Why are Medicare and Medicaid shown separately instead of combined?

They come from two different CMS data sources with no shared claim identifier, so they can't be reconciled into one number without double-counting or guessing. Every table and chart on this page keeps them fully separate.

Why is there no private/commercial revenue figure?

Private and commercial payer data comes from Transparency in Coverage files, which only publish negotiated rates — not claims or utilization volume. Without a volume figure, no revenue number can be computed for any provider from that data.

What does "Rank" mean in the Competitive Analysis & Benchmarks tables?

For a given CPT/HCPCS code, it's this provider's position by claims volume among all providers billing that same code at that geography level (State, National, or Virginia for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to Virginia only?

Medicaid is administered per-state with no single national fee schedule, so a state or national comparison the way Medicare has one isn't available. Virginia (this provider's own state) is the only grouping that's conceptually meaningful.

Why are the numbers rounded to the nearest 10?

To avoid implying more precision than the underlying data supports at a single-provider level. Ratios are kept precise since they're a relative comparison, not a volume or dollar figure.

How current is this data?

The Medicare and Medicaid tables are both single current snapshots, not refreshed on a recurring schedule yet.

Privia Medical Group, LLC (NPI 1013042480)

Key Findings

Field	Value
Entity Type	Organization
Organization	Privia Medical Group, LLC
Address	950 N Glebe Rd Ste 700
City	Arlington
State	VA
ZIP	22203
Taxonomy	Internal Medicine Physician
NPI Enumerated	February 23, 2007

Payer Source	Total Paid
Medicaid	$81.2M
Medicare	$0

This entity reports no Medicare billing on file and $81.2M in lifetime Medicaid revenue, making its public claims footprint effectively single-payer in the available data. The absence of Medicare activity alongside sizable Medicaid revenue suggests the provider’s billed population and revenue exposure are concentrated in Medicaid programs rather than dual-eligible or fee-for-service Medicare lines.

Revenue is highly concentrated in a small set of outpatient evaluation-and-management and preventive codes: the precomputed top three Medicaid codes account for 77.5% of the provider’s Medicaid revenue, driven by 99214 (38.1% of Medicaid revenue), 99213 (37.2% of Medicaid revenue), and 99392 (2.2% of Medicaid revenue). This concentration indicates the business is primarily ambulatory care with very large volumes of established-patient visits and periodic preventive encounters.

The code mix (dominant revenue from 99214 and 99213) points to a high-volume primary care/internal medicine operation focused on office/outpatient evaluation and management. 99214 and 99213 describe moderate-to-low complexity established-patient office visits, which together generate the vast majority of reported Medicaid revenue and reflect a practice model centered on repeat outpatient management rather than specialty procedural revenue.

Competitive standing for core E/M services is statewide-dominant: 99213 ranks #1 of 4012 providers in-state (100th percentile; extreme outlier, far above typical state volume for this code) and 99214 ranks #2 of 3523 providers in-state (100th percentile; extreme outlier). Those rank positions indicate this provider is an outlier on volume for routine office visits compared with in-state peers and is one of the largest Medicaid E/M billers in Virginia.

Preventive care and well-visit services are also unusually large across age groups: 99392 ($1.5M, ranks #5 of 646, 99th percentile; extreme outlier), 99393 ($1.1M, ranks #2 of 627, 100th percentile; extreme outlier), 99395 ($763K, ranks #1 of 197, 100th percentile; extreme outlier), 99396 ($742.7K, ranks #1 of 129, 100th percentile; extreme outlier), and 99394 ($643.9K, ranks #2 of 428, 100th percentile; extreme outlier). This pattern shows the provider delivers a broad, high-volume preventive medicine program spanning pediatrics through adult well visits in Medicaid.

Obstetric and ultrasound imaging codes are a meaningful secondary revenue stream and often appear as top statewide volumes: 76819 ($925.6K, ranks #1 of 65, 100th percentile; extreme outlier), 76830 ($798.3K, ranks #1 of 206, 100th percentile; extreme outlier), 76820 ($483.2K, ranks #1 of 43, 100th percentile; extreme outlier), and 76805 ($742.7K, ranks #2 of 145, 99th percentile; extreme outlier). These procedure-level revenues indicate substantial maternal-fetal imaging activity embedded in the practice or its network of sites.

The provider reports extremely high claim volumes for several low-unit-value or testing codes that reflect operational scale and recurring workflows: 3074F shows 199.7K claims at $2 avg paid/claim for $399.3K revenue (ranks #1 of 184, 100th percentile; extreme outlier), and 87880 shows 37.1K claims/$482.9K (0.7% of revenue, ranks #6 of 915, 99th percentile; extreme outlier). Pandemic-era and infectious disease testing also appear: U0003 ($1.2M, ranks #13 of 111, 89th percentile; typical, unremarkable), 87428 ($636.7K, ranks #2 of 195, 99th percentile; notably above typical), and 87426 ($468.6K, ranks #14 of 343, 96th percentile; typical, unremarkable).

