1790789238

1790789238 was paid $1.66M by Medicaid between Jan 2018 and Aug 2019, across 17 billing codes. Its largest line is B4161, Enteral formula, for pediatrics, hydrolyzed/amino acids and peptide chain proteins, includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit — 33% of everything it billed.

33Billing provider info1790789238

33aNPI1790789238

33bProvider type—

28Total paid$1.66M

24GClaims14,057

24DCodes billed17

24AFirst – last monthJan 2018 – Aug 2019

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	9,922	$1.28M
2019	4,135	$380K

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
B4161	Enteral formula, for pediatrics, hydrolyzed/amino acids and peptide chain proteins, includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit	33%	1,634	1,120	$549K
B4160	Enteral formula, for pediatrics, nutritionally complete calorically dense (equal to or greater than 0.7 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit	15%	1,558	1,188	$256K
B4035	Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape	13%	2,903	2,001	$208K
A4213	Syringe, sterile, 20 cc or greater, each	11%	971	863	$185K
B4152	Enteral formula, nutritionally complete, calorically dense (equal to or greater than 1.5 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit	4.6%	469	357	$76K
J1642	Injection, heparin sodium, (heparin lock flush), per 10 units	3.9%	168	63	$65K
B4150	Enteral formula, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit	3.8%	549	401	$63K
B9998	Noc for enteral supplies	3.2%	2,682	1,764	$54K
A4222	Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately)	2.5%	162	87	$41K
B4154	Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit	2.4%	90	63	$40K
B4153	Enteral formula, nutritionally complete, hydrolyzed proteins (amino acids and peptide chain), includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit	2.2%	43	37	$37K
B4155	Enteral formula, nutritionally incomplete/modular nutrients, includes specific nutrients, carbohydrates (e.g., glucose polymers), proteins/amino acids (e.g., glutamine, arginine), fat (e.g., medium chain triglycerides) or combination, administered through an enteral feeding tube, 100 calories = 1 unit	1.5%	793	521	$25K

5 more codes

B4100	Food thickener, administered orally, per ounce	1.4%	434	$23K
B9002	Enteral nutrition infusion pump, any type	1.3%	697	$22K
A4221	Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately)	<1%	449	$10K
E0776	Iv pole	<1%	105	$6K
A6209	Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing	<1%	350	$2K

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.