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 Montana for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to Montana 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. Montana (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.

Michael Groover (NPI 1023455748)

Field	Value
Entity Type	Individual
Organization	Michael Groover
Address	2900 12th Ave N Ste 140w
City	Billings
State	MT
ZIP	59101
Taxonomy	Adult Reconstructive Orthopaedic Surgery Physician
NPI Enumerated	June 4, 2013

Payer Source	Total Paid
Medicare	$370.4K
Medicaid	$0

Key Findings

This provider’s Medicare billing is concentrated in large-joint arthroplasty: the three highest-revenue codes are 27447, 27130, and 27487, which together account for 80.8% of the provider’s total Medicare revenue. Individually those codes generated $171.9K (27447), $95.7K (27130), and $31.7K (27487), signaling a surgical practice focused on primary knee and hip replacement plus knee revision.

Top-line Medicare revenue is $370.4K while there is no Medicaid billing on file, so the provider is effectively a single-payer (Medicare) biller in the available data. This concentration of payers increases exposure to Medicare coverage and reimbursement dynamics since there is $0 reported from Medicaid.

27447 (total knee arthroplasty) is an extreme statistical outlier: the provider billed 169 claims for 27447 with an average paid per claim of $1017 and ranks #178 of 12089 providers nationally (98th percentile; extreme outlier). That national standing indicates unusually high volume for knee replacement relative to peers and identifies the provider as a high-volume knee arthroplasty surgeon on a national scale.

27130 (total hip arthroplasty) likewise shows elevated volume: 94 claims with an average paid per claim of $1018 and $95.7K revenue, ranking #273 of 8062 providers nationally (96th percentile; notably above typical national volume). This reinforces that hip replacement is a second major revenue stream and that the provider’s practice draws above-typical national procedure volumes for large-joint arthroplasty.

27487 (revision knee arthroplasty) appears at more typical volumes for revision work: 23 claims, $1378 avg paid/claim and $31.7K revenue, ranking #39 of 361 providers nationally (88th percentile; typical, unremarkable volume). The presence of revision arthroplasty billing indicates management of complex joint cases, but the relative revenue and rank suggest revision work is a smaller, complementary component of the practice compared with primary arthroplasty.

Office-based E/M and imaging are meaningful but secondary revenue contributors: 99214 appears with 249 claims, $95 avg paid/claim and $23.7K revenue (6.4% of Medicare revenue), while 99213 and multiple knee/hip X-ray codes (73562, 73564, 73502) together support routine pre/post-operative evaluation and imaging. These non-procedural codes indicate the provider maintains outpatient clinic activity for evaluation, follow-up and imaging that complements the surgical volume.

The provider’s NPI was enumerated on 2013-06-04 (~13 years ago), indicating an established billing history in Medicare over roughly a decade-plus window. This tenure, combined with high national ranks for primary arthroplasty, is consistent with an experienced adult reconstructive orthopaedic surgery practice entrenched in joint replacement referrals.

From a business and operational perspective, the billing mix—high-revenue primary knee and hip arthroplasty codes concentrated into 80.8% of Medicare revenue—signals that practice financial performance is tightly coupled to surgical volume for large-joint replacements. Given the absence of Medicaid revenue, the provider’s revenue base is concentrated by both procedure type and payer, which suggests sensitivity to changes in Medicare policy, local referral patterns, and surgical throughput rather than diversification across payers or service lines.

Medicare: Complete Services Breakdown

The CPT/HCPCS codes generating the most Medicare revenue for this provider.

