Support Your Metabolism with Clinically-Studied Ingredients

Mitolyn — 6 plant-based nutrients to boost mitochondrial health, energy & natural fat burning.

★★★★★ 127,000+ customers · 90-day money-back guarantee

Manhouly Phouthachack

Family Bristol, CT Female

NPI: 1295965481

Medicare Patients

574

Medicare Billing

$25,013

Medicare Billing by Year

Year	Procedures	Beneficiaries	Services	Submitted	Medicare Paid
2023	5	109	113	$12,032	$5,911
2022	5	130	130	$9,923	$5,801
2021	6	247	247	$22,074	$10,830
2020	3	88	88	$3,166	$2,472

Total Patients

574

Total Services

578

Medicare Billing

$25,013

Procedure Codes

All Medicare Procedures & Services

19 procedure records from CMS Medicare Utilization

HCPCS	Description	Setting	Year	Patients	Services	Charges	Medicare Paid	Ratio
99203	New patient office or other outpatient visit, 30-44 minutes	Office	2023	23	23	$3,347	$1,789	53.5%
99213	Established patient office or other outpatient visit, 20-29 minutes	Office	2023	22	23	$3,197	$1,248	39.0%
90694	Influenza vaccine, quadrivalent inactivated, 0.5 ml dosage	Office	2023	18	18	$1,242	$1,217	98.0%
87426	Detection test by immunoassay technique for severe acute respiratory syndrome coronavirus	Office	2023	27	30	$3,600	$1,039	28.9%
G0008	Administration of influenza virus vaccine	Office	2023	19	19	$646.00	$617.50	95.6%
90662	Influenza vaccine split virus, preservative free	Office	2022	32	32	$2,187	$2,144	98.0%
87426	Detection test by immunoassay technique for severe acute respiratory syndrome coronavirus	Office	2022	35	35	$4,200	$1,221	29.1%
G0008	Administration of influenza virus vaccine	Office	2022	37	37	$962.00	$943.28	98.1%
99202	New patient office or other outpatient visit, 15-29 minutes	Office	2022	12	12	$1,188	$787.23	66.3%
99212	Established patient office or other outpatient visit, 10-19 minutes	Office	2022	14	14	$1,386	$705.39	50.9%
99202	New patient outpatient visit, total time 15-29 minutes	Office	2021	53	53	$5,247	$3,439	65.6%
87426	Elisa detection of severe acute respiratory syndrome coronavirus 2 (covid-19) antigen	Office	2021	90	90	$10,800	$3,180	29.4%
99212	Established patient outpatient visit, total time 10-19 minutes	Office	2021	31	31	$2,919	$1,601	54.9%
90662	Vaccine for influenza for injection into muscle, split virus, preservation free	Office	2021	24	24	$1,152	$1,152	100.0%
0064A	Fee covid-19 vac 7 res	Office	2021	22	22	$1,254	$957.00	76.3%
G0008	Administration of influenza virus vaccine	Office	2021	27	27	$702.00	$500.31	71.3%
90662	Vaccine for influenza for injection into muscle	Office	2020	30	30	$1,320	$1,320	100.0%
G0008	Administration of influenza virus vaccine	Office	2020	32	32	$832.00	$586.56	70.5%
99211	Established patient office or other outpatient visit, typically 5 minutes	Office	2020	26	26	$1,014	$564.98	55.7%

About Manhouly Phouthachack

Manhouly Phouthachack is a Family healthcare provider based in Bristol, Connecticut. This provider has been registered with the National Plan and Provider Enumeration System (NPPES) since 07/22/2009. The National Provider Identifier (NPI) number assigned to this provider is 1295965481.

As a Medicare-enrolled provider, Phouthachack has provided services to 574 Medicare beneficiaries, totaling 578 services with total Medicare billing of $25,013. Data is available for 4 years (2020–2023), covering 19 distinct procedure/service records.

16,000 Woodworking Plans

Step-by-step blueprints for any project. Beginner to expert.

Detailed schematics Cutting lists & materials Lifetime access — $67

★★★★★ 60-day guarantee

Get Instant Access

Practice Information

Specialty Family
Location Bristol, CT
Active Since 07/22/2009
Last Updated 05/16/2025
Taxonomy Code 363LF0000X
Entity Type Individual
NPI Number 1295965481

Explore

Data Sources

Provider data from NPPES. Payment data from CMS Open Payments. Medicare data from CMS Medicare Provider Utilization. All data is public and updated periodically.