Clinic
Summit Medical Group PA
Summit Medical Group PA was paid $6.74M by Medicaid between Jan 2018 and Dec 2024, across 142 billing codes. Its largest line is 99214, doctor's office visit, returning patient (more involved) — 22% of everything it billed.
33Billing provider infoSUMMIT MEDICAL GROUP PA
BERKELEY HEIGHTS, NJ 07922
BERKELEY HEIGHTS, NJ 07922
33aNPI1942254347assigned 05/20/2006
33bProvider typeMulti-Specialty Clinic/Center
28Total paid$6.74M
24GClaims335,132
24DCodes billed142
24AFirst – last monthJan 2018 – Dec 2024
Compared with peers
Next to other Multi-Specialty Clinic/Center providers in New Jersey
Rank by total paid#2 of 27
Median peer was paid$554K
This provider vs. median12×
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.
Auditor's notes
Automated statistical signals. Not evidence of fraud — how these are computed.
Entity ProliferationAuthorized official HENRY, SWAHILI controls 15+ related entities in our dataset. Read more
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 | 1,590 | $30K | |
| 2019 | 825 | $28K | |
| 2020 | 885 | $27K | |
| 2021 | 24,518 | $1.05M | |
| 2022 | 115,919 | $2.00M | |
| 2023 | 89,901 | $2.08M | |
| 2024incomplete | 101,494 | $1.52M |
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 | 22% | 31,145 | 27,693 | $1.51M |
| U0003 | Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high throughput technologies as described by cms-2020-01-r | 17% | 17,536 | 17,250 | $1.13M |
| 99213 | Doctor's office visit, returning patient (routine)Office or other outpatient visit for the evaluation and management of an established patient, low complexity | 17% | 33,085 | 29,177 | $1.12M |
| 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 | 6.9% | 4,711 | 4,405 | $465K |
| U0005 | Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, cdc or non-cdc, making use of high throughput technologies, completed within 2 calendar days from date of specimen collection (list separately in addition to either hcpcs code u0003 or u0004) as described by cms-2020-01-r2 | 4.6% | 14,570 | 14,389 | $311K |
| 76857 | 4.2% | 8,345 | 7,350 | $282K | |
| 87491 | Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe | 3.5% | 15,252 | 14,925 | $233K |
| 76775 | 2.2% | 2,835 | 2,530 | $151K | |
| 88120 | 2.2% | 1,800 | 1,347 | $151K | |
| 87591 | Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe | 1.9% | 15,230 | 14,902 | $125K |
| 99203 | Doctor's office visit, new patient (routine)Office or other outpatient visit for the evaluation and management of a new patient, low complexity | 1.7% | 1,704 | 1,611 | $113K |
| 87661 | Infectious agent detection by nucleic acid; Trichomonas vaginalis, amplified probe | 1.6% | 10,261 | 10,137 | $109K |
130 more codes
| 51798 | 1.2% | 7,960 | $83K | |
| G6015 | Intensity modulated treatment delivery, single or multiple fields/arcs,via narrow spatially and temporally modulated beams, binary, dynamic mlc, per treatment session | 1.1% | 934 | $74K |
| 87389 | Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies | <1% | 8,545 | $67K |
| 76872 | <1% | 1,185 | $63K | |
| 87340 | <1% | 9,536 | $62K | |
| 51741 | <1% | 4,187 | $61K | |
| 86803 | <1% | 9,487 | $60K | |
| 87070 | <1% | 19,421 | $50K | |
| 86780 | <1% | 9,114 | $48K | |
| 87631 | <1% | 2,678 | $46K | |
| 99232 | Hospital visit by a doctor, follow-up day | <1% | 2,799 | $37K |
| 52000 | <1% | 287 | $34K | |
| 87088 | <1% | 10,802 | $28K | |
