Somerset Pediatric Specialists PLLC

Somerset Pediatric Specialists PLLC was paid $801K by Medicaid between Jan 2018 and May 2019, across 34 billing codes. Its largest line is 99213, doctor's office visit, returning patient (routine) — 41% of everything it billed.

33Billing provider infoSOMERSET PEDIATRIC SPECIALISTS PLLC
SOMERSET, KY 42503

33aNPI1902031602assigned 05/26/2009

33bProvider typePediatric Nurse Practitioner

28Total paid$801K

24GClaims27,140

24DCodes billed34

24AFirst – last monthJan 2018 – May 2019

Compared with peers

Next to other Pediatric Nurse Practitioner providers in Kentucky

Rank by total paid#4 of 27

Median peer was paid$37K

This provider vs. median22×

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
2018	19,419	$562K
2019	7,721	$239K

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
99213	Doctor's office visit, returning patient (routine)Office or other outpatient visit for the evaluation and management of an established patient, low complexity	41%	8,819	7,402	$331K
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	14%	1,928	1,784	$110K
90460	Immunization administration through 18 years of age via any route, first or only component	8.3%	2,125	1,987	$66K
87880	Infectious agent antigen detection by immunoassay; Streptococcus, group A	7.0%	3,813	3,498	$56K
99392	Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years)	5.9%	706	668	$47K
99391	Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year)	4.6%	640	593	$37K
99393	Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years)	3.7%	433	417	$30K
87804	Infectious agent antigen detection by immunoassay; Influenza, each type	3.6%	1,324	1,188	$29K
99051		3.4%	514	428	$27K
90461		2.8%	682	657	$22K
99394	Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years)	2.1%	227	218	$17K
96110	Developmental screening, with scoring and documentation, per standardized instrument	<1%	183	177	$5K

22 more codes

85025	Blood count; complete (CBC), automated, and automated differential WBC count	<1%	534	$5K
99212	Office or other outpatient visit for the evaluation and management of an established patient, straightforward	<1%	155	$4K
87807		<1%	288	$3K
96127		<1%	787	$3K
90471	Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine	<1%	123	$2K
90670		<1%	606	$1K
90633		<1%	543	$1K
90686		<1%	764	$1K
90723		<1%	389	$1K
90647		<1%	348	$754.10
90680		<1%	283	$672.11
83655		<1%	46	$621.10
90651		<1%	179	$459.20
94640	Pressurized or nonpressurized inhalation treatment for acute airway obstruction	<1%	44	$371.49
90734		<1%	126	$262.40
36416		<1%	410	$90.69
90685		<1%	27	$83.01
90620		<1%	27	$56.80
81001		<1%	29	$26.32
90715		<1%	13	$18.40
J7613	Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg	<1%	13	$1.20
90707		0%	12	$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 officialISON, JANIE (ASST. OFFICE MANAGER)