NPI: 1790854644 · SANTA ANA, CA 92704 · Pharmacy · NPI assigned 11/07/2006
| Authorized Official | LY, JEAN (PRESIDENT) |
| NPI Enumeration Date | 11/07/2006 |
Other providers sharing the same authorized official: LY, JEAN
| Provider | City | State | Total Paid |
|---|---|---|---|
| MERCY PHARMACY GROUP, INC | TORRANCE | CA | $78.42 |
| RX CONSULTANTS GROUP INC | ARTESIA | CA | $35.02 |
| Year | Claims | Total Paid |
|---|---|---|
| 2018 | 54 | $4K |
| 2019 | 82 | $6K |
| 2021 | 13 | $2K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| E0570 | Nebulizer, with compressor | 68 | 68 | $10K |
| 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 | 13 | 13 | $2K |
| A7015 | Aerosol mask, used with dme nebulizer | 68 | 68 | $97.24 |