Pulmonary Medicine Associates Medical Group, INC

Pulmonary Medicine Associates Medical Group, INC was paid $6.54M by Medicaid between Jan 2018 and Nov 2024, across 33 billing codes. Its largest line is 99291, Critical care, evaluation and management of the critically ill patient, first 30-74 minutes — 70% of everything it billed.

33Billing provider infoPULMONARY MEDICINE ASSOCIATES MEDICAL GROUP, INC
SACRAMENTO, CA 95825

33aNPI1407880719assigned 07/10/2006

33bProvider typeHospice and Palliative Medicine (Internal Medicine) Physician

28Total paid$6.54M

24GClaims167,795

24DCodes billed33

24AFirst – last monthJan 2018 – Nov 2024

Compared with peers

Next to other Hospice and Palliative Medicine (Internal Medicine) Physician providers in California

Rank by total paid#1 of 22

Median peer was paid$13K

This provider vs. median522×

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	24,971	$817K
2019	25,842	$656K
2020	25,986	$769K
2021	25,220	$909K
2022	19,406	$935K
2023	24,802	$1.22M
2024incomplete	21,568	$1.23M

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
99291	Critical care, evaluation and management of the critically ill patient, first 30-74 minutes	70%	70,752	35,156	$4.57M
99233	Hospital visit by a doctor, follow-up day (complex)Prolong inpt eval add15 m	11%	29,793	17,289	$703K
99232	Hospital visit by a doctor, follow-up daySubsequent hospital care, per day, moderate complexity	9.7%	34,202	14,784	$633K
99223	Prolong inpt eval add15 m	4.2%	9,876	9,510	$272K
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	1.8%	4,916	4,728	$118K
99204	Doctor's office visit, new patient (more involved)Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity	<1%	731	724	$35K
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%	2,456	2,432	$27K
95811		<1%	161	161	$19K
95810	Polysomnography; sleep staging with 4 or more additional parameters	<1%	185	184	$16K
94726		<1%	1,576	1,546	$15K
94729		<1%	1,541	1,515	$15K
Z4304		<1%	257	257	$14K

21 more codes

Z4306		<1%	259	$13K
99292		<1%	285	$12K
99222	Initial hospital care, per day, moderate complexity	<1%	216	$11K
95144		<1%	1,094	$11K
94010		<1%	1,673	$10K
94060		<1%	520	$9K
99215	Doctor's office visit, returning patient (complex)	<1%	55	$8K
99203	Doctor's office visit, new patient (routine)	<1%	203	$5K
99255		<1%	85	$5K
95117		<1%	4,579	$4K
95004	Percutaneous tests with allergenic extracts, immediate type reaction	<1%	259	$4K
95165	Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy, multiple dose vials	<1%	1,604	$3K
95806		<1%	24	$2K
99238	Hospital discharge day management, 30 minutes or less	<1%	59	$1K
99205	Prolong outpt/office vis	<1%	12	$1K
95024		<1%	30	$995.42
99367		<1%	15	$476.16
96372	Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular	<1%	257	$365.77
95115		<1%	38	$187.15
94618		<1%	66	$113.46
98967		0%	16	$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 officialEFSTRATIS, STEPHANIE (CPC, BUSINESS SERVICES MANAGER)