| 87086 | Culture, bacterial; quantitative colony count, urine | <1% | 10,215 | $28K |
| 99212 | Office or other outpatient visit for the evaluation and management of an established patient, straightforward | <1% | 1,142 | $27K |
| 87510 | <1% | 2,905 | $27K | |
| 77014 | <1% | 913 | $26K | |
| 87660 | <1% | 2,661 | $24K | |
| 86480 | <1% | 813 | $20K | |
| 87480 | <1% | 2,907 | $14K | |
| 86696 | <1% | 1,222 | $10K | |
| 76705 | Ultrasound, abdominal, real time with image documentation; limited | <1% | 139 | $10K |
| 36415 | Collection of venous blood by venipuncture | <1% | 8,418 | $10K |
| 51701 | <1% | 424 | $9K | |
| 87077 | <1% | 3,139 | $9K | |
| 99223 | Prolong inpt eval add15 m | <1% | 150 | $8K |
| 87186 | <1% | 3,404 | $8K | |
| 87635 | Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe | <1% | 958 | $8K |
| 88108 | <1% | 2,503 | $7K | |
| 51728 | <1% | 85 | $6K | |
| 52281 | <1% | 50 | $6K | |
| 87426 | Infectious agent antigen detection, SARS-CoV-2 (COVID-19) | <1% | 209 | $5K |
| 84153 | <1% | 4,139 | $5K | |
| 99231 | Subsequent hospital care, per day, straightforward or low complexity | <1% | 611 | $5K |
| 95813 | <1% | 56 | $5K | |
| 81003 | <1% | 15,132 | $4K | |
| 99222 | Initial hospital care, per day, moderate complexity | <1% | 171 | $4K |
| 87428 | <1% | 191 | $3K | |
| 86695 | <1% | 1,225 | $3K | |
| 99291 | Critical care, evaluation and management of the critically ill patient, first 30-74 minutes | <1% | 25 | $3K |
| 76770 | <1% | 143 | $3K | |
| 80053 | Comprehensive metabolic panel | <1% | 1,964 | $2K |
| 52315 | <1% | 91 | $2K | |
| 86706 | <1% | 313 | $2K | |
| 84403 | <1% | 741 | $1K | |
| 86762 | <1% | 305 | $1K | |
| 76856 | Ultrasound, pelvic (nonobstetric), real time with image documentation; complete | <1% | 123 | $1K |
| 51700 | <1% | 20 | $1K | |
| 87205 | <1% | 623 | $1K | |
| 86765 | <1% | 283 | $1K | |
| 96372 | Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular | <1% | 91 | $1K |
| 99215 | Doctor's office visit, returning patient (complex) | <1% | 68 | $988.14 |
| 84154 | <1% | 977 | $972.23 | |
| 85025 | Blood count; complete (CBC), automated, and automated differential WBC count | <1% | 2,056 | $959.71 |
| 99308 | Subsequent nursing facility care, per day, straightforward | <1% | 271 | $930.10 |
| 84702 | <1% | 154 | $923.30 | |
| 77067 | Screening mammography, bilateral, including computer-aided detection | <1% | 67 | $911.00 |
| 86769 | <1% | 67 | $900.64 | |
| 83036 | Hemoglobin; glycosylated (A1C) | <1% | 742 | $841.09 |
| 70551 | Magnetic resonance imaging, brain; without contrast material | <1% | 14 | $840.62 |
| 84270 | <1% | 438 | $813.22 | |
| 86735 | <1% | 294 | $775.76 | |
| 84443 | Thyroid stimulating hormone (TSH) | <1% | 800 | $765.27 |
| 86592 | <1% | 322 | $751.22 | |
| 93306 | Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete | <1% | 53 | $726.03 |
| 80061 | Lipid panel | <1% | 846 | $614.65 |
| 77063 | Screening digital breast tomosynthesis, bilateral | <1% | 51 | $573.83 |
| 82306 | Vitamin D; 25 hydroxy, includes fraction(s), if performed | <1% | 184 | $540.50 |
| 87147 | <1% | 1,056 | $458.73 | |
| 99233 | Hospital visit by a doctor, follow-up day (complex) | <1% | 45 | $447.53 |
| 86787 | <1% | 146 | $380.77 | |
| 80048 | Basic metabolic panel (calcium, ionized) | <1% | 431 | $377.50 |
| 71045 | Radiologic examination, chest; single view | <1% | 173 | $375.06 |
| 93000 | <1% | 116 | $331.03 | |
| 87481 | <1% | 25 | $315.75 | |
