Medicaid Provider Spending

$1.09 trillion in Medicaid claims data, 2018–2024 · 617K+ providers

GRACE SOUTHERN MEDICAL CLINIC, PLLC

NPI: 1821486358 · DALLAS, TX 75228 · Primary Care Clinic/Center · NPI assigned 01/07/2015

$235K
Total Medicaid Paid
10,124
Total Claims
9,342
Beneficiaries
17
Codes Billed
2018-01
First Month
2024-11
Last Month

Provider Details

Authorized OfficialCALIXTO-MONTANEZ, SERGIO (MEMBER)
NPI Enumeration Date01/07/2015

Monthly Spending Trend

Yearly Breakdown

YearClaimsTotal Paid
2018 303 $4K
2019 163 $3K
2020 1,725 $26K
2021 2,353 $58K
2022 2,325 $57K
2023 1,891 $53K
2024 1,364 $35K

Billing Codes

CodeDescriptionClaimsBeneficiariesTotal Paid
99214 Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity 4,901 4,456 $154K
99213 Office or other outpatient visit for the evaluation and management of an established patient, low complexity 2,086 1,952 $64K
90471 Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine 772 753 $7K
99211 Office or other outpatient visit for the evaluation and management of an established patient, minimal severity 286 252 $3K
90688 352 342 $2K
87426 Infectious agent antigen detection, SARS-CoV-2 (COVID-19) 47 44 $2K
90686 358 346 $1K
99396 Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years 18 15 $992.81
90656 34 34 $593.98
87880 Infectious agent antigen detection by immunoassay; Streptococcus, group A 13 13 $180.57
G2211 Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient's single, serious condition or a complex condition. (add-on code, list separately in addition to office/outpatient evaluation and management visit, new or established) 299 267 $64.74
96127 47 46 $5.66
3078F 63 53 $0.00
99457 140 139 $0.00
99454 13 13 $0.00
3044F 655 577 $0.00
G0008 Administration of influenza virus vaccine 40 40 $0.00