Theoria Medical

Theoria Medical was paid $9.72M by Medicaid between Aug 2019 and Dec 2024, across 31 billing codes. Its largest line is 99309, Subsequent nursing facility care, per day, low to moderate complexity — 44% of everything it billed.

33Billing provider infoTHEORIA MEDICAL
NOVI, MI 48375

33aNPI1609362375assigned 07/06/2018

33bProvider typeCardiovascular Disease Physician

28Total paid$9.72M

24GClaims462,169

24DCodes billed31

24AFirst – last monthAug 2019 – Dec 2024

Compared with peers

Next to other Cardiovascular Disease Physician providers in Michigan

Rank by total paid#3 of 134

Median peer was paid$91K

This provider vs. median106×

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
2019	331	$7K
2020	22,179	$506K
2021	70,613	$1.53M
2022	116,557	$2.22M
2023	117,203	$2.41M
2024incomplete	135,286	$3.05M

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
99309	Subsequent nursing facility care, per day, low to moderate complexity	44%	194,081	89,164	$4.29M
99308	Subsequent nursing facility care, per day, straightforward	33%	174,822	86,704	$3.18M
99306	Prolong nursin fac eval 15m	5.8%	11,452	9,465	$565K
99310	Prolong nursin fac eval 15m	5.3%	18,943	11,389	$518K
99305		3.9%	8,904	7,657	$383K
99497		2.3%	12,282	10,495	$225K
99307		2.3%	21,559	14,019	$222K
99316		1.5%	2,691	2,660	$142K
99490	Ccm add 20min	<1%	7,309	6,252	$53K
99315		<1%	1,255	1,247	$36K
99304		<1%	1,029	898	$27K
99318		<1%	739	722	$27K

19 more codes

99439		<1%	3,839	$22K
11042	Debridement, subcutaneous tissue (includes epidermis, dermis, and subcutaneous tissue); first 20 sq cm	<1%	335	$10K
G0180	Physician or allowed practitioner certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians and allowed practitioners to affirm the initial implementation of the plan of care	<1%	922	$5K
99356		<1%	241	$5K
17250		<1%	245	$5K
99487	Ccm add 20min	<1%	296	$4K
99491	Ccm add 20min	<1%	263	$816.31
99489	Ccm add 20min	<1%	84	$517.24
99406		<1%	170	$383.28
97597		<1%	87	$317.48
99422		<1%	20	$272.22
G0317	Prolonged nursing facility evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using 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 99306, 99310 for nursing facility evaluation and management services). (do not report g0317 on the same date of service as other prolonged services for evaluation and management 99358, 99359, 99418). (do not report g0317 for any time unit less than 15 minutes)	<1%	19	$218.04
99358	Prolong nursin fac eval 15m	<1%	243	$125.57
1101F		0%	155	$0.00
96127		0%	72	$0.00
80050	General health panel	0%	15	$0.00
G9717	Documentation stating the patient has had a diagnosis of bipolar disorder	0%	16	$0.00
1100F		0%	65	$0.00
G8482	Influenza immunization administered or previously received	0%	16	$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 officialVINOKUR, SVETLANA (CFO)