RANDY COX, OD
NPI 1467939249, individual, Anadarko, OK, Optometrist
- Hours beyond a day in 1 month, but with up to 391 patients a month, which points to a supervising clinician on the claims rather than one person's hours.
- Records needed.
- Medicaid dollars per patient on code 99211 ($699 per patient-month) sit in the top 5% of every provider billing that code.
Hours billed per day
Medicaid billing converted into hours of hands-on care per day. The lower bound counts one unit per claim line and needs no price; the other two divide dollars by a unit price, the conservative one at 1.5 times the price. The clinician on the claim may be a supervisor under state rules, so billing organizations are counted too.
| month | what was found | hours per day, lower bound | hours per day, at price | hours per day, conservative | per working day | patients | billing organizations | codes | paid |
|---|---|---|---|---|---|---|---|---|---|
| Aug 2023 | More hours than a day holds at a conservative unit price | 1.1 | 36.3 | 24.2 | 32.6 | 391 | 1 | 99211 | $263K |
National provider registry
From the CMS NPPES Registry, refreshed daily.
| Name | RANDY COX, OD |
| Type | Individual, sole proprietor |
| Status | Active |
| NPI issued | July 24, 2018, last updated September 22, 2021 |
| Practice location | 201 E PARKER MCKENZIE DRIVE, Anadarko, OK 73005, 405-247-7945 |
| Mailing address | 1515 NE LAWRIE TATUM RD, Lawton, OK 73507-3099 |
| Specialties | Optometrist (152W00000X, license OPT-002387 AZ) Optometrist (152W00000X, primary, license 2974 OK) |
Procedures billed
The specific codes behind the dollars. Medicaid figures come from T-MSIS (2018 to 2024) and are compared with every other provider billing the same code; Medicare figures come from the 2024 physician and supplier file and compare this provider's submitted charge with what Medicare allowed, against the usual ratio for that code.
| code | what it is | paid | share | per patient-month | typical | rank among providers | |
|---|---|---|---|---|---|---|---|
| 99211 | Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional | $1.3M | 100% | $699 | $16 (top 5% from $128) | 100th percentile | |
| 99214 | Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more | $3K | 0% | $46 | $60 (top 5% from $133) | too few months to rank |
| code | what it is | services | beneficiaries | paid | submitted per service | allowed per service | charge to allowed | usual for this code |
|---|---|---|---|---|---|---|---|---|
| 92014 | Established patient complete exam of visual system | 266 | 251 | $13K | $255 | $70 | 3.6x | 1.4x (90th percentile 2.7x) |
| 92012 | Established patient problem focused exam of visual system | 194 | 148 | $7K | $112 | $46 | 2.4x | 1.6x (90th percentile 2.9x) |
| 92134 | Imaging of retina | 104 | 92 | $2K | $100 | $23 | 4.4x | 2.5x (90th percentile 4.7x) |
| 92250 | Photography of the retina | 85 | 84 | $1K | $102 | $19 | 5.3x | 2.9x (90th percentile 5.0x) |
| 92083 | Exam of visual field with extended testing | 45 | 41 | $790 | $138 | $25 | 5.6x | 2.1x (90th percentile 3.8x) |
| 92133 | Imaging of optic nerve | 16 | 15 | $236 | $102 | $20 | 5.2x | 2.7x (90th percentile 5.1x) |
A submitted charge many times the allowed amount is common and lawful; it matters when it is far above what other providers submit for the same code.
In this area
2 providers in Caddo County, OK carry an indicator in the public record, with $2.8M at stake between them. The most common is more hours than a day holds, on 2 of them.
| tier | provider | at stake | why |
|---|---|---|---|
| 4 | MARITZA ROMAN Anadarko, OK, ranked 7623 | $2.5M |
|
| 5 | AMY COHEE Anadarko, OK, ranked 10349 | $280K |
|
Recent enforcement in OK
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Referral packet
The packet is a draft for a reviewer. It reads every public record behind this case, states what the records show with a citation for each finding, names the regulation each finding relates to, and lists the ordinary explanations to rule out first. It never asserts intent.