Clinic
Big Sandy Health Care INC
Big Sandy Health Care INC was paid $1.73M by Medicaid between Jan 2018 and Dec 2024, across 68 billing codes. Its largest line is 99213, doctor's office visit, returning patient (routine) — 49% of everything it billed.
33Billing provider infoBIG SANDY HEALTH CARE INC
PIKEVILLE, KY 41501
PIKEVILLE, KY 41501
33aNPI1700828597assigned 06/13/2006
33bProvider typeFederally Qualified Health Center (FQHC)
28Total paid$1.73M
24GClaims106,698
24DCodes billed68
24AFirst – last monthJan 2018 – Dec 2024
Compared with peers
Next to other Federally Qualified Health Center (FQHC) providers in Kentucky
Rank by total paid#18 of 37
Median peer was paid$1.29M
This provider vs. median1.3×
Peers share this provider's primary NPPES type and state. Size alone says nothing about billing quality: a big agency or a hospital system is expected to sit far above the median.
Box 24A · Dates of service
Paid by month
Paid that monthNov–Dec 2024: claims still arriving when the file was cut, so these months run low for every provider
By year, as a table
| Year | Claims | Paid | |
|---|---|---|---|
| 2018 | 17,988 | $264K | |
| 2019 | 18,031 | $278K | |
| 2020 | 13,836 | $246K | |
| 2021 | 15,886 | $249K | |
| 2022 | 15,159 | $249K | |
| 2023 | 12,960 | $243K | |
| 2024incomplete | 12,838 | $203K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| 99213 | Doctor's office visit, returning patient (routine)Office or other outpatient visit for the evaluation and management of an established patient, low complexity | 49% | 29,192 | 25,422 | $856K |
| 90837 | Psychotherapy session, about an hourPsychotherapy, 53 minutes with patient | 7.3% | 1,682 | 1,146 | $126K |
| G0467 | Community health center visit, returning patientFederally qualified health center (fqhc) visit, established patient; a medically-necessary, face-to-face encounter (one-on-one) between an established patient and a fqhc practitioner during which time one or more fqhc services are rendered and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving a fqhc visit | 5.7% | 11,706 | 4,508 | $100K |
| 99214 | Doctor's office visit, returning patient (more involved)Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity | 3.8% | 1,535 | 1,449 | $66K |
| 92014 | Ophthalmological services: medical examination and evaluation, comprehensive, established patient | 3.0% | 823 | 794 | $53K |
| 90834 | Psychotherapy session, about 45 minutesPsychotherapy, 45 minutes with patient | 3.0% | 1,013 | 718 | $52K |
| D1110 | Prophylaxis - adult | 2.8% | 1,096 | 1,061 | $48K |
| D0330 | Panoramic radiographic image | 2.6% | 1,156 | 1,121 | $45K |
| D7140 | Extraction, erupted tooth or exposed root | 2.2% | 1,048 | 560 | $38K |
| 99212 | Office or other outpatient visit for the evaluation and management of an established patient, straightforward | 2.1% | 1,332 | 1,202 | $37K |
| 85025 | Blood count; complete (CBC), automated, and automated differential WBC count | 2.0% | 5,855 | 5,540 | $34K |
| D0150 | Comprehensive oral evaluation - new or established patient | 1.8% | 1,148 | 1,112 | $31K |
56 more codes
| 36415 | Collection of venous blood by venipuncture | 1.7% | 11,370 | $30K |
| 83036 | Hemoglobin; glycosylated (A1C) | 1.4% | 3,558 | $24K |
| D0274 | Bitewings - four radiographic images | 1.3% | 1,019 | $23K |
| D0140 | Limited oral evaluation - problem focused | 1.2% | 616 | $20K |
| V2020 | Frames, purchases | 1.1% | 931 | $18K |
| 87811 | Infectious agent antigen detection by immunoassay; SARS-CoV-2 (COVID-19) | <1% | 538 | $17K |
| 87804 | Infectious agent antigen detection by immunoassay; Influenza, each type | <1% | 1,004 | $13K |
| 87635 | Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe | <1% | 346 | $12K |
| 90832 | Psychotherapy session, about 30 minutes | <1% | 250 | $11K |
| G2025 | Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only | <1% | 1,185 | $11K |
| 92004 | Ophthalmological services: medical examination and evaluation, comprehensive, new patient | <1% | 130 | $11K |
| 92015 | Determination of refractive state | <1% | 1,670 | $7K |
| 90471 | Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine | <1% | 499 | $6K |
| D0220 | Intraoral - periapical first radiographic image | <1% | 617 | $4K |
