EDWIN FAIR CMHC

NPI: 1972764736 · PONCA CITY, OK 74601 · Community/Behavioral Health Agency · NPI assigned 06/24/2008

$188K

Total Medicaid Paid

2,671

Total Claims

1,390

Beneficiaries

Codes Billed

2018-01

First Month

2019-08

Last Month

Provider Details

Authorized Official	DANIELS, MISTY (EXECUTIVE DIRECTOR)
NPI Enumeration Date	06/24/2008

Other providers sharing the same authorized official: DANIELS, MISTY

Provider	City	State	Total Paid
EDWIN FAIR COMMUNITY MENTAL HEALTH CENTER, INC.	PONCA CITY	OK	$773K
EDWIN FAIR COMMUNITY MENTAL HEALTH CENTER, INC.	PONCA CITY	OK	$22K

Year	Claims	Total Paid
2018	1,847	$135K
2019	824	$53K

Code	Description	Claims	Beneficiaries	Total Paid
H0039	Assertive community treatment, face-to-face, per 15 minutes	1,408	449	$102K
G9002	Coordinated care fee, maintenance rate	408	380	$59K
H2017	Psychosocial rehabilitation services, per 15 minutes	547	352	$20K
H2015	Comprehensive community support services, per 15 minutes	197	126	$4K
T1017	Targeted case management, each 15 minutes	98	70	$2K
99213	Office or other outpatient visit for the evaluation and management of an established patient, low complexity	13	13	$741.86