Roosevelt Vision Clinic, PC
Roosevelt Vision Clinic, PC was paid $550K by Medicaid between Jan 2018 and Nov 2024, across 10 billing codes. Its largest line is 92014, Ophthalmological services: medical examination and evaluation, comprehensive, established patient — 57% of everything it billed.
33Billing provider infoROOSEVELT VISION CLINIC, PC
ROOSEVELT, UT 84066
ROOSEVELT, UT 84066
33aNPI1710973052assigned 09/22/2005
33bProvider typeOptometrist
28Total paid$550K
24GClaims12,609
24DCodes billed10
24AFirst – last monthJan 2018 – Nov 2024
Compared with peers
Next to other Optometrist providers in Utah
Rank by total paid#2 of 130
Median peer was paid$6K
This provider vs. median93×
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 | 1,070 | $38K | |
| 2019 | 1,081 | $40K | |
| 2020 | 1,619 | $75K | |
| 2021 | 2,202 | $107K | |
| 2022 | 2,068 | $94K | |
| 2023 | 2,623 | $107K | |
| 2024incomplete | 1,946 | $89K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| 92014 | Ophthalmological services: medical examination and evaluation, comprehensive, established patient | 57% | 3,193 | 3,086 | $314K |
| 92004 | Ophthalmological services: medical examination and evaluation, comprehensive, new patient | 26% | 1,262 | 1,216 | $145K |
| V2020 | Frames, purchases | 8.8% | 998 | 969 | $49K |
| V2103 | Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens | 2.9% | 762 | 677 | $16K |
| 92015 | Determination of refractive state | 2.2% | 5,685 | 5,464 | $12K |
| 99213 | Doctor's office visit, returning patient (routine)Office or other outpatient visit for the evaluation and management of an established patient, low complexity | 2.0% | 420 | 315 | $11K |
| V2100 | Sphere, single vision, plano to plus or minus 4.00, per lens | <1% | 14 | 14 | $1K |
| 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 | <1% | 15 | 12 | $983.50 |
| 92250 | <1% | 14 | 13 | $141.96 | |
| V2760 | Scratch resistant coating, per lens | <1% | 246 | 231 | $20.90 |
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 officialKOWALLIS, SCOTT (OWNER/DOCTOR)