PUYALLUP TRIBAL OPIOID CLINIC, INC.

NPI: 1992582613 · TACOMA, WA 98421 · Substance Use Disorder Rehabilitation Clinic/Center · NPI assigned 09/14/2023

$8.01M

Total Medicaid Paid

27,051

Total Claims

3,171

Beneficiaries

Codes Billed

2024-05

First Month

2024-12

Last Month

Provider Details

Authorized Official	KERSHNER, ROBERT (MANAGER)
NPI Enumeration Date	09/14/2023

Other providers sharing the same authorized official: KERSHNER, ROBERT

Provider	City	State	Total Paid
NEW LIFE HEALTH AUTHORITY	UKIAH	CA	$3.14M
REVIVE PATHWAY	EL CAJON	CA	$1.38M

Year	Claims	Total Paid
2024	27,051	$8.01M

Code	Description	Claims	Beneficiaries	Total Paid
T1015	Clinic visit/encounter, all-inclusive	13,763	1,739	$7.74M
H0020	Alcohol and/or drug services; methadone administration and/or service (provision of the drug by a licensed program)	12,691	933	$239K
99204	Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity	169	168	$15K
90832	Psychotherapy, 30 minutes with patient	168	110	$9K
99213	Office or other outpatient visit for the evaluation and management of an established patient, low complexity	184	164	$8K
90853	Group psychotherapy (other than of a multiple-family group)	76	57	$1K