Physician
DR. Karelys Rivera and Associates
DR. Karelys Rivera and Associates was paid $1.41M by Medicaid between Dec 2018 and Dec 2024, across 40 billing codes. Its largest line is 99214, doctor's office visit, returning patient (more involved) — 24% of everything it billed.
33Billing provider infoDR. KARELYS RIVERA AND ASSOCIATES
EDINBURG, TX 78539
EDINBURG, TX 78539
33aNPI1467841668assigned 01/12/2015
33bProvider typePediatrics Physician
28Total paid$1.41M
24GClaims58,988
24DCodes billed40
24AFirst – last monthDec 2018 – Dec 2024
Compared with peers
Next to other Pediatrics Physician providers in Texas
Rank by total paid#307 of 1,136
Median peer was paid$329K
This provider vs. median4.3×
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.
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 | 18 | $912.40 | |
| 2020 | 1,476 | $32K | |
| 2021 | 12,888 | $296K | |
| 2022 | 16,608 | $380K | |
| 2023 | 16,068 | $387K | |
| 2024incomplete | 11,930 | $311K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| 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 | 24% | 6,599 | 5,819 | $338K |
| 99213 | Doctor's office visit, returning patient (routine)Office or other outpatient visit for the evaluation and management of an established patient, low complexity | 22% | 8,639 | 7,446 | $315K |
| 99392 | Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) | 11% | 1,940 | 1,923 | $151K |
| 99393 | Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) | 7.7% | 1,307 | 1,304 | $108K |
| 99391 | Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) | 7.6% | 1,417 | 1,355 | $107K |
| 90460 | Immunization administration through 18 years of age via any route, first or only component | 5.6% | 7,224 | 3,394 | $78K |
| 87804 | Infectious agent antigen detection by immunoassay; Influenza, each type | 4.0% | 4,330 | 2,071 | $57K |
| 85025 | Blood count; complete (CBC), automated, and automated differential WBC count | 3.0% | 6,754 | 6,266 | $42K |
| 87880 | Infectious agent antigen detection by immunoassay; Streptococcus, group A | 2.7% | 2,839 | 2,719 | $38K |
| 96110 | Developmental screening, with scoring and documentation, per standardized instrument | 2.3% | 4,517 | 4,320 | $32K |
| 99394 | Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) | 2.2% | 347 | 345 | $31K |
| 92588 | 1.9% | 1,500 | 1,490 | $26K |
28 more codes
| 99429 | 1.6% | 699 | $23K | |
| 96372 | Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular | 1.4% | 1,680 | $19K |
| 87426 | Infectious agent antigen detection, SARS-CoV-2 (COVID-19) | <1% | 268 | $11K |
| 87807 | <1% | 860 | $9K | |
| 90461 | <1% | 1,458 | $7K | |
| 99212 | Office or other outpatient visit for the evaluation and management of an established patient, straightforward | <1% | 217 | $5K |
| 83655 | <1% | 284 | $3K | |
| 99203 | Doctor's office visit, new patient (routine) | <1% | 20 | $1K |
| 99204 | Doctor's office visit, new patient (more involved) | <1% | 12 | $1K |
| 99000 | <1% | 69 | $745.20 | |
| 81002 | <1% | 219 | $618.84 | |
| J0696 | Injection, ceftriaxone sodium, per 250 mg | <1% | 505 | $489.12 |
| J1100 | Injection, dexamethasone sodium phosphate, 1 mg | <1% | 885 | $358.71 |
| 90680 | 0% | 691 | $0.00 | |
| 90698 | 0% | 882 | $0.00 | |
| 90744 | 0% | 333 | $0.00 | |
| 90686 | 0% | 837 | $0.00 | |
| 90677 | 0% | 266 | $0.00 | |
| 90651 | 0% | 38 | $0.00 | |
| 90716 | 0% | 27 | $0.00 | |
| 90696 | 0% | 13 | $0.00 | |
| 90619 | 0% | 12 | $0.00 | |
| 90633 | 0% | 378 | $0.00 | |
| 90670 | 0% | 846 | $0.00 | |
| 90700 | 0% | 24 | $0.00 | |
| 90707 | 0% | 27 | $0.00 | |
| 90710 | 0% | 13 | $0.00 | |
| 90734 | 0% | 12 | $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 officialRIVERA, KARELYS (OWNER)