Medicaid Provider Spending

$1.09 trillion in Medicaid claims data, 2018–2024 · 617K+ providers

HETHERINGTON, NICKOLAS

NPI: 1467804278 · MELBOURNE, FL 32901 · Occupational Therapist · NPI assigned 07/05/2016

Billing Flags · Automated signals — not evidence of fraud
Single-Code Concentration

94% of spending on code 97530 with only 3 total codes billed. Highly concentrated billing profile.

$1.31M
Total Medicaid Paid
21,210
Total Claims
2,882
Beneficiaries
3
Codes Billed
2019-01
First Month
2022-11
Last Month

Monthly Spending Trend

Yearly Breakdown

YearClaimsTotal Paid
2019 2,872 $164K
2020 4,748 $304K
2021 7,846 $484K
2022 5,744 $359K

Billing Codes

CodeDescriptionClaimsBeneficiariesTotal Paid
97530 Therapeutic activities, direct patient contact, each 15 minutes 20,148 2,709 $1.24M
97110 Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion 1,050 161 $74K
97166 12 12 $1K