South Summit Pediatrics. LLC
South Summit Pediatrics. LLC was paid $392K by Medicaid between Jan 2018 and Nov 2024, across 30 billing codes. Its largest line is 99214, doctor's office visit, returning patient (more involved) — 49% of everything it billed.
33Billing provider infoSOUTH SUMMIT PEDIATRICS. LLC
DRAPER, UT 84020
DRAPER, UT 84020
33aNPI1760490122assigned 08/03/2006
33bProvider typeLegal Medicine
28Total paid$392K
24GClaims11,111
24DCodes billed30
24AFirst – last monthJan 2018 – Nov 2024
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 | 368 | $20K | |
| 2019 | 357 | $19K | |
| 2020 | 475 | $23K | |
| 2021 | 1,985 | $97K | |
| 2022 | 1,641 | $94K | |
| 2023 | 2,823 | $63K | |
| 2024incomplete | 3,462 | $76K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| 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 | 49% | 2,474 | 2,215 | $192K |
| 99213 | Doctor's office visit, returning patient (routine)Office or other outpatient visit for the evaluation and management of an established patient, low complexity | 32% | 2,101 | 1,851 | $124K |
| 99391 | Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) | 8.9% | 659 | 557 | $35K |
| 99392 | Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) | 4.2% | 431 | 421 | $16K |
| 99393 | Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) | 2.0% | 197 | 193 | $8K |
| 90686 | <1% | 542 | 531 | $4K | |
| 90460 | Immunization administration through 18 years of age via any route, first or only component | <1% | 543 | 523 | $3K |
| 90461 | <1% | 280 | 273 | $2K | |
| 96127 | <1% | 790 | 697 | $2K | |
| 90472 | Immunization administration, each additional vaccine (list separately) | <1% | 137 | 132 | $1K |
| 99000 | <1% | 379 | 318 | $1K | |
| 87426 | Infectious agent antigen detection, SARS-CoV-2 (COVID-19) | <1% | 146 | 134 | $846.87 |
18 more codes
| 90672 | <1% | 146 | $789.58 | |
| 90471 | Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine | <1% | 635 | $755.79 |
| 87651 | Infectious agent detection by nucleic acid; Streptococcus, group A, amplified probe | <1% | 83 | $679.11 |
| 90473 | <1% | 150 | $352.23 | |
| 90480 | <1% | 16 | $280.00 | |
| 0002A | <1% | 13 | $200.00 | |
| 99394 | Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) | <1% | 56 | $170.84 |
| 90656 | <1% | 53 | $89.50 | |
| 36416 | <1% | 68 | $41.47 | |
| 90660 | <1% | 12 | $28.91 | |
| 99174 | <1% | 36 | $6.55 | |
| 90648 | <1% | 266 | $0.02 | |
| 90723 | <1% | 137 | $0.01 | |
| 90671 | <1% | 228 | $0.01 | |
| 90680 | 0% | 93 | $0.00 | |
| 99173 | 0% | 416 | $0.00 | |
| 90707 | 0% | 12 | $0.00 | |
| 90670 | 0% | 12 | $0.00 |
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 officialLEI, PAUL (OWNER)
| Provider | Location | Paid |
|---|---|---|
| Copperview Medical Center, LLC | South Jordan, UT | $1.51M |
Matched on the authorized-official name exactly as entered in NPPES. A common name can match unrelated people.