1790840122

1790840122 was paid $2K by Medicaid between Sep 2018 and Jun 2021, across 5 billing codes. Its largest line is 90471, Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine — 28% of everything it billed.

33Billing provider info1790840122

33aNPI1790840122

33bProvider type—

28Total paid$2K

24GClaims138

24DCodes billed5

24AFirst – last monthSep 2018 – Jun 2021

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	19	$217.52
2019	18	$0.00
2020	69	$968.20
2021	32	$960.96

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
90471	Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine	28%	55	55	$598.32
90686		27%	33	33	$587.40
0012A		22%	15	15	$480.48
0011A		22%	17	17	$480.48
S9430	Pharmacy compounding and dispensing services	0%	18	14	$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.