Clinic
Prisma Health-Upstate
Prisma Health-Upstate was paid $4.48M by Medicaid between Jan 2018 and Dec 2024, across 23 billing codes. Its largest line is T1015, a visit at a community health center or clinic (one all-in rate) — 64% of everything it billed.
33Billing provider infoPRISMA HEALTH-UPSTATE
SENECA, SC 29672
SENECA, SC 29672
33aNPI1437605524assigned 08/29/2016
33bProvider typeRural Health Clinic/Center
28Total paid$4.48M
24GClaims59,780
24DCodes billed23
24AFirst – last monthJan 2018 – Dec 2024
Compared with peers
Next to other Rural Health Clinic/Center providers in South Carolina
Rank by total paid#7 of 81
Median peer was paid$302K
This provider vs. median15×
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 | 7,690 | $488K | |
| 2019 | 7,379 | $571K | |
| 2020 | 6,903 | $525K | |
| 2021 | 8,149 | $603K | |
| 2022 | 8,771 | $667K | |
| 2023 | 11,084 | $819K | |
| 2024incomplete | 9,804 | $807K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| T1015 | A visit at a community health center or clinic (one all-in rate)Clinic visit/encounter, all-inclusive | 64% | 27,370 | 23,296 | $2.86M |
| 99213 | Doctor's office visit, returning patient (routine)Office or other outpatient visit for the evaluation and management of an established patient, low complexity | 14% | 11,400 | 10,568 | $629K |
| 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 | 12% | 6,544 | 6,290 | $544K |
| 99393 | Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) | 2.6% | 1,232 | 1,220 | $118K |
| 99392 | Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) | 2.2% | 1,089 | 1,081 | $100K |
| 90460 | Immunization administration through 18 years of age via any route, first or only component | 1.5% | 5,057 | 5,013 | $67K |
| 99391 | Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) | 1.2% | 627 | 612 | $53K |
| 99394 | Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) | <1% | 400 | 391 | $41K |
| 99212 | Office or other outpatient visit for the evaluation and management of an established patient, straightforward | <1% | 1,237 | 1,135 | $32K |
| 96127 | <1% | 1,767 | 1,706 | $17K | |
| 90461 | <1% | 392 | 390 | $7K | |
| 96110 | Developmental screening, with scoring and documentation, per standardized instrument | <1% | 455 | 453 | $3K |
11 more codes
| 87880 | Infectious agent antigen detection by immunoassay; Streptococcus, group A | <1% | 169 | $2K |
| 87804 | Infectious agent antigen detection by immunoassay; Influenza, each type | <1% | 78 | $1K |
| 85018 | <1% | 344 | $825.52 | |
| 81003 | <1% | 266 | $590.19 | |
| 0071A | <1% | 13 | $532.00 | |
| 90686 | <1% | 1,165 | $114.03 | |
| 90656 | <1% | 109 | $0.31 | |
| 90680 | 0% | 12 | $0.00 | |
| 90677 | 0% | 28 | $0.00 | |
| 90697 | 0% | 12 | $0.00 | |
| 90670 | 0% | 14 | $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 (SVP FINANCE, ENTERPRISE CONTRACTING)
| 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.