1427484435

1427484435 was paid $139K by Medicaid between Jan 2018 and Apr 2020, across 6 billing codes. Its largest line is J7503, Tacrolimus, extended release, (envarsus xr), oral, 0.25 mg — 57% of everything it billed.

33Billing provider info1427484435

33aNPI1427484435

33bProvider type—

28Total paid$139K

24GClaims5,317

24DCodes billed6

24AFirst – last monthJan 2018 – Apr 2020

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	1,951	$39K
2019	2,652	$74K
2020	714	$27K

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
J7503	Tacrolimus, extended release, (envarsus xr), oral, 0.25 mg	57%	502	442	$80K
J7518	Mycophenolic acid, oral, 180 mg	29%	560	540	$41K
J7507	Tacrolimus, immediate release, oral, 1 mg	6.8%	551	522	$10K
Q0511	Pharmacy supply fee for oral anti-cancer, oral anti-emetic or immunosuppressive drug(s); for the first prescription in a 30-day period	3.7%	1,204	1,154	$5K
Q0512	Pharmacy supply fee for oral anti-cancer, oral anti-emetic or immunosuppressive drug(s); for a subsequent prescription in a 30-day period	2.6%	1,698	1,110	$4K
J7512	Prednisone, immediate release or delayed release, oral, 1 mg	<1%	802	766	$355.80

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.