Physician
Pratt Pediatric Associates INC
Pratt Pediatric Associates INC was paid $7.66M by Medicaid between Jan 2018 and Dec 2024, across 72 billing codes. Its largest line is 99214, doctor's office visit, returning patient (more involved) — 20% of everything it billed.
33Billing provider infoPRATT PEDIATRIC ASSOCIATES INC
BOSTON, MA 02111
BOSTON, MA 02111
33aNPI1477590511assigned 05/31/2006
33bProvider typeClinical Genetics (M.D.) Physician
28Total paid$7.66M
24GClaims150,464
24DCodes billed72
24AFirst – last monthJan 2018 – Dec 2024
Compared with peers
Next to other Clinical Genetics (M.D.) Physician providers in Massachusetts
Rank by total paid#1 of 6
Median peer was paid$4K
This provider vs. median2,133×
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 GALLEGOS, EDWARD 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 | 18,572 | $944K | |
| 2019 | 21,966 | $1.18M | |
| 2020 | 23,580 | $1.15M | |
| 2021 | 30,089 | $1.55M | |
| 2022 | 17,002 | $1.03M | |
| 2023 | 19,935 | $936K | |
| 2024incomplete | 19,320 | $871K |
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 | 20% | 22,089 | 21,593 | $1.50M |
| 99213 | Doctor's office visit, returning patient (routine)Office or other outpatient visit for the evaluation and management of an established patient, low complexity | 15% | 27,155 | 25,739 | $1.17M |
| 99215 | Doctor's office visit, returning patient (complex)Prolong outpt/office vis | 15% | 12,333 | 11,914 | $1.14M |
| 99204 | Doctor's office visit, new patient (more involved)Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity | 9.3% | 6,292 | 6,281 | $711K |
| 99479 | Subsequent intensive care, per day, very low birth weight infant | 3.7% | 2,959 | 1,216 | $282K |
| 99239 | Hospital discharge day management, more than 30 minutes | 3.5% | 3,278 | 3,255 | $270K |
| 99393 | Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) | 3.5% | 4,726 | 4,724 | $268K |
| 99205 | Prolong outpt/office vis | 3.3% | 1,771 | 1,771 | $250K |
| 99392 | Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) | 2.7% | 3,219 | 3,215 | $208K |
| 93306 | Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete | 2.5% | 2,276 | 1,961 | $191K |
| 96110 | Developmental screening, with scoring and documentation, per standardized instrument | 2.4% | 18,117 | 17,893 | $187K |
| 99391 | Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) | 2.3% | 2,973 | 2,840 | $175K |
60 more codes
| 93303 | Transthoracic echocardiography for congenital cardiac anomalies, follow-up or limited study | 2.2% | 2,251 | $165K |
| 99394 | Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) | 2.1% | 2,548 | $160K |
| 99460 | 2.0% | 1,528 | $152K | |
| 99469 | Subsequent inpatient neonatal critical care, per day, 28 days or younger | 1.8% | 457 | $135K |
| 99480 | Subsequent intensive care, per day, low birth weight infant | 1.2% | 989 | $93K |
| 99462 | 1.1% | 1,897 | $83K | |
| 93000 | <1% | 4,465 | $57K | |
| 93010 | Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only | <1% | 7,063 | $40K |
| 76825 | <1% | 636 | $39K | |
| 99203 | Doctor's office visit, new patient (routine) | <1% | 549 | $37K |
| 99417 | Prolong home eval add 15m | <1% | 1,200 | $32K |
| 93320 | <1% | 1,553 | $31K | |
| 96127 | <1% | 2,726 | $25K | |
| 90791 | Psychiatric diagnostic evaluation | <1% | 198 | $22K |
| 93325 | <1% | 3,609 | $21K | |
| 99307 | <1% | 886 | $20K | |
| 99212 | Office or other outpatient visit for the evaluation and management of an established patient, straightforward | <1% | 440 | $19K |
| 99232 | Hospital visit by a doctor, follow-up day | <1% | 338 | $18K |
| T2023 | Targeted case management; per month | <1% | 75 | $18K |
| 99233 | Hospital visit by a doctor, follow-up day (complex) | <1% | 204 | $15K |
| 99395 | Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years | <1% | 304 | $14K |
| 76827 | <1% | 639 | $14K | |
| 43239 | Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple | <1% | 147 | $13K |
| 99238 | Hospital discharge day management, 30 minutes or less | <1% | 198 | $11K |
