1609370246

1609370246 was paid $130K by Medicaid between Apr 2018 and May 2022, across 13 billing codes. Its largest line is 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 — 80% of everything it billed.

33Billing provider info1609370246

33aNPI1609370246

33bProvider type—

28Total paid$130K

24GClaims1,126

24DCodes billed13

24AFirst – last monthApr 2018 – May 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	775	$73K
2019	240	$47K
2020	33	$5K
2021	51	$3K
2022	27	$3K

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
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	80%	608	514	$105K
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	9.0%	74	59	$12K
B4035	Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape	5.3%	115	99	$7K
B9998	Noc for enteral supplies	2.9%	113	65	$4K
B4158	Enteral formula, for pediatrics, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber and/or iron, administered through an enteral feeding tube, 100 calories = 1 unit	1.1%	15	13	$1K
E1390	Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate	<1%	27	27	$1K
A6402	Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing	<1%	46	41	$213.04
E0431	Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing	<1%	14	14	$81.78
S8189	Tracheostomy supply, not otherwise classified	<1%	40	15	$71.28
A4213	Syringe, sterile, 20 cc or greater, each	<1%	17	13	$62.95
A4927	Gloves, non-sterile, per 100	<1%	12	12	$26.02
B9002	Enteral nutrition infusion pump, any type	<1%	18	12	$24.48

1 more codes

A4210

Needle-free injection device, each

<1%

$7.11

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.