| 83550 | <1% | 161 | $307.52 | |
| 81002 | <1% | 1,195 | $302.01 | |
| 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) | <1% | 280 | $290.99 |
| 87880 | Infectious agent antigen detection by immunoassay; Streptococcus, group A | <1% | 84 | $290.40 |
| 76700 | Ultrasound, abdominal, real time with image documentation; complete | <1% | 16 | $290.25 |
| 83540 | <1% | 166 | $272.62 | |
| 87511 | <1% | 25 | $263.25 | |
| 82728 | <1% | 184 | $248.01 | |
| 71046 | Radiologic examination, chest; 2 views | <1% | 82 | $231.33 |
| 86618 | <1% | 31 | $204.36 | |
| 76642 | <1% | 12 | $180.26 | |
| G0279 | Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066) | <1% | 13 | $173.61 |
| 82040 | <1% | 389 | $171.39 | |
| 82607 | <1% | 129 | $148.04 | |
| 81001 | <1% | 539 | $147.61 | |
| 82565 | <1% | 223 | $132.96 | |
| 80076 | <1% | 56 | $125.26 | |
| 70450 | Computed tomography, head or brain; without contrast material | <1% | 12 | $115.14 |
| 82570 | <1% | 122 | $112.60 | |
| 84520 | <1% | 219 | $107.99 | |
| 84439 | <1% | 99 | $91.17 | |
| 82746 | <1% | 75 | $84.91 | |
| 87324 | <1% | 17 | $75.92 | |
| 86593 | <1% | 40 | $70.50 | |
| 82043 | <1% | 92 | $70.14 | |
| J1580 | Injection, garamycin, gentamicin, up to 80 mg | <1% | 114 | $63.50 |
| 84550 | <1% | 49 | $60.86 | |
| 87449 | <1% | 17 | $51.58 | |
| 86140 | <1% | 86 | $44.47 | |
| 86038 | <1% | 41 | $42.00 | |
| 83002 | <1% | 19 | $34.00 | |
| 83735 | <1% | 51 | $33.18 | |
| 31231 | <1% | 16 | $30.00 | |
| 83690 | <1% | 16 | $29.05 | |
| 85652 | <1% | 81 | $26.67 | |
| 85027 | <1% | 25 | $18.98 | |
| 20610 | <1% | 22 | $16.58 | |
| 84100 | <1% | 34 | $8.72 | |
| 85610 | <1% | 32 | $7.38 | |
| 85730 | <1% | 12 | $6.01 | |
| 83014 | <1% | 25 | $1.57 | |
| 3074F | 0% | 670 | $0.00 | |
| 1036F | 0% | 2,236 | $0.00 | |
| 3044F | 0% | 159 | $0.00 | |
| 3008F | 0% | 748 | $0.00 | |
| 3079F | 0% | 139 | $0.00 | |
| 1101F | 0% | 58 | $0.00 | |
| 99429 | 0% | 957 | $0.00 | |
| 1160F | 0% | 1,040 | $0.00 | |
| 3725F | 0% | 675 | $0.00 | |
| 99080 | 0% | 133 | $0.00 | |
| 1159F | 0% | 1,024 | $0.00 | |
| 3288F | 0% | 440 | $0.00 | |
| 3078F | 0% | 554 | $0.00 | |
| S9083 | Global fee urgent care centers | 0% | 89 | $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 officialHENRY, SWAHILI (DIRECTOR PROVIDER ENROLLMENT)
| Provider | Location | Paid |
|---|---|---|
| City Medical of Upper East Side, PLLC | New York, NY | $643.18M |
| Westchester Medical Group, P.C. | Rye Brook, NY | $16.09M |
| City Medical of Upper East Side, PLLC | New York, NY | $260K |
| City Medical of Upper East Side, PLLC | Deer Park, NY | $90K |
| City Medical of Upper East Side, PLLC | Bay Shore, NY | $89K |
| City Medical of Upper East Side, PLLC | Sayville, NY | $81K |
| City Medical of Upper East Side, PLLC | Selden, NY | $80K |
| City Medical of Upper East Side, PLLC | Ronkonkoma, NY | $62K |
| City Medical of Upper East Side, PLLC | Port Jefferson Station, NY | $61K |
| City Medical of Upper East Side, PLLC | Rocky Point, NY | $47K |
| City Medical of Upper East Side, PLLC | Riverhead, NY | $44K |
| City Medical of Upper East Side, PLLC | Brooklyn, NY | $41K |
| City Medical of Upper East Side, PLLC | Smithtown, NY | $14K |
| City Medical of Upper East Side, PLLC | Plainview, NY | $7K |
| Summit Medical Group PA | Berkeley Heights, NJ | $5K |
Matched on the authorized-official name exactly as entered in NPPES. A common name can match unrelated people.