NPI: 1609834449 · SALIDA, CO 81201 · State or Local Public Health Clinic/Center · NPI assigned 05/02/2006
| Authorized Official | CARLSTROM, ANDREA (DIRECTOR) |
| NPI Enumeration Date | 05/02/2006 |
| Year | Claims | Total Paid |
|---|---|---|
| 2018 | 360 | $6K |
| 2019 | 336 | $5K |
| 2020 | 166 | $3K |
| 2021 | 179 | $3K |
| 2022 | 12 | $217.69 |
| 2023 | 160 | $3K |
| 2024 | 113 | $4K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D0190 | 723 | 635 | $12K | |
| D1206 | Topical application of fluoride varnish | 289 | 255 | $6K |
| D1120 | Prophylaxis - child | 90 | 82 | $4K |
| 90471 | Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine | 144 | 139 | $2K |
| 90686 | 68 | 66 | $668.85 | |
| 90472 | Immunization administration, each additional vaccine (list separately) | 12 | 12 | $285.74 |