Medicaid Provider Spending

$1.09 trillion in Medicaid claims data, 2018–2024 · 617K+ providers
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PRIMARY HEALTH NETWORK

NPI: 1417932609 · SHARON, PA 16146 · Federally Qualified Health Center (FQHC) · NPI assigned 12/09/2005

Billing Flags · Automated signals — not evidence of fraud
Entity Proliferation

Authorized official SIZER, CARL controls 20+ related entities in our dataset. Read more

$57.95M
Total Medicaid Paid
396,925
Total Claims
323,610
Beneficiaries
61
Codes Billed
2018-01
First Month
2024-12
Last Month

Provider Details

Authorized OfficialSIZER, CARL (CHIEF FINANCIAL OFFICER)
NPI Enumeration Date12/09/2005

Related Entities

Other providers sharing the same authorized official: SIZER, CARL

ProviderCityStateTotal Paid
PRIMARY HEALTH NETWORK ALTOONA PA $19.65M
PRIMARY HEALTH NETWORK MERCER PA $12.27M
PRIMARY HEALTH NETWORK FARRELL PA $5.60M
PRIMARY HEALTH NETWORK LEWISTOWN PA $5.05M
PRIMARY HEALTH NETWORK CLARION PA $3.53M
PRIMARY HEALTH NETWORK SHARON PA $3.47M
PRIMARY HEALTH NETWORK NEW CASTLE PA $3.21M
PRIMARY HEALTH NETWORK SHARON PA $2.51M
PRIMARY HEALTH NETWORK GREENVILLE PA $2.39M
PRIMARY HEALTH NETWORK INDIANA PA $1.94M
PRIMARY HEALTH NETWORK NEW CASTLE PA $1.84M
PRIMARY HEALTH NETWORK ROCHESTER PA $1.66M
PRIMARY HEALTH NETWORK SHEAKLEYVILLE PA $1.65M
PRIMARY HEALTH NETWORK WARREN PA $1.28M
PRIMARY HEALTH NETWORK MINERSVILLE PA $1.24M
PRIMARY HEALTH NETWORK SHAMOKIN PA $1.19M
PRIMARY HEALTH NETWORK BEAVER FALLS PA $1.02M
PRIMARY HEALTH NETWORK LATROBE PA $914K
PRIMARY HEALTH NETWORK FARRELL PA $622K
PRIMARY HEALTH NETWORK ERIE PA $546K

Monthly Spending Trend

Yearly Breakdown

YearClaimsTotal Paid
2018 39,937 $5.42M
2019 30,114 $4.11M
2020 41,235 $5.89M
2021 85,370 $10.52M
2022 78,866 $11.21M
2023 60,924 $10.45M
2024 60,479 $10.35M

Billing Codes

CodeDescriptionClaimsBeneficiariesTotal Paid
T1015 Clinic visit/encounter, all-inclusive 297,950 232,108 $57.22M
99213 Office or other outpatient visit for the evaluation and management of an established patient, low complexity 33,878 31,214 $405K
99214 Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity 8,861 8,471 $196K
99212 Office or other outpatient visit for the evaluation and management of an established patient, straightforward 6,273 5,761 $62K
0012A 706 697 $24K
0011A 744 726 $21K
0064A 166 165 $5K
99394 Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) 57 55 $3K
90471 Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine 228 219 $3K
36415 Collection of venous blood by venipuncture 1,244 1,228 $2K
90686 1,177 1,132 $2K
99392 Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) 122 122 $1K
83036 Hemoglobin; glycosylated (A1C) 437 430 $1K
G0467 Federally qualified health center (fqhc) visit, established patient; a medically-necessary, face-to-face encounter (one-on-one) between an established patient and a fqhc practitioner during which time one or more fqhc services are rendered and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving a fqhc visit 411 384 $595.38
99395 Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years 247 243 $449.48
11721 515 513 $391.60
90460 Immunization administration through 18 years of age via any route, first or only component 15 14 $232.50
87880 Infectious agent antigen detection by immunoassay; Streptococcus, group A 17 16 $209.75
99393 Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) 29 29 $174.49
90472 Immunization administration, each additional vaccine (list separately) 17 16 $159.64
98940 433 180 $75.81
99396 Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years 115 114 $66.45
98941 Chiropractic manipulative treatment; spinal, 3-4 regions 45 25 $21.19
91301 1,218 1,172 $0.04
3008F 23,956 22,434 $0.00
D1206 Topical application of fluoride varnish 1,455 1,409 $0.00
G8510 Screening for depression is documented as negative, a follow-up plan is not required 8,716 7,916 $0.00
3079F 752 688 $0.00
D0272 Bitewings - two radiographic images 68 68 $0.00
D1351 Sealant - per tooth 428 120 $0.00
D0140 Limited oral evaluation - problem focused 206 152 $0.00
3074F 1,134 1,060 $0.00
D0120 Periodic oral evaluation - established patient 1,213 1,112 $0.00
3075F 197 181 $0.00
90723 17 13 $0.00
90656 19 19 $0.00
91306 160 159 $0.00
D9995 42 41 $0.00
D2392 Resin-based composite - two surfaces, posterior, primary or permanent 58 46 $0.00
G2025 Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only 36 36 $0.00
D0603 65 46 $0.00
90651 44 44 $0.00
D0150 Comprehensive oral evaluation - new or established patient 16 16 $0.00
92551 12 12 $0.00
90647 12 12 $0.00
3078F 544 525 $0.00
D0274 Bitewings - four radiographic images 258 192 $0.00
90734 133 131 $0.00
D1110 Prophylaxis - adult 877 793 $0.00
D1120 Prophylaxis - child 358 330 $0.00
D0330 Panoramic radiographic image 77 50 $0.00
99215 Prolong outpt/office vis 211 108 $0.00
G0444 Annual depression screening, 5 to 15 minutes 203 195 $0.00
99173 227 222 $0.00
90715 77 75 $0.00
90670 102 96 $0.00
87210 27 26 $0.00
D0220 Intraoral - periapical first radiographic image 242 183 $0.00
G9920 Screening performed and negative 29 29 $0.00
G9919 Screening performed and positive and provision of recommendations 36 24 $0.00
90633 13 13 $0.00