KENTUCKY MSO LLC

NPI: 1710252622 · GEORGETOWN, KY 40324 · Family Medicine Physician · NPI assigned 03/12/2012

$119K

Total Medicaid Paid

4,124

Total Claims

3,188

Beneficiaries

Codes Billed

2018-01

First Month

2019-06

Last Month

Provider Details

Authorized Official	VAUGHN, TIMOTHY (VICE PRESIDENT)
NPI Enumeration Date	03/12/2012

Other providers sharing the same authorized official: VAUGHN, TIMOTHY

Provider	City	State	Total Paid
DLP MARIA PARHAM PHYSICIAN PRACTICES, LLC	HENDERSON	NC	$424K
DLP MARIA PARHAM PHYSICIAN PRACTICES, LLC	HENDERSON	NC	$322K
KENTUCKY MSO LLC	GEORGETOWN	KY	$265K
LAKE CUMBERLAND PHYSICIAN PRACTICES	SOMERSET	KY	$247K
CASTLEVIEW PHYSICIAN PRACTICES, LLC	PRICE	UT	$11K
DLP MARIA PARHAM PHYSICIAN PRACTICES, LLC	HENDERSON	NC	$11K

Year	Claims	Total Paid
2018	3,000	$87K
2019	1,124	$32K

Code	Description	Claims	Beneficiaries	Total Paid
99213	Office or other outpatient visit for the evaluation and management of an established patient, low complexity	2,775	2,162	$80K
99214	Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity	1,050	809	$37K
90688		76	59	$596.74
90471	Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine	36	33	$550.43
99318		25	15	$525.44
99308	Subsequent nursing facility care, per day, straightforward	129	86	$219.49
99307		33	24	$8.32