Loading...
NPI 1023584216 · Hartford, CT · Surgery Physician
Customize your policy alerts
Get alerted when relevant policies change without checking for updates manually.
Monitor payer policy activity
Hartford Healthcare Medical Group Specialists, PLLC is a surgery physician provider located in Hartford, Connecticut. This profile covers 0 Medicare and 265 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.
Provider details (source: NPPES NPI Registry)
| Field | Value |
|---|---|
| Entity Type | Organization |
| Organization | Hartford Healthcare Medical Group Specialists, PLLC |
| Address | 85 Seymour St Ste 415 |
| City | Hartford |
| State | CT |
| ZIP | 06106 |
| Taxonomy | Surgery Physician |
| NPI Enumerated | October 16, 2018 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $46M |
| Medicare | $0 |
This provider has no Medicare billing on file and is effectively a single-payer (Medicaid) operation at scale: lifetime Medicaid revenue is $46M and there is no recorded Medicare revenue. That concentration means payor exposure and growth are tied primarily to Connecticut Medicaid policy and managed care relationships rather than to traditional Medicare volumes.
Revenue concentration is high: the precomputed top 3 Medicaid codes account for 52.0% of this provider’s total Medicaid revenue, driven by 99214 ($13.4M, 31.8%), 99213 ($5.6M, 13.2%), and 99232 ($2.9M, 6.9%). This indicates the practice’s revenue base is dominated by evaluation-and-management visits for established outpatients and subsequent inpatient visits.
The clinical/service mix implied by the top codes points to a high-volume ambulatory and inpatient E/M footprint: 99214 and 99213 together represent substantial office-based established-patient care (311.2K and 173.9K claims respectively), while 99232 (127.1K claims) indicates a heavy volume of subsequent hospital inpatient or observation care. Combined with the Surgery Physician taxonomy, the pattern suggests an organization that manages large clinic rosters and also provides substantial inpatient follow-up or consult services.
Competitive standing within Connecticut is prominent for multiple codes. 99214 ranks #4 of 1589 providers in-state (100th percentile; extreme outlier), 99213 ranks #12 of 1714 (99th percentile; extreme outlier), and 99232 ranks #4 of 169 (98th percentile; extreme outlier), signaling the provider is a dominant statewide volume player for core E/M services.
Beyond E/M, the provider is an outlier on high-volume cardiac diagnostics and related services: 93000 appears with 107.6K claims and $968K revenue and ranks #1 of 204 providers in-state (100th percentile; extreme outlier), and 93306 (echo) shows $1.4M revenue and ranks #3 of 96 (98th percentile; extreme outlier). These diagnostic volumes suggest embedded cardiac testing capacity that complements clinical visit throughput.
There are several notable high-revenue procedure entries that diversify the revenue mix despite E/M dominance: J0585 (onabotulinumtoxina) contributes $2.2M (rank #2 of 19, 94th percentile) and 43775 (laparoscopic sleeve gastrectomy) contributes $301.7K while ranking #1 of 8 (100th percentile). Presence of these procedure codes indicates the group bills for selected specialty interventions in addition to high-volume E/M and diagnostics.
Operational tenure is established but not long-standing: the NPI was enumerated 2018-10-16 (~8 years ago). This relatively recent enumeration paired with very large Medicaid volumes suggests rapid scale-up within the state Medicaid market over a short timeframe.
Concentration risk and competitive leverage are both evident. With 52.0% of Medicaid revenue tied to three E/M codes and with numerous 100th-/99th-percentile rankings across key services, the provider appears to wield strong market share in Connecticut Medicaid for ambulatory and inpatient E/M as well as cardiac diagnostics, but is also financially sensitive to reimbursement or utilization shifts in those high-volume code groups.
Medicaid revenue breakdown by year and by CPT/HCPCS procedure code, including monthly billing trends and the top codes driving revenue.
View: By Year1 / 3
Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.
265 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… | 311,210 | $40 | $13.4M |
| 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… | 173,930 | $30 | $5.6M |
| 99232 | The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or… | 127,060 | $20 | $2.9M |
| 99284 | The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making. | 44,040 | $60 | $2.6M |
| 99285 | The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a high level of medical decision making. | 31,810 | $80 | $2.5M |
| J0585 | Injection, onabotulinumtoxina, 1 unit | 4,840 | $470 | $2.2M |
| 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… | 20,520 | $70 | $1.5M |
| 99233 | The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the… | 49,970 | $30 | $1.5M |
| 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… | 29,400 | $50 | $1.4M |
| 99203 | The provider sees a new 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 provider… | 22,480 | $50 | $1.1M |
Showing 1–10 of 265
How this provider's Medicaid billing volume and revenue compare to other Connecticut providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Connecticut median
265 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 99285 | The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a high level of medical decision making. | 29 | 130 | 520 | $330 | $5.9M |
| 99284 | The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making. | 29 | 130 | 690 | $180 | $4.7M |
| 99283 | The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a low level of medical decision making. | 44 | 110 | 1,520 | $140 | $3.4M |
| 96413 | Chemotherapy is a therapeutic procedure used for the treatment of cancer via the use of chemical agents. These chemical agents (drugs) work on the cancerous cells of the body to destroy them. These… | 43 | 40 | 1,910 | $190 | $1.1M |
| 96365 | The provider administers the initial intravenous infusion of a medication or other substance for a period up to one hour to prevent, treat, or diagnose a condition or disease. | 39 | 40 | 5,360 | $120 | $1M |
| J0585 | Injection, onabotulinumtoxina, 1 unit | 2 | 20 | 1,530 | $380 | $1M |
| 99282 | The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a straightforward level of medical decision making. | 47 | 60 | 3,070 | $100 | $907.8K |
| 96375 | Following the administration of a drug or other substance via intravenous, or IV, push, the provider sequentially infuses a different medication or medications, also via IV push. He administers the… | 38 | 40 | 15,430 | $40 | $744.3K |
| 95810 | Polysomnography refers to the continuous and simultaneous monitoring and recording of various physiological and pathophysiological parameters of sleep for six or more hours with physician review,… | 41 | 50 | 870 | $510 | $687.2K |
| 99291 | Critical care services include the treatment of vital organ failure or prevention of further life–threatening conditions. Delivering medical care in a moment of crisis and in time of emergency is… | 13 | 80 | 790 | $240 | $650K |
Showing 1–10 of 265
Other providers in the same ZIP code as Hartford Healthcare Medical Group Specialists, PLLC, ranked by combined Medicare and Medicaid revenue.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.