MP SOUTHPARK PHARMACY LLC
NPI: 1427081447
· SAN ANGELO, TX 76903
· Durable Medical Equipment & Medical Supplies
· NPI assigned 07/10/2006
$122K
Total Medicaid Paid
Provider Details
| Authorized Official | PRATT, MICAH (OWNER) |
| NPI Enumeration Date | 07/10/2006 |
Related Entities
Other providers sharing the same authorized official: PRATT, MICAH
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
178 |
$3K |
| 2019 |
469 |
$9K |
| 2020 |
628 |
$23K |
| 2021 |
721 |
$31K |
| 2022 |
902 |
$39K |
| 2023 |
536 |
$14K |
| 2024 |
185 |
$4K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
353 |
353 |
$60K |
| A4554 |
Disposable underpads, all sizes |
1,436 |
1,434 |
$52K |
| A4335 |
Incontinence supply; miscellaneous |
1,743 |
1,737 |
$9K |
| 90662 |
|
14 |
14 |
$0.00 |
| 90674 |
|
16 |
16 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
57 |
57 |
$0.00 |