MARY DACOSTA, MD

Family Medicine Physician · ALICE, TX

Individual Active NPI 1255919965

Medicare payment data Part B · 2024

Year	Beneficiaries	Services	Submitted	Allowed	Paid
2024	49	96	$12,238	$7,666	$6,148

HCPCS	Description	Services	Avg allowed	Avg paid
99214	Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	44	$114	$89
99213	Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more	22	$87	$69

Specialty	Code	Primary	License	State
Family Medicine Physician	207Q00000X	✓	V2049	TX
Family Medicine Physician	207Q00000X		79645	MN
Student in an Organized Health Care Education/Training Program	390200000X		—	—

Source: NPPES (public domain) and CMS Medicare Physician & Other Practitioners data. Not affiliated with CMS, NPPES, or any government agency.