Clinic
Jacksonville Hospital LLC
Jacksonville Hospital LLC was paid $2.41M by Medicaid between Oct 2020 and Dec 2024, across 37 billing codes. Its largest line is T1015, a visit at a community health center or clinic (one all-in rate) — 85% of everything it billed.
33Billing provider infoJACKSONVILLE HOSPITAL LLC
RUSK, TX 75785
RUSK, TX 75785
33aNPI1770082299assigned 02/10/2018
33bProvider typeRural Health Clinic/Center
28Total paid$2.41M
24GClaims23,637
24DCodes billed37
24AFirst – last monthOct 2020 – Dec 2024
Compared with peers
Next to other Rural Health Clinic/Center providers in Texas
Rank by total paid#32 of 225
Median peer was paid$428K
This provider vs. median5.6×
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.
Auditor's notes
Automated statistical signals. Not evidence of fraud — how these are computed.
Entity ProliferationAuthorized official PETROVICH, STEPHEN controls 20+ related entities in our dataset. Read more
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 | |
|---|---|---|---|
| 2020 | 922 | $86K | |
| 2021 | 5,174 | $535K | |
| 2022 | 7,036 | $708K | |
| 2023 | 7,147 | $768K | |
| 2024incomplete | 3,358 | $311K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| T1015 | A visit at a community health center or clinic (one all-in rate)Clinic visit/encounter, all-inclusive | 85% | 13,133 | 11,407 | $2.06M |
| 99392 | Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) | 4.0% | 562 | 558 | $97K |
| 99307 | 3.2% | 3,002 | 2,996 | $78K | |
| 99391 | Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) | 2.7% | 396 | 381 | $65K |
| 99393 | Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) | 2.5% | 354 | 349 | $60K |
| 99394 | Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) | <1% | 155 | 150 | $24K |
| 99309 | Subsequent nursing facility care, per day, low to moderate complexity | <1% | 181 | 181 | $7K |
| 99000 | <1% | 180 | 173 | $4K | |
| 90460 | Immunization administration through 18 years of age via any route, first or only component | <1% | 1,643 | 839 | $4K |
| 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% | 50 | 46 | $4K |
| 90686 | <1% | 187 | 183 | $4K | |
| CP005 | <1% | 111 | 104 | $2K |
25 more codes
| 99305 | <1% | 40 | $2K | |
| 90670 | <1% | 345 | $1K | |
| 99304 | <1% | 12 | $343.92 | |
| CP006 | <1% | 28 | $285.74 | |
| 90471 | Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine | <1% | 502 | $170.50 |
| 90734 | <1% | 38 | $170.50 | |
| 90696 | <1% | 13 | $168.15 | |
| 90461 | <1% | 1,538 | $0.20 | |
| 3074F | 0% | 81 | $0.00 | |
| 3008F | 0% | 227 | $0.00 | |
| 90723 | 0% | 54 | $0.00 | |
| 36415 | Collection of venous blood by venipuncture | 0% | 143 | $0.00 |
| 90680 | 0% | 14 | $0.00 | |
| 90651 | 0% | 14 | $0.00 | |
| 90677 | 0% | 13 | $0.00 | |
| 90648 | 0% | 105 | $0.00 | |
| 90472 | Immunization administration, each additional vaccine (list separately) | 0% | 278 | $0.00 |
| 90633 | 0% | 80 | $0.00 | |
| 3078F | 0% | 67 | $0.00 | |
| 90681 | 0% | 15 | $0.00 | |
| 90715 | 0% | 16 | $0.00 | |
| 90473 | 0% | 15 | $0.00 | |
| 99211 | Office or other outpatient visit for the evaluation and management of an established patient, minimal severity | 0% | 17 | $0.00 |
| 90710 | 0% | 16 | $0.00 | |
| 90661 | 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 officialPETROVICH, STEPHEN (EVP)
Parent organizationAHS EAST TEXAS HEALTH SYSTEM, LLC
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Matched on the authorized-official name exactly as entered in NPPES. A common name can match unrelated people.