NPI: 1750466405 · JACKSON, WY 83001 · Pediatrics Physician · NPI assigned 10/25/2006
| Year | Claims | Total Paid |
|---|---|---|
| 2018 | 177 | $9K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| 90460 | Immunization administration through 18 years of age via any route, first or only component | 134 | 131 | $6K |
| 99392 | Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) | 15 | 14 | $1K |
| 99391 | Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) | 15 | 13 | $1K |
| 96110 | Developmental screening, with scoring and documentation, per standardized instrument | 13 | 12 | $256.44 |