1508484726

1508484726 was paid $1.61M by Medicaid between Nov 2020 and Feb 2023, across 7 billing codes. Its largest line is 90876, — 79% of everything it billed.

33Billing provider info1508484726

33aNPI1508484726

33bProvider type—

28Total paid$1.61M

24GClaims45,539

24DCodes billed7

24AFirst – last monthNov 2020 – Feb 2023

Auditor's notes

Automated statistical signals. Not evidence of fraud — how these are computed.

OIG exclusionListed on the federal exclusion list (06/20/2024).

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	4,114	$145K
2021	39,929	$1.46M
2022	729	$0.00
2023	767	$0.00

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
90876		79%	14,792	1,452	$1.26M
Q3014	Telehealth originating site facility fee	12%	15,068	1,773	$188K
99211	Office or other outpatient visit for the evaluation and management of an established patient, minimal severity	9.8%	14,550	1,439	$158K
90833	Psychotherapy, 30 minutes with patient when performed with an E&M service (add-on)	0%	478	305	$0.00
90901		0%	162	56	$0.00
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	0%	137	87	$0.00
99213	Doctor's office visit, returning patient (routine)Office or other outpatient visit for the evaluation and management of an established patient, low complexity	0%	352	219	$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.