Medicaid Provider Spending

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

DE BACA FAMILY PRACTICE CLINIC

NPI: 1699082644 · FORT SUMNER, NM 88119 · Federally Qualified Health Center (FQHC) · NPI assigned 09/10/2010

$181K
Total Medicaid Paid
1,716
Total Claims
1,630
Beneficiaries
7
Codes Billed
2018-06
First Month
2024-09
Last Month

Provider Details

Authorized OfficialWALRAVEN, LISA (CEO)
Parent OrganizationDE BACA FAMILY PRACTICE CLINIC
NPI Enumeration Date09/10/2010

Related Entities

Other providers sharing the same authorized official: WALRAVEN, LISA

ProviderCityStateTotal Paid
DE BACA FAMILY PRACTICE CLINIC FORT SUMNER NM $2.28M

Monthly Spending Trend

Yearly Breakdown

YearClaimsTotal Paid
2018 353 $38K
2019 743 $80K
2020 380 $42K
2021 15 $2K
2022 28 $4K
2023 12 $2K
2024 185 $13K

Billing Codes

CodeDescriptionClaimsBeneficiariesTotal Paid
99213 Office or other outpatient visit for the evaluation and management of an established patient, low complexity 854 795 $78K
87880 Infectious agent antigen detection by immunoassay; Streptococcus, group A 562 547 $66K
99212 Office or other outpatient visit for the evaluation and management of an established patient, straightforward 92 83 $15K
87804 Infectious agent antigen detection by immunoassay; Influenza, each type 103 101 $9K
99393 Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) 51 51 $9K
99394 Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) 14 14 $3K
87635 Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe 40 39 $493.73