16 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
27447	In this procedure, the provider replaces the damaged weight bearing surfaces of both the medial and lateral compartments in the knee joint using implants of metal or other strong materials. The…	170	$1,020	$171.9K
27130	In this procedure, the provider surgically replaces the hip joint by prosthesis, or artificial hip joint. He replaces both the femoral and acetabular components with or without using an autograft or…	90	$1,020	$95.7K
27487	In this procedure, the provider performs revision arthroplasty of the knee joint. She revises both the femoral and tibial components. She may or may not use an allograft to perform this procedure.…	20	$1,380	$31.7K
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…	250	$100	$23.7K
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…	130	$70	$9K
27430	In this procedure, the provider performs a surgical procedure on the quadriceps femoris muscle to release adhesions and improve mobility. The aim is to improve the range of the bending motion at the…	30	$310	$8K
99204	The provider sees a new 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 provider…	60	$110	$6.6K
73562	In this procedure, the provider takes three X–ray images of a patient’s knee joint to check for any fracture, swelling, or reason for pain in the knee area.	190	$30	$6K
73502	In this diagnostic procedure, the provider takes X–ray images of one hip, either left or right, from two or three projections (directions or angles) to check for any fracture, swelling, or other…	140	$30	$4.9K
73564	In this procedure, the provider takes four or more X–ray views of the knee joint to check for any fracture, swelling, or reason for pain in the knee area.	130	$40	$4.5K

Showing 1–10 of 16

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 16 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Montana Distribution

Michael Groover — 4 of 16 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Montana

Full comparison — all codes billed, vs. state median

16 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
27447	4	80	40	$1,080	$60.6K
27130	2	50	40	$1,150	$54.1K
27487	1	10	20	$820	$14.8K
99214	400	1,810	100	$70	$12.4K
99213	602	1,730	90	$50	$7.2K
99204	182	780	30	$100	$4.8K
27430	1	10	20	$190	$4.4K
20610	86	210	40	$40	$3.3K
99203	405	700	30	$70	$3.1K
73564	27	120	60	$20	$1.8K

Showing 1–10 of 16

Related Providers

Other providers that share a Tax Identification Number (TIN) with Michael Groover, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Nathan Steinle	CA	Retina Specialist (Ophthalmology) Physician	$9.5M	$0
Prema Abraham	SD	Retina Specialist (Ophthalmology) Physician	$7.1M	$0
Kyle Thompson	ID	Retina Specialist (Ophthalmology) Physician	$4.5M	$0
Douglas Holmes	WY	Retina Specialist (Ophthalmology) Physician	$4.1M	$0
Mitchell Goff	UT	Retina Specialist (Ophthalmology) Physician	$3.8M	$0
Richard Kinsey	TN	Anatomic Pathology & Clinical Pathology Physician	$3.3M	$147.3K
Brendan Girschek	AZ	Ophthalmology Physician	$3.2M	$0
John Bormes	SD	Ophthalmology Physician	$2.6M	$0
John Purviance	WY	Radiation Oncology Physician	$2.5M	$0
Cary Chisholm	TX	Anatomic Pathology & Clinical Pathology Physician	$2.5M	$24.7K

Nearby Providers

Other providers in the same ZIP code as Michael Groover, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Billings Clinic	MT	General Practice Physician	$0	$53.8M
Rimrock Foundation	MT	Substance Use Disorder Rehabilitation Clinic/Center	$0	$44.9M
Scl Health Medical Group - Billings LLC	MT	Clinic/Center	$0	$32.2M
Residential Support Services	MT	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$30.6M
Billings Public School District 2	MT	Local Education Agency (LEA)	$0	$19.2M
South Central Montana Regional Mental Health Center	MT	Clinic/Center	$0	$16.6M
Billings Clinic	MT	Emergency Care Clinic/Center	$0	$15.7M
Community Solutions Incorporated	MT	Clinical Medical Laboratory	$0	$14.1M
Scl Health Montana	MT	General Acute Care Hospital	$0	$13.5M
Benefis Community Care, Inc.	MT	Case Management Agency	$0	$10.8M

Michael Groover — Billing Profile & Reimbursement Data

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Michael Groover — Billing Profile & Reimbursement Data

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Key Findings

Medicare: Total Revenue Breakdown by CPT/HCPCS Code

Medicare: Complete Services Breakdown

Medicare: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References