Medicaid Provider Spending

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

CALDWELL MEMORIAL HOSPITAL, INC

NPI: 1689881831 · GRANITE FALLS, NC 28630 · Pediatrics Physician · NPI assigned 05/17/2007

Billing Flags · Automated signals — not evidence of fraud
Entity Proliferation

Authorized official SHADOWENS, KAREN controls 20+ related entities in our dataset. Read more

$7.30M
Total Medicaid Paid
333,687
Total Claims
274,102
Beneficiaries
48
Codes Billed
2018-01
First Month
2024-12
Last Month

Provider Details

Authorized OfficialSHADOWENS, KAREN (CFO)
Parent OrganizationCALDWELL MEMORIAL HOSPITAL, INC
NPI Enumeration Date05/17/2007

Related Entities

Other providers sharing the same authorized official: SHADOWENS, KAREN

ProviderCityStateTotal Paid
CALDWELL MEMORIAL HOSPITAL, INC. LENOIR NC $28.83M
UNC ROCKINGHAM HEALTH CARE, INC. EDEN NC $10.35M
CALDWELL MEMORIAL HOSPITAL, INC LENOIR NC $5.30M
CALDWELL MEMORIAL HOSPITAL, INC LENOIR NC $1.65M
CALDWELL MEMORIAL HOSPITAL, INC. LENOIR NC $1.44M
CALDWELL MEMORIAL HOSPITAL, INC. HUDSON NC $1.34M
CALDWELL MEMORIAL HOSPITAL, INC LENOIR NC $861K
CALDWELL MEMORIAL HOSPITAL, INC. LENOIR NC $547K
CALDWELL MEMORIAL HOSPITAL, INC. LENOIR NC $393K
CALDWELL MEMORIAL HOSPITAL, INC LENOIR NC $323K
CALDWELL MEMORIAL HOSPITAL, INC LENOIR NC $289K
HIGHLAND HEALTH PROVIDERS CORP LYNCHBURG OH $251K
CALDWELL MEMORIAL HOSPITAL, INC LENOIR NC $229K
CALDWELL MEMORIAL HOSPITAL INC LENOIR NC $224K
CALDWELL MEMORIAL HOSPITAL, INC. BLOWING ROCK NC $202K
CALDWELL MEMORIAL HOSPITAL, INC. LENOIR NC $177K
CALDWELL MEMORIAL HOSPTIAL, INC LENOIR NC $168K
CALDWELL MEMORIAL HOSPITAL, INC. HUDSON NC $108K
CALDWELL MEMORIAL HOSPITAL, INC. LENOIR NC $82K
CALDWELL MEMORIAL HOSPITAL, INC. LENOIR NC $64K

Monthly Spending Trend

Yearly Breakdown

YearClaimsTotal Paid
2018 30,426 $772K
2019 29,866 $974K
2020 21,262 $705K
2021 41,966 $1.25M
2022 75,433 $1.41M
2023 72,993 $1.27M
2024 61,741 $921K

Billing Codes

CodeDescriptionClaimsBeneficiariesTotal Paid
99213 Office or other outpatient visit for the evaluation and management of an established patient, low complexity 71,108 58,898 $2.87M
99214 Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity 13,830 11,319 $893K
99392 Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) 7,536 6,511 $677K
90460 Immunization administration through 18 years of age via any route, first or only component 14,331 12,372 $607K
99391 Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) 6,934 5,537 $580K
99199 Unlisted special service, procedure or report 132,931 106,400 $541K
99393 Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) 5,390 4,645 $490K
99394 Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) 1,836 1,603 $188K
96110 Developmental screening, with scoring and documentation, per standardized instrument 10,210 8,699 $86K
96127 21,190 17,482 $75K
90472 Immunization administration, each additional vaccine (list separately) 2,134 1,652 $55K
90471 Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine 3,246 2,642 $53K
D0145 Oral evaluation for a patient under three years of age 1,281 1,054 $43K
99203 Office or other outpatient visit for the evaluation and management of a new patient, low complexity 595 440 $32K
99215 Prolong outpt/office vis 289 253 $22K
99051 785 771 $19K
D1206 Topical application of fluoride varnish 1,247 1,036 $16K
96161 3,328 2,571 $8K
92551 5,900 4,999 $7K
99173 8,412 7,212 $7K
99212 Office or other outpatient visit for the evaluation and management of an established patient, straightforward 249 220 $5K
99401 226 141 $5K
99442 92 87 $3K
90474 232 177 $3K
90686 5,765 4,926 $3K
90651 390 339 $3K
90734 386 335 $2K
99381 17 12 $1K
87651 Infectious agent detection by nucleic acid; Streptococcus, group A, amplified probe 181 150 $757.08
99238 Hospital discharge day management, 30 minutes or less 13 12 $652.08
90670 3,863 3,190 $651.00
87502 Infectious agent detection by nucleic acid, influenza virus, for multiple types or subtypes, includes all targets 123 103 $645.99
87635 Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe 710 691 $635.18
90715 72 64 $160.17
92552 1,808 1,605 $145.43
96160 32 25 $98.25
90680 1,562 1,254 $97.06
90723 2,042 1,683 $93.33
87880 Infectious agent antigen detection by immunoassay; Streptococcus, group A 30 28 $66.56
90633 694 605 $32.86
90647 2,050 1,736 $0.00
99000 75 71 $0.00
90677 204 202 $0.00
90656 284 276 $0.00
90696 12 12 $0.00
90685 37 37 $0.00
90710 13 13 $0.00
94642 12 12 $0.00