| T1015 | A visit at a community health center or clinic (one all-in rate) | <1% | 1,258 | $4K |
| 96372 | Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular | <1% | 317 | $4K |
| 90791 | Psychiatric diagnostic evaluation | <1% | 44 | $4K |
| D0120 | Dental checkup, returning patient | <1% | 148 | $4K |
| 80053 | Comprehensive metabolic panel | <1% | 412 | $3K |
| 90674 | <1% | 147 | $3K | |
| V2784 | Lens, polycarbonate or equal, any index, per lens | <1% | 291 | $3K |
| 87880 | Infectious agent antigen detection by immunoassay; Streptococcus, group A | <1% | 204 | $3K |
| 90756 | <1% | 99 | $1K | |
| 80061 | Lipid panel | <1% | 133 | $1K |
| 90686 | <1% | 81 | $1K | |
| 71046 | Radiologic examination, chest; 2 views | <1% | 61 | $969.89 |
| 92340 | Fitting of spectacles, except for aphakia; monofocal | <1% | 47 | $957.62 |
| 99203 | Doctor's office visit, new patient (routine) | <1% | 15 | $776.55 |
| D2392 | Resin-based composite - two surfaces, posterior, primary or permanent | <1% | 15 | $730.50 |
| 80305 | <1% | 75 | $590.30 | |
| 99211 | Office or other outpatient visit for the evaluation and management of an established patient, minimal severity | <1% | 30 | $532.38 |
| J0696 | Injection, ceftriaxone sodium, per 250 mg | <1% | 14 | $493.49 |
| 81001 | <1% | 332 | $377.77 | |
| 90661 | <1% | 13 | $361.66 | |
| G2012 | Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion | <1% | 34 | $264.44 |
| V2103 | Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens | <1% | 23 | $210.00 |
| V2107 | Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens | <1% | 12 | $175.00 |
| G0071 | Payment for communication technology-based services for 5 minutes or more of a virtual (non-face-to-face) communication between an rural health clinic (rhc) or federally qualified health center (fqhc) practitioner and rhc or fqhc patient, or 5 minutes or more of remote evaluation of recorded video and/or images by an rhc or fqhc practitioner, occurring in lieu of an office visit; rhc or fqhc only | <1% | 103 | $154.55 |
| V2203 | Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens | <1% | 17 | $133.72 |
| 36416 | <1% | 76 | $132.34 | |
| 94760 | <1% | 12 | $12.58 | |
| 81003 | <1% | 12 | $8.31 | |
| 3074F | <1% | 1,571 | $6.52 | |
| 3078F | <1% | 1,458 | $5.90 | |
| 3044F | <1% | 430 | $1.61 | |
| 4004F | <1% | 7,376 | $1.35 | |
| 3079F | <1% | 245 | $0.99 | |
| 1036F | <1% | 3,561 | $0.91 | |
| D0999 | Unspecified diagnostic procedure, by report | <1% | 914 | $0.44 |
| 3075F | <1% | 41 | $0.15 | |
| G8510 | Screening for depression is documented as negative, a follow-up plan is not required | <1% | 4,742 | $0.04 |
| D1330 | 0% | 15 | $0.00 | |
| G8417 | Bmi is documented above normal parameters and a follow-up plan is documented | 0% | 902 | $0.00 |
| G8431 | Screening for depression is documented as being positive and a follow-up plan is documented | 0% | 52 | $0.00 |
| G8482 | Influenza immunization administered or previously received | 0% | 33 | $0.00 |
| G8483 | Influenza immunization was not administered for reasons documented by clinician (e.g., patient allergy or other medical reasons, patient declined or other patient reasons, vaccine not available or other system reasons) | 0% | 14 | $0.00 |
Claims and beneficiary counts add up across code × month rows, so one patient seen every month counts many times. Rows with fewer than 12 claims are suppressed by HHS, so small lines can be missing.
From NPPES
Who's on the registration
Authorized officialHERALD, JAMES (CEO)
| Provider | Location | Paid |
|---|---|---|
| Big Sandy Health Care INC | Auxier, KY | $4.57M |
| Big Sandy Health Care, INC | Inez, KY | $2.30M |
| Big Sandy Health Care INC | Salyersville, KY | $1.99M |
| Big Sandy Health Care INC | Grethel, KY | $1.74M |
| Big Sandy Health Care INC | Salyersville, KY | $1.01M |
| Big Sandy Health Care INC | Pikeville, KY | $530K |
| Big Sandy Health Care INC | Harold, KY | $416K |
| The Pathology Group PC | Memphis, TN | $380K |
| Big Sandy Health Care INC | Freeburn, KY | $114K |
| Big Sandy Health Care INC | Paintsville, KY | $48K |
Matched on the authorized-official name exactly as entered in NPPES. A common name can match unrelated people.