SPIRIT LAKE TRIBE
NPI: 1720152457
· FORT TOTTEN, ND 58335
· Case Management Agency
· NPI assigned 11/17/2006
$766K
Total Medicaid Paid
Provider Details
| Authorized Official | CAVANAUGH, PEGGY (TRIBAL CHAIRPERSON) |
| NPI Enumeration Date | 11/17/2006 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
75 |
$27K |
| 2019 |
131 |
$47K |
| 2020 |
383 |
$174K |
| 2021 |
356 |
$176K |
| 2022 |
163 |
$96K |
| 2023 |
263 |
$164K |
| 2024 |
117 |
$81K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,430 |
1,368 |
$737K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
28 |
28 |
$19K |
| 99382 |
|
30 |
28 |
$9K |