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

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

Douglas Edgren (NPI 1033145164)

Field	Value
Entity Type	Individual
Organization	Douglas Edgren
Address	1331 Prairie Ave Ste 1
City	Cheyenne
State	WY
ZIP	82009
Taxonomy	Family Medicine Physician
NPI Enumerated	June 23, 2006

Payer Source	Total Paid
Medicare	$284.7K
Medicaid	$0

Key Findings

DOUGLAS EDGREN is effectively a Medicare-focused solo billing entity with Total Medicare revenue of $284.7K and no Medicaid billing on file; the absence of Medicaid activity indicates a payer mix concentrated on Medicare beneficiaries rather than dual Medicaid/Medicare panels. The provider’s NPI was enumerated on 2006-06-23 (~20 years ago), suggesting long tenure in the market which may support an established referral and patient base.

Revenue is highly concentrated in a small set of primary care services: 99215 ($50.7K, 18.0%), 99213 ($46.7K, 16.5%), and G0439 ($46.1K, 16.3%) — together the top 3 Medicare codes by revenue account for 50.8% of this provider's total Medicare revenue. This concentration indicates that a majority of Medicare dollars are coming from high- and mid-level established patient evaluation & management and annual wellness visits rather than procedural or specialist services.

The code mix points to a traditional family medicine/primary care operation with a strong emphasis on longitudinal management and prevention: high-revenue E/M codes 99215, 99213 and annual wellness visit G0439 dominate, and vaccine administration (90662, G0008, 91320) and therapeutic injections (J0897, J1040, 96372) appear as consistent ancillary services. Presence of codes like 20610 (joint injection) and 11102 (skin lesion biopsy) indicates some in-office procedures, but these are relatively small contributors to total Medicare revenue.

Competitive standing versus national Medicare peers is uneven: 99215 ranks #2771 of 145531 providers nationally (98th percentile; extreme outlier, far above typical national volume for this code) and 99213 ranks #10177 of 457151 (98th percentile; notably above typical national volume), while G0439 ranks #2346 of 105855 (98th percentile; notably above typical national volume). These rankings imply the provider is a high-volume outlier for key primary-care office visit and annual wellness services on a national scale, even though total Medicare revenue ($284.7K) is modest in absolute terms.

Some service lines show high unit volume but low per-claim payment: J0897 has 1.1K claims at $18 avg paid/claim producing $19.4K (6.9% of Medicare revenue) yet ranks #8823 of 10057 nationally (10th percentile; typical, unremarkable volume for this code). This pattern is consistent with frequent low-dollar infusion/injection events (likely denosumab for osteoporosis) that add operational throughput without dominating revenue.

Preventive care and immunization activity is prominent: G0439 (annual wellness visit, subsequent) and G0438 (annual wellness visit, initial) together contribute meaningful revenue ($46.1K and $20.9K respectively) and both are high national outliers (G0439 98th percentile; notably above typical national volume, and G0438 99th percentile; extreme outlier). Vaccine-related codes such as 90662 (157 claims, $69 avg, $10.8K; 91th percentile) and 91320 (45 claims, $128 avg, $5.8K; 40th percentile) further underscore a preventive-service orientation in the patient panel.

There is evidence the provider also services institutional settings: nursing facility visit codes 99307 (104 claims, $26 avg, $2.7K) and 99308 (48 claims, $54 avg, $2.6K) appear on the profile, indicating periodic SNF/subacute care activity which diversifies patient settings beyond the office. These facility codes are smaller revenue contributors but confirm a mixed ambulatory and institutional practice footprint.

The lack of any Medicaid billing on file should be a key consideration for contracting and network strategy: this provider operates as essentially single-payer (Medicare) from the dataset provided, which suggests their patient population and revenue streams are skewed toward older adults and Medicare-eligible patients rather than Medicaid-covered populations. Analysts should treat this provider as Medicare-centric when evaluating risk, network value, or competitive positioning in Wyoming.

Medicare: Complete Services Breakdown

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

38 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	430	$120	$50.7K
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…	820	$60	$46.7K
G0439	Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	360	$130	$46.1K
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…	560	$80	$45.7K
G0438	Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit	130	$160	$20.9K
J0897	Injection, denosumab, 1 mg	1,080	$20	$19.4K
90662	This code represents a flu vaccine product that is a split virus type, contains no preservatives, and has enhanced effectiveness due to a higher antigen content. It is administered as an injection…	160	$70	$10.8K
91320	This code represents a SARS–CoV–2 vaccine product (tris–sucrose formulation) administered by intramuscular injection to reduce the patient’s risk of contracting COVID–19. The dosage is 30 mcg/0.3 mL.	50	$130	$5.8K
99211	An established patient presents for an office or other outpatient visit that may not require the presence of a physician or other qualified healthcare professional.	420	$10	$5.5K
G0008	Administration of influenza virus vaccine	170	$30	$4.4K

Showing 1–10 of 38

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 38 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Wyoming Distribution

Douglas Edgren — 7 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Wyoming

Full comparison — all codes billed, vs. state median

38 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0897	45	50	1,800	$20	$51.1K
99214	52	780	100	$80	$14.8K
91320	30	60	50	$120	$13.9K
G0439	6	170	70	$120	$13.1K
99213	21	850	110	$60	$9.9K
11102	38	40	130	$60	$9.6K
99308	24	40	50	$50	$8.9K
17000	38	50	120	$30	$8.6K
90662	42	140	70	$70	$8.6K
99215	4	220	40	$120	$8.3K

Showing 1–10 of 38

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Babson & Associates Primary Care, PC	WY	Family Medicine Physician	$0	$288.4K
Vickie Richards	WY	Family Nurse Practitioner	$73.4K	$0
Brittany Joannides	WY	Family Nurse Practitioner	$51.3K	$0
Jennifer Davis	WY	Family Nurse Practitioner	$51.2K	$0
Marianne Denton	WY	Family Nurse Practitioner	$39.9K	$0
Jennifer Fryman	WY	Family Nurse Practitioner	$420	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Children's Dentistry LLC	WY	Pediatric Dentistry	$0	$8M
Emg Cheyenne Sh LLC	WY	Assisted Living Facility	$0	$5.8M
Liv In-home Counseling & Care Management, LLC	WY	Primary Care Clinic/Center	$0	$5.7M
Lucy Russell	WY	Developmentally Disabled Services Day Training Agency	$0	$5.4M
Pediatric Dentistry LLC	WY	Pediatric Dentistry	$0	$4.1M
Bridges Of Wyoming, Inc	WY	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$2.2M
Renee Dreher	WY	Clinical Social Worker	$0	$817.9K
Breanna Barnes	WY	Pediatric Dentistry	$0	$794.4K
College Drive Urgent Care LLC	WY	Urgent Care Clinic/Center	$0	$770.4K
Sandra Surbrugg	WY	Dermatology Physician	$664.9K	$0

Douglas Edgren — 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