| 92551 | <1% | 767 | $7K | |
| 99222 | Initial hospital care, per day, moderate complexity | <1% | 65 | $7K |
| 90460 | Immunization administration through 18 years of age via any route, first or only component | <1% | 2,629 | $7K |
| 99173 | <1% | 645 | $6K | |
| 99051 | <1% | 414 | $6K | |
| 99231 | Subsequent hospital care, per day, straightforward or low complexity | <1% | 162 | $5K |
| 99464 | <1% | 83 | $5K | |
| 99211 | Office or other outpatient visit for the evaluation and management of an established patient, minimal severity | <1% | 159 | $4K |
| 99309 | Subsequent nursing facility care, per day, low to moderate complexity | <1% | 72 | $4K |
| 94010 | <1% | 203 | $3K | |
| 87880 | Infectious agent antigen detection by immunoassay; Streptococcus, group A | <1% | 320 | $3K |
| 87804 | Infectious agent antigen detection by immunoassay; Influenza, each type | <1% | 208 | $2K |
| 90461 | <1% | 790 | $2K | |
| 99223 | Prolong inpt eval add15 m | <1% | 15 | $2K |
| 95816 | <1% | 42 | $2K | |
| 94016 | <1% | 152 | $2K | |
| 90471 | Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine | <1% | 368 | $1K |
| 93304 | <1% | 31 | $1K | |
| 99443 | <1% | 37 | $1K | |
| 99221 | <1% | 12 | $934.80 | |
| 99310 | Prolong nursin fac eval 15m | <1% | 12 | $839.20 |
| 99188 | <1% | 26 | $700.96 | |
| 96112 | <1% | 13 | $627.98 | |
| 94664 | <1% | 44 | $603.96 | |
| 90472 | Immunization administration, each additional vaccine (list separately) | <1% | 138 | $597.25 |
| 81002 | <1% | 105 | $281.70 | |
| G2212 | Prolonged office or other outpatient evaluation and management service(s) beyond the maximum required time of the primary procedure which has been selected using total time on the date of the primary service; each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (list separately in addition to cpt codes 99205, 99215, 99483 for office or other outpatient evaluation and management services) (do not report g2212 on the same date of service as 99358, 99359, 99415, 99416). (do not report g2212 for any time unit less than 15 minutes) | <1% | 38 | $273.57 |
| 99442 | <1% | 14 | $216.97 | |
| 99050 | <1% | 12 | $174.56 | |
| 93321 | <1% | 15 | $151.30 | |
| 85018 | <1% | 58 | $58.14 | |
| 90686 | <1% | 47 | $56.38 | |
| G2211 | Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient's single, serious condition or a complex condition. (add-on code, list separately in addition to office/outpatient evaluation and management visit, new or established) | <1% | 570 | $56.04 |
| 96161 | <1% | 12 | $6.42 | |
| 94760 | <1% | 47 | $1.98 | |
| 99001 | 0% | 51 | $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 officialGALLEGOS, EDWARD (DIRECTOR)
| Provider | Location | Paid |
|---|---|---|
| Pratt Ophthalmology Associates INC | Boston, MA | $2.95M |
| Pratt Ob/Gyn Associates, INC | Boston, MA | $2.62M |
| Pratt Medical Group, INC | Boston, MA | $2.18M |
| Pratt Radiology Associates, INC | Boston, MA | $1.58M |
| Pratt Pathology Associates, INC | Boston, MA | $1.47M |
| Pratt Med/Surg Dermatology Associates INC | Boston, MA | $851K |
| Cardiovascular Center at Tufts Medical Center, INC. | Boston, MA | $721K |
| Pratt Medical Group, INC | Boston, MA | $705K |
| Pratt Orthopaedic Associates, INC | Boston, MA | $566K |
| Pratt Otolaryngology- Head & Neck Surgery Associates INC | Boston, MA | $536K |
| Pratt Psychiatric Associates, INC | Boston, MA | $346K |
| Pratt Neurology Associates, INC | Boston, MA | $279K |
| Pratt Medical Group, INC | Boston, MA | $269K |
| Pratt Medical Group, INC | Boston, MA | $247K |
| Pratt Medical Group, INC | Boston, MA | $240K |
| Pratt Urology Associates, INC | Boston, MA | $204K |
| Pratt Anesthesiology Associates, INC | Boston, MA | $197K |
| Pratt Medical Group, INC | Boston, MA | $141K |
| Pratt Medical Group, INC | Boston, MA | $127K |
| Pratt Surgical Associates INC | Boston, MA | $123K |
Matched on the authorized-official name exactly as entered in NPPES. A common name can match unrelated people.