PROVIDENCE PEDIATRIC PRACTICE LLC
NPI: 1932160629
· MEDIA, PA 19063
· Pediatrics Physician
· NPI assigned 03/31/2006
$860.23
Total Medicaid Paid
Provider Details
| Authorized Official | GIBBONS, JACQUELYN (PHYSICIAN SENIOR PARTNER) |
| NPI Enumeration Date | 03/31/2006 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2021 |
81 |
$860.23 |
| 2023 |
26 |
$0.00 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
18 |
13 |
$399.96 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
18 |
18 |
$377.74 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
28 |
26 |
$82.53 |
| 90686 |
|
13 |
13 |
$0.00 |
| 99173 |
|
15 |
15 |
$0.00 |
| 92552 |
|
15 |
15 |
$0.00 |