Is Provider 1538500343 flagged for Medicaid fraud?

Provider 1538500343 (NPI: 1538500343) has not been flagged by our statistical fraud detection tests. Their billing patterns fall within normal ranges for their specialty.

How much does Provider 1538500343 bill Medicaid?

Provider 1538500343 received $0.0B in total Medicaid payments from 2018-2024, based on HHS billing records.

What is NPI 1538500343?

NPI 1538500343 is the National Provider Identifier for Provider 1538500343.. This NPI is registered with the CMS NPI Registry.

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Provider 1538500343

NPI: 1538500343Share

Active Billing Period:2018-01→2024-12(84 months)

Total Paid

$10.2M

$10,248,784

Total Claims

142K

Beneficiaries

56K

2.5 claims/patient

Avg Cost/Claim

$72

Monthly Spending Trend

Yearly Spending

2018

$1.2M

+18%

2019

$1.5M

+26%

2020

$1.8M

-47%

2021

$980K

+48%

2022

$1.4M

-2%

2023

$1.4M

+30%

2024

$1.8M

Procedure Breakdown

Cost per claim compared to national benchmarks

This provider bills for 10 distinct procedure codes. The top code (H0020 (Alcohol/drug services; methadone administration)) accounts for 64% of total spending.

ProcedureTotalYour Cost/ClaimNational Medianvs MedianPercentile

H0020Alcohol/drug services; methadone administrationSee all providers →

$6.6M

89K claims

$73.67

$18.95

3.9×

Top 25%

H0020Top 25%

Alcohol/drug services; methadone administration

$6.6M

89K claims · 64.1%

Your Cost: $73.67/claim|Median: $18.95

3.9× median

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

$2.6M

28K claims

$95.12

$74.63

1.3×

Normal range

H0004Normal range

Behavioral health counseling & therapy, per 15 min

$2.6M

28K claims · 25.6%

Your Cost: $95.12/claim|Median: $74.63

1.3× median

99211Office/outpatient visit, minimal complexitySee all providers →

$409K

18K claims

$23.23

$12.93

1.8×

Top 25%

99211Top 25%

Office/outpatient visit, minimal complexity

$409K

18K claims · 4.0%

Your Cost: $23.23/claim|Median: $12.93

1.8× median

H0001Alcohol and/or drug assessmentSee all providers →

$227K

1,383 claims

$164.37

$94.22

1.7×

Top 25%

H0001Top 25%

Alcohol and/or drug assessment

$227K

1,383 claims · 2.2%

Your Cost: $164.37/claim|Median: $94.22

1.7× median

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

$126K

2,958 claims

$42.67

$47.35

0.9×

Normal range

H0005Normal range

Alcohol and/or drug services, group counseling

$126K

2,958 claims · 1.2%

Your Cost: $42.67/claim|Median: $47.35

0.9× median

99212Office/outpatient visit, low complexitySee all providers →

$122K

2,060 claims

$59.21

$25.06

2.4×

Top 10%

99212Top 10%

Office/outpatient visit, low complexity

$122K

2,060 claims · 1.2%

Your Cost: $59.21/claim|Median: $25.06

2.4× median

99215Office/outpatient visit, high complexitySee all providers →

$99K

543 claims

$182.63

$74.09

2.5×

Top 5%

99215Top 5%

Office/outpatient visit, high complexity

$99K

543 claims · 1.0%

Your Cost: $182.63/claim|Median: $74.09

2.5× median

H0016Alcohol or drug abuse services, prenatalSee all providers →

$63K

308 claims

$203.65

$182.66

1.1×

Normal range

H0016Normal range

Alcohol or drug abuse services, prenatal

$63K

308 claims · 0.6%

Your Cost: $203.65/claim|Median: $182.66

1.1× median

W9520 See all providers →

$6K

516 claims

$11.96

$10.26

1.2×

Top 10%

W9520Top 10%

$6K

516 claims · 0.1%

Your Cost: $11.96/claim|Median: $10.26

1.2× median

99213Office/outpatient visit, est. patient, low-mod complexitySee all providers →

$5K

62 claims

$73.08

$37.81

1.9×

Top 10%

99213Top 10%

Office/outpatient visit, est. patient, low-mod complexity

$5K

62 claims · 0.0%

Your Cost: $73.08/claim|Median: $37.81

1.9× median

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