NPI: 1982903720 · BENICIA, CA 94510 · Prosthetic/Orthotic Supplier · NPI assigned 03/18/2011
| Authorized Official | SOVAK, DALE (OWNER) |
| NPI Enumeration Date | 03/18/2011 |
| Year | Claims | Total Paid |
|---|---|---|
| 2024 | 65 | $16K |
| Code | Description | Claims | Bene. Records | Total Paid |
|---|---|---|---|---|
| A5513 | For diabetics only, multiple density insert, custom molded from model of patient's foot, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each | 25 | 25 | $10K |
| A5500 | For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe | 40 | 40 | $6K |