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NPI 1457828055
NPI deactivated
1457828055
1457828055 was paid $1.30M by Medicaid between Sep 2020 and Dec 2024, across 8 billing codes. Its largest line is B4155, Enteral formula, nutritionally incomplete/modular nutrients, includes specific nutrients, carbohydrates (e.g., glucose polymers), proteins/amino acids (e.g., glutamine, arginine), fat (e.g., medium chain triglycerides) or combination, administered through an enteral feeding tube, 100 calories = 1 unit — 89% of everything it billed.
33Billing provider info1457828055
33aNPI1457828055
33bProvider type—
28Total paid$1.30M
24GClaims5,925
24DCodes billed8
24AFirst – last monthSep 2020 – Dec 2024
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 | |
|---|---|---|---|
| 2020 | 134 | $568K | |
| 2021 | 157 | $505K | |
| 2022 | 1,312 | $41K | |
| 2023 | 2,683 | $127K | |
| 2024incomplete | 1,639 | $55K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| B4155 | Enteral formula, nutritionally incomplete/modular nutrients, includes specific nutrients, carbohydrates (e.g., glucose polymers), proteins/amino acids (e.g., glutamine, arginine), fat (e.g., medium chain triglycerides) or combination, administered through an enteral feeding tube, 100 calories = 1 unit | 89% | 568 | 392 | $1.15M |
| A4554 | Disposable underpads, all sizes | 4.3% | 888 | 810 | $56K |
| B4154 | Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit | 2.3% | 206 | 170 | $30K |
| A5120 | Skin barrier, wipes or swabs, each | 1.7% | 1,674 | 1,077 | $22K |
| A4927 | Gloves, non-sterile, per 100 | 1.6% | 1,287 | 1,019 | $21K |
| A6250 | Skin sealants, protectants, moisturizers, ointments, any type, any size | <1% | 1,277 | 1,017 | $8K |
| T4527 | Adult sized disposable incontinence product, protective underwear/pull-on, large size, each | <1% | 12 | 12 | $4K |
| T4535 | Disposable liner/shield/guard/pad/undergarment, for incontinence, each | <1% | 13 | 13 | $1K |
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.