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NPI 1992292536 · Mantachie, MS · Community/Retail Pharmacy
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Mantachie Pharmacy LLC is a community/retail pharmacy provider located in Mantachie, Mississippi. This profile covers 4 Medicare and 11 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.
Provider details (source: NPPES NPI Registry)
| Field | Value |
|---|---|
| Entity Type | Organization |
| Organization | Mantachie Pharmacy LLC |
| Address | 3309 Highway 371 N |
| City | Mantachie |
| State | MS |
| ZIP | 38855 |
| Taxonomy | Community/Retail Pharmacy |
| NPI Enumerated | April 19, 2018 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $4.1M |
| Medicare | $6.2K |
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
4 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 90694 | This code represents a vaccine product administered into the muscle to protect against four strains of influenza (flu). It is an inactivated, adjuvanted, preservative–free vaccine given as a 0.5 mL… | 40 | $80 | $3.2K |
| G0008 | Administration of influenza virus vaccine | 70 | $30 | $2K |
| 90686 | This code represents a vaccine product administered into the muscle to protect against four strains of influenza (flu). It is preservative free, uses split virus technology, and is given as a 0.5 mL… | 30 | $20 | $620 |
| G0009 | Administration of pneumococcal vaccine | 20 | $30 | $480 |
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 4 CPT/HCPCS codes.
Medicaid revenue breakdown by year and by CPT/HCPCS procedure code, including monthly billing trends and the top codes driving revenue.
View: By Year1 / 3
Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.
11 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| A9276 | Sensor; invasive (e.g., subcutaneous), disposable, for use with non-durable medical equipment interstitial continuous glucose monitoring system, one unit = 1 day supply | 3,360 | $430 | $1.5M |
| E0784 | External ambulatory infusion pump, insulin | 240 | $3,510 | $845.9K |
| A9274 | External ambulatory insulin delivery system, disposable, each, includes all supplies and accessories | 1,400 | $460 | $641.7K |
| A9277 | Transmitter; external, for use with non-durable medical equipment interstitial continuous glucose monitoring system | 1,270 | $500 | $631.2K |
| K0553 | Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service | 2,690 | $80 | $212.6K |
| A9278 | Receiver (monitor); external, for use with non-durable medical equipment interstitial continuous glucose monitoring system | 390 | $440 | $169.5K |
| A4239 | Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service | 1,620 | $50 | $82.7K |
| A4238 | Supply allowance for adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service | 430 | $140 | $59.5K |
| 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 | 50 | $30 | $1.5K |
| K0554 | Receiver (monitor), dedicated, for use with therapeutic glucose continuous monitor system | 20 | $70 | $1K |
Showing 1–10 of 11
How this provider's Medicaid billing volume and revenue compare to other Mississippi providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Mississippi median
11 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| A9276 | Sensor; invasive (e.g., subcutaneous), disposable, for use with non-durable medical equipment interstitial continuous glucose monitoring system, one unit = 1 day supply | 2 | 10 | 1,960 | $360 | $8M |
| A9277 | Transmitter; external, for use with non-durable medical equipment interstitial continuous glucose monitoring system | 2 | 10 | 1,270 | $410 | $3.9M |
| A9274 | External ambulatory insulin delivery system, disposable, each, includes all supplies and accessories | 2 | 10 | 9,610 | $390 | $3.7M |
| E0784 | External ambulatory infusion pump, insulin | 2 | 10 | 1,630 | $1,430 | $2.3M |
| A9278 | Receiver (monitor); external, for use with non-durable medical equipment interstitial continuous glucose monitoring system | 2 | 10 | 390 | $380 | $595.5K |
| A4239 | Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service | 4 | 10 | 380 | $70 | $214.7K |
| K0553 | Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service | 3 | 10 | 350 | $50 | $181.8K |
| 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 | 10 | 20 | 70 | $60 | $94.6K |
| A4238 | Supply allowance for adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service | 2 | 10 | 580 | $130 | $75.6K |
| K0554 | Receiver (monitor), dedicated, for use with therapeutic glucose continuous monitor system | 3 | 10 | 220 | $70 | $44.2K |
Showing 1–10 of 11
Other providers in the same ZIP code as Mantachie Pharmacy LLC, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Kimberly Stanley | MS | Family Nurse Practitioner | $36.3K | $0 |
| Joy Franks | MS | Nurse Practitioner | $35.1K | $0 |
| Crystal Nichols | MS | Family Nurse Practitioner | $6.5K | $0 |
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