Is Provider 1205022159 flagged for Medicaid fraud?

Provider 1205022159 (NPI: 1205022159) has not been flagged by our statistical fraud detection tests. Their billing patterns fall within normal ranges for their specialty.

How much does Provider 1205022159 bill Medicaid?

Provider 1205022159 received $0.0B in total Medicaid payments from 2018-2024, based on HHS billing records.

What is NPI 1205022159?

NPI 1205022159 is the National Provider Identifier for Provider 1205022159.. This NPI is registered with the CMS NPI Registry.

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Provider 1205022159

NPI: 1205022159Share

Active Billing Period:2020-04→2024-12(52 months)

Total Paid

$8.3M

$8,324,584

Total Claims

161K

Beneficiaries

33K

4.9 claims/patient

Avg Cost/Claim

$52

Monthly Spending Trend

Yearly Spending

2020

$201K

+300%

2021

$804K

+164%

2022

$2.1M

+35%

2023

$2.9M

-20%

2024

$2.3M

Procedure Breakdown

Cost per claim compared to national benchmarks

This provider bills for 12 distinct procedure codes. The top code (H0012) accounts for 32% of total spending.

ProcedureTotalYour Cost/ClaimNational Medianvs MedianPercentile

H0012 See all providers →

$2.7M

36K claims

$74.38

$295.95

0.3×

Normal range

H0012Normal range

$2.7M

36K claims · 31.9%

Your Cost: $74.38/claim|Median: $295.95

0.3× median

H0004Behavioral health counseling & therapy, per 15 minSee all providers →

$1.8M

26K claims

$71.93

$74.63

1.0×

Normal range

H0004Normal range

Behavioral health counseling & therapy, per 15 min

$1.8M

26K claims · 22.1%

Your Cost: $71.93/claim|Median: $74.63

1.0× median

H0005Alcohol and/or drug services, group counselingSee all providers →

$1.6M

29K claims

$55.29

$47.35

1.2×

Normal range

H0005Normal range

Alcohol and/or drug services, group counseling

$1.6M

29K claims · 19.5%

Your Cost: $55.29/claim|Median: $47.35

1.2× median

H0031Mental health assessment by non-physicianSee all providers →

$933K

36K claims

$26.12

$96.18

0.3×

Normal range

H0031Normal range

Mental health assessment by non-physician

$933K

36K claims · 11.2%

Your Cost: $26.12/claim|Median: $96.18

0.3× median

H2035Alcohol and/or drug treatment, per hourSee all providers →

$567K

4,370 claims

$129.67

$94.63

1.4×

Normal range

H2035Normal range

Alcohol and/or drug treatment, per hour

$567K

4,370 claims · 6.8%

Your Cost: $129.67/claim|Median: $94.63

1.4× median

S9445 See all providers →

$235K

3,829 claims

$61.43

$12.72

4.8×

Top 25%

S9445Top 25%

$235K

3,829 claims · 2.8%

Your Cost: $61.43/claim|Median: $12.72

4.8× median

T1007Alcohol/drug services, treatment plan reviewSee all providers →

$158K

3,944 claims

$40.07

$64.10

0.6×

Normal range

T1007Normal range

Alcohol/drug services, treatment plan review

$158K

3,944 claims · 1.9%

Your Cost: $40.07/claim|Median: $64.10

0.6× median

H0001Alcohol and/or drug assessmentSee all providers →

$152K

2,599 claims

$58.62

$94.22

0.6×

Normal range

H0001Normal range

Alcohol and/or drug assessment

$152K

2,599 claims · 1.8%

Your Cost: $58.62/claim|Median: $94.22

0.6× median

H0016Alcohol or drug abuse services, prenatalSee all providers →

$105K

11K claims

$9.59

$182.66

0.1×

Normal range

H0016Normal range

Alcohol or drug abuse services, prenatal

$105K

11K claims · 1.3%

Your Cost: $9.59/claim|Median: $182.66

0.1× median

H0050 See all providers →

$34K

1,762 claims

$19.15

$46.71

0.4×

Normal range

H0050Normal range

$34K

1,762 claims · 0.4%

Your Cost: $19.15/claim|Median: $46.71

0.4× median

H0049 See all providers →

$16K

2,598 claims

$6.34

$9.27

0.7×

Normal range

H0049Normal range

$16K

2,598 claims · 0.2%

Your Cost: $6.34/claim|Median: $9.27

0.7× median

H0047Alcohol and/or drug abuse, not otherwise specifiedSee all providers →

4,372 claims

$0.00

$81.37

—

Normal range

H0047Normal range

Alcohol and/or drug abuse, not otherwise specified

4,372 claims · 0.0%

Your Cost: $0.00/claim|Median: $81.37

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