UTAH MODERN MEDICAL LLC
NPI: 1689310948
· LEHI, UT 84043
· Medical Physician Assistant
· NPI assigned 05/10/2022
$160.04
Total Medicaid Paid
Provider Details
| Authorized Official | BULLOCK, DAVE (OWNER) |
| NPI Enumeration Date | 05/10/2022 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2024 |
246 |
$160.04 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99454 |
|
76 |
65 |
$158.86 |
| 99458 |
|
84 |
72 |
$1.18 |
| 99457 |
|
86 |
74 |
$0.00 |