Medicaid Provider Spending

$1.09 trillion in Medicaid claims data, 2018–2024 · 617K+ providers

SOUTH SIDE CONVENIENT CARE INC

NPI: 1679007249 · BELLEVUE, NE 68147 · Physician Assistant · NPI assigned 04/20/2017

$112K
Total Medicaid Paid
2,977
Total Claims
2,135
Beneficiaries
8
Codes Billed
2018-03
First Month
2024-12
Last Month

Provider Details

Authorized OfficialSENANAYAKA, SAMANTHA (CLINIC CREDENTIALING CONTACT)
NPI Enumeration Date04/20/2017

Monthly Spending Trend

Yearly Breakdown

YearClaimsTotal Paid
2018 72 $3K
2019 253 $9K
2020 242 $6K
2021 367 $17K
2022 638 $24K
2023 692 $24K
2024 713 $29K

Billing Codes

CodeDescriptionClaimsBeneficiariesTotal Paid
99214 Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity 1,936 1,306 $88K
99213 Office or other outpatient visit for the evaluation and management of an established patient, low complexity 642 532 $20K
87880 Infectious agent antigen detection by immunoassay; Streptococcus, group A 119 112 $1K
87804 Infectious agent antigen detection by immunoassay; Influenza, each type 106 48 $1K
96372 Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular 54 26 $499.77
36415 Collection of venous blood by venipuncture 58 53 $290.10
96127 17 16 $195.07
99000 45 42 $0.00