OSAGE NATION SI-SI A-PE-TXA
NPI: 1902272826
· PAWHUSKA, OK 74056
· Dental Clinic/Center
· NPI assigned 08/14/2015
$995.80
Total Medicaid Paid
Provider Details
| Authorized Official | HUDGINS, HARRISON (BUSINESS OFFICE MANAGER) |
| NPI Enumeration Date | 08/14/2015 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
13 |
$995.80 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| G0467 |
Federally qualified health center (fqhc) visit, established patient; a medically-necessary, face-to-face encounter (one-on-one) between an established patient and a fqhc practitioner during which time one or more fqhc services are rendered and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving a fqhc visit |
13 |
12 |
$995.80 |