Brockport Vine Medical PC

Brockport Vine Medical PC was paid $614K by Medicaid between May 2020 and Dec 2024, across 21 billing codes. Its largest line is 99214, doctor's office visit, returning patient (more involved) — 87% of everything it billed.

33Billing provider infoBROCKPORT VINE MEDICAL PC
BROCKPORT, NY 14420

33aNPI1871144543assigned 09/24/2019

33bProvider typeInternal Medicine Physician

28Total paid$614K

24GClaims7,051

24DCodes billed21

24AFirst – last monthMay 2020 – Dec 2024

Compared with peers

Next to other Internal Medicine Physician providers in New York

Rank by total paid#401 of 6,049

Median peer was paid$11K

This provider vs. median54×

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.

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	638	$36K
2021	1,684	$132K
2022	1,683	$157K
2023	1,937	$181K
2024incomplete	1,109	$108K

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
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	87%	4,953	4,430	$535K
99213	Doctor's office visit, returning patient (routine)Office or other outpatient visit for the evaluation and management of an established patient, low complexity	6.4%	526	483	$39K
99204	Doctor's office visit, new patient (more involved)Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity	1.4%	62	62	$9K
90756		<1%	189	189	$5K
94010		<1%	161	161	$4K
90471	Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine	<1%	316	315	$4K
96372	Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular	<1%	220	207	$3K
99395	Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years	<1%	29	29	$3K
87426	Infectious agent antigen detection, SARS-CoV-2 (COVID-19)	<1%	55	54	$2K
99396	Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years	<1%	19	19	$2K
0011A		<1%	32	32	$1K
99402		<1%	36	27	$1K

9 more codes

90661		<1%	33	$1K
0012A		<1%	27	$1K
90688		<1%	52	$973.89
96127		<1%	180	$837.67
0064A		<1%	12	$492.78
93000		<1%	21	$298.61
80305		<1%	28	$202.53
J3420	Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg	<1%	78	$153.86
99072		0%	22	$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 officialFAHOURY, ALEX (OWNER)