | Greenville, SC | $5.00M |
| Prisma Health-Upstate | Greenville, SC | $4.65M |
| Prisma Health-Midlands | Columbia, SC | $4.63M |
Matched on the authorized-official name exactly as entered in NPPES. A common name can match unrelated people.