The provider’s NPI tenure (enumerated 2007-02-23, ~19 years ago) coupled with repeated #1/#2 statewide rankings across multiple high-volume codes indicates an established operation with persistent scale in Medicaid primary care, preventive services, and select procedural lines. For payer/provider analysts, this profile suggests an entrenched Medicaid-focused delivery footprint that could influence network capacity and utilization benchmarks for E/M and outpatient maternal/diagnostic services in the region.

Medicaid: Complete Services Breakdown

Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.

389 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
99214	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the…	378,890	$70	$26.5M
99213	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the…	446,860	$60	$25.9M
99392	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	16,810	$90	$1.5M
99391	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	14,800	$90	$1.3M
U0003	Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high…	15,330	$80	$1.2M
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	11,800	$90	$1.1M
76819	The provider performs a biophysical profile test to measure the health of the baby during pregnancy using only ultrasound and not a nonstress test.	13,410	$70	$925.6K
99215	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the…	9,390	$90	$826.4K
76816	The provider reexamines the fetus to follow up on a prior abnormal transabdominal ultrasound.	9,060	$90	$815.7K
76830	The provider performs a transvaginal ultrasound to assess the reproductive organs, that is, the uterus, fallopian tubes, ovaries, cervix, and vagina in a female patient.	7,980	$100	$798.3K

Showing 1–10 of 389

Medicaid: Competitive Analysis & Benchmarks

How this provider's Medicaid billing volume and revenue compare to other Virginia providers billing the same CPT/HCPCS codes.

Claims Volume vs. Virginia Distribution

Privia Medical Group, LLC — 21 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Virginia

Full comparison — all codes billed, vs. Virginia median

389 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
80307	The lab analyst performs presumptive drug test(s) via instrumented chemistry analyzers to screen for any number of drug classes on a single date.	153	170	3,790	$40	$415.2K
97110	Therapeutic exercise is a form of physical therapy that utilizes specially designed exercises and activities to help patients gain better mobility and fitness levels. Normally used on patients with…	148	400	1,910	$50	$412.6K
97530	The provider uses various activities during direct contact with the patient to improve the patient’s functional performance. Use this code for each 15 minutes of activity.	262	400	2,060	$60	$407.3K
93306	The provider uses transducers to obtain two–dimensional (2D) images of the heart structures through the chest wall. He evaluates the anatomy and function of all four heart chambers, valves, adjacent…	19	210	920	$140	$367.6K
U0003	Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high…	13	110	1,150	$40	$331.1K
0241U	N/A	53	90	1,840	$80	$306.3K
99214	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the…	2	3,520	370	$70	$280.7K
90837	In this service, the provider performs psychotherapy, a series of technique for treating the psychiatric disorders of the patient. The treatment session typically lasts for a minimum of 53 minutes or…	1,096	1,340	710	$90	$245K
59025	In this procedure, the provider measures the fetal heart rate of the fetus in response to its own movements.	74	130	340	$110	$210.5K
78452	In this procedure, the provider performs multiple SPECT studies of the heart to determine the areas of deficient blood flow. The goal of the procedure is to determine areas that have deficient blood…	17	100	160	$470	$207K

Showing 1–10 of 389

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Columbus Radiology Corp	OH	Diagnostic Radiology Physician	$0	$49.9M
Robert Brennan	VA	Infectious Disease Physician	$15.9M	$0
Adebowale Prest	MD	Family Medicine Physician	$2.8M	$0
Bluestone Health Association, Inc.	WV	Federally Qualified Health Center (FQHC)	$0	$1.9M
Enrico Giangeruso	VA	Anatomic Pathology & Clinical Pathology Physician	$1.4M	$0
Glenda Mccarter	MD	Nurse Practitioner	$1.3M	$0
Marilyn Chengot	NY	Cardiovascular Disease Physician	$909.9K	$15.1K
Nizar Eskandar	GA	Nephrology Physician	$899.7K	$0
Scott Rojas	FL	Infectious Disease Physician	$806K	$0
Momodu Jack	DC	Gastroenterology Physician	$25K	$759K

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
National Capital Treatment And Recovery	VA	Substance Abuse Rehabilitation Facility	$0	$80.2M
Pearl Healthcare Inc	VA	Home Health Agency	$0	$6.2M
Lindsay Smithen	VA	Ophthalmology Physician	$264.3K	$13.8K
Assaf Gordon	VA	Interventional Pain Medicine Physician	$256.5K	$0
Diane Hendel	VA	Family Nurse Practitioner	$148.7K	$0
Rajesh Bhojwani	VA	Diagnostic Radiology Physician	$120.3K	$0
Lillian Hunt	VA	Internal Medicine Physician	$99.6K	$0
Shirley Frimpong	VA	Family Nurse Practitioner	$85K	$0
Maria Kiely	VA	Surgery Physician	$20.6K	$0

Privia Medical Group, LLC — Billing Profile & Reimbursement Data

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Privia Medical Group, LLC — Billing Profile & Reimbursement Data

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Key Findings

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References