Pinelake Physician Practice, LLC
Pinelake Physician Practice, LLC was paid $152K by Medicaid between Jul 2019 and Nov 2024, across 30 billing codes. Its largest line is 99213, doctor's office visit, returning patient (routine) — 74% of everything it billed.
FULTON, KY 42041
Next to other Rural Health Clinic/Center providers in Kentucky
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.
Paid by month
By year, as a table
| Year | Claims | Paid | |
|---|---|---|---|
| 2019 | 601 | $12K | |
| 2020 | 1,294 | $26K | |
| 2021 | 1,616 | $27K | |
| 2022 | 2,981 | $27K | |
| 2023 | 10,448 | $40K | |
| 2024incomplete | 4,518 | $22K |
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| 99213 | Doctor's office visit, returning patient (routine)Office or other outpatient visit for the evaluation and management of an established patient, low complexity | 74% | 4,469 | 3,720 | $112K |
| 99203 | Doctor's office visit, new patient (routine)Office or other outpatient visit for the evaluation and management of a new patient, low complexity | 8.3% | 383 | 299 | $13K |
| 87428 | 7.3% | 304 | 278 | $11K | |
| 36415 | Collection of venous blood by venipuncture | 2.6% | 1,378 | 1,126 | $4K |
| 87430 | 2.0% | 215 | 192 | $3K | |
| 87804 | Infectious agent antigen detection by immunoassay; Influenza, each type | 1.7% | 219 | 96 | $3K |
| 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% | 47 | 40 | $1K |
| 87426 | Infectious agent antigen detection, SARS-CoV-2 (COVID-19) | <1% | 79 | 63 | $1K |
| 87880 | Infectious agent antigen detection by immunoassay; Streptococcus, group A | <1% | 84 | 76 | $1K |
| 96372 | Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular | <1% | 78 | 66 | $809.18 |
| G2023 | Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source | <1% | 49 | 41 | $736.77 |
| 96127 | <1% | 282 | 261 | $649.63 |
18 more codes
| 83036 | Hemoglobin; glycosylated (A1C) | <1% | 199 | $359.41 |
| G0444 | Annual depression screening, 5 to 15 minutes | <1% | 154 | $214.97 |
| 81002 | <1% | 15 | $11.47 | |
| 3074F | <1% | 1,400 | $2.77 | |
| 3079F | <1% | 858 | $2.15 | |
| 3078F | <1% | 1,049 | $1.91 | |
| 99000 | <1% | 71 | $1.90 | |
| 3008F | <1% | 2,487 | $1.71 | |
| 3077F | <1% | 354 | $0.87 | |
| 3075F | <1% | 319 | $0.82 | |
| 3080F | <1% | 248 | $0.58 | |
| 1159F | <1% | 1,787 | $0.33 | |
| 1160F | <1% | 1,787 | $0.33 | |
| 1036F | <1% | 1,490 | $0.15 | |
| 1034F | <1% | 804 | $0.09 | |
| 36416 | <1% | 62 | $0.01 | |
| 3725F | 0% | 748 | $0.00 | |
| T1015 | A visit at a community health center or clinic (one all-in rate) | 0% | 39 | $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.
Who's on the registration
Matched on the authorized-official name exactly as entered in NPPES. A common name can match unrelated people.