1528498490

1528498490 was paid $486K by Medicaid between Feb 2018 and Mar 2022, across 14 billing codes. Its largest line is B4161, Enteral formula, for pediatrics, hydrolyzed/amino acids and peptide chain proteins, includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit — 33% of everything it billed.

33Billing provider info1528498490

33aNPI1528498490

33bProvider type—

28Total paid$486K

24GClaims3,967

24DCodes billed14

24AFirst – last monthFeb 2018 – Mar 2022

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	1,119	$61K
2019	1,680	$200K
2020	547	$99K
2021	582	$109K
2022	39	$18K

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
B4161	Enteral formula, for pediatrics, hydrolyzed/amino acids and peptide chain proteins, includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit	33%	701	600	$159K
B4160	Enteral formula, for pediatrics, nutritionally complete calorically dense (equal to or greater than 0.7 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit	19%	995	794	$93K
A4221	Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately)	15%	416	190	$72K
S9342	Home therapy; enteral nutrition via pump; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (enteral formula and nursing visits coded separately), per diem	8.9%	90	89	$43K
S9502	Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every 8 hours, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem	7.8%	114	41	$38K
A4223	Infusion supplies not used with external infusion pump, per cassette or bag (list drugs separately)	7.0%	395	121	$34K
J1642	Injection, heparin sodium, (heparin lock flush), per 10 units	2.7%	665	144	$13K
B4150	Enteral formula, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit	2.3%	98	90	$11K
S9500	Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every 24 hours; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem	2.0%	58	14	$10K
99601		<1%	41	13	$4K
A4216	Sterile water, saline and/or dextrose, diluent/flush, 10 ml	<1%	285	90	$3K
B4035	Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape	<1%	44	39	$2K

2 more codes

S9123	Nursing care, in the home; by registered nurse, per hour (use for general nursing care only, not to be used when cpt codes 99500-99602 can be used)	<1%	40	$2K
B4152	Enteral formula, nutritionally complete, calorically dense (equal to or greater than 1.5 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit	<1%	25	$2K

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.