PRAIRIE GARDENS MEDICAL LLC
NPI: 1689280067
· OKLAHOMA CITY, OK 73114
· General Practice Physician
· NPI assigned 09/21/2020
$189K
Total Medicaid Paid
Provider Details
| Authorized Official | TUPPER, DIANNE (PRACTICE MANAGER) |
| NPI Enumeration Date | 09/21/2020 |
Related Entities
Other providers sharing the same authorized official: TUPPER, DIANNE
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2020 |
43 |
$325.16 |
| 2021 |
258 |
$8K |
| 2022 |
889 |
$52K |
| 2023 |
1,366 |
$77K |
| 2024 |
964 |
$52K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,552 |
1,443 |
$106K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,560 |
1,480 |
$75K |
| 99215 |
Prolong outpt/office vis |
83 |
79 |
$6K |
| 11721 |
|
117 |
117 |
$1K |
| 11056 |
|
12 |
12 |
$392.93 |
| G2211 |
Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient's single, serious condition or a complex condition. (add-on code, list separately in addition to office/outpatient evaluation and management visit, new or established) |
166 |
128 |
$276.12 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
12 |
12 |
$107.95 |
| 36415 |
Collection of venous blood by venipuncture |
18 |
18 |
$48.06 |