Managed care
Prospect Healthsource Medical Group INC
Prospect Healthsource Medical Group INC was paid $571.69 by Medicaid between Jan 2018 and Sep 2018, across 14 billing codes. Its largest line is 80061, Lipid panel — 46% of everything it billed.
33Billing provider infoPROSPECT HEALTHSOURCE MEDICAL GROUP INC
ORANGE, CA 92868
ORANGE, CA 92868
33aNPI1730200221assigned 04/02/2007
33bProvider typeHealth Maintenance Organization
28Total paid$571.69
24GClaims1,205
24DCodes billed14
24AFirst – last monthJan 2018 – Sep 2018
Compared with peers
Next to other Health Maintenance Organization providers in California
Rank by total paid#121 of 151
Median peer was paid$59K
This provider vs. median0.0×
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 | 1,205 | $571.69 |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| 80061 | Lipid panel | 46% | 129 | 129 | $261.03 |
| 83036 | Hemoglobin; glycosylated (A1C) | 19% | 141 | 140 | $107.77 |
| 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 | 14% | 29 | 28 | $79.90 |
| 80053 | Comprehensive metabolic panel | 12% | 189 | 181 | $68.13 |
| 86592 | 6.8% | 12 | 12 | $38.75 | |
| 84443 | Thyroid stimulating hormone (TSH) | 2.6% | 146 | 146 | $14.76 |
| 85025 | Blood count; complete (CBC), automated, and automated differential WBC count | <1% | 201 | 195 | $1.35 |
| 87591 | Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe | 0% | 40 | 39 | $0.00 |
| 36415 | Collection of venous blood by venipuncture | 0% | 153 | 148 | $0.00 |
| 87389 | Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies | 0% | 13 | 13 | $0.00 |
| 99213 | Doctor's office visit, returning patient (routine)Office or other outpatient visit for the evaluation and management of an established patient, low complexity | 0% | 28 | 27 | $0.00 |
| 82306 | Vitamin D; 25 hydroxy, includes fraction(s), if performed | 0% | 13 | 13 | $0.00 |
2 more codes
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 officialKAM, LILY (CFO)
| Provider | Location | Paid |
|---|---|---|
| Prospect Medical Group, INC. | Orange, CA | $209K |
| Prospect Professional Care Medical Group, INC. | Santa Ana, CA | $10K |
| Nuestra Familia Medical Group INC | Orange, CA | $71.72 |
Matched on the authorized-official name exactly as entered in NPPES. A common name can match unrelated people.