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

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

Promedica Central Physicians (NPI 1043270150)

Promedica Central Physicians is a family medicine physician provider located in Toledo, Ohio. This profile covers 0 Medicare and 245 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.

Medicaid: Complete Services Breakdown

Field	Value
Entity Type	Organization
Organization	Promedica Central Physicians
Address	100 Madison Ave
City	Toledo
State	OH
ZIP	43604
Taxonomy	Family Medicine Physician
NPI Enumerated	March 23, 2006

Payer Source	Total Paid
Medicaid	$40.9M
Medicare	$0

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

245 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	339,530	$40	$13.2M
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…	199,610	$50	$10.4M
90460	In this procedure, the provider administers a single live attenuated vaccine through a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age.	65,450	$30	$1.9M
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…	63,830	$20	$1.4M
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…	19,420	$60	$1.1M
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…	22,020	$50	$1.1M
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…	10,970	$80	$844.6K
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…	18,820	$30	$639.8K
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…	12,550	$50	$627.4K
92014	An ophthalmologist sees an established patient for a comprehensive level eye examination. Generally, a patient is considered to be "established" if the same physician, or any physician in the group…	13,400	$40	$589.6K

Showing 1–10 of 245

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Ohio Distribution

Promedica Central Physicians — 17 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Ohio

Full comparison — all codes billed, vs. Ohio median

245 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0178	Injection, aflibercept, 1 mg	7	20	310	$1,070	$1.4M
J0585	Injection, onabotulinumtoxina, 1 unit	58	60	250	$730	$707.7K
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…	1,386	2,640	620	$90	$408.2K
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…	22	4,510	500	$60	$377.8K
95720	A physician or other QHCP reviews recorded events and analyzes spike and seizure detection of a continuous electroencephalography, a study of the electrical activity of the brain. A video is…	11	30	1,060	$120	$372K
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…	14	5,080	560	$40	$323.9K
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	430	560	$60	$303.2K
00170	The provider performs anesthesia services for a patient undergoing an intraoral procedure, including biopsy.	32	90	320	$110	$293.3K
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…	15	480	450	$70	$292.9K
43239	The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum where he removes one or more tissue biopsy specimens for diagnostic analysis.	158	280	570	$250	$276.5K

Showing 1–10 of 245

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Niraj Shah	OH	Ophthalmology Physician	$1.3M	$0
Stanley Tao	OH	Ophthalmology Physician	$832K	$0
Jeffery Stephens	OH	Ophthalmology Physician	$540.8K	$0
Christine Kuhlman	OH	Family Nurse Practitioner	$401.1K	$0
Amish Oza	OH	Family Medicine Physician	$387.5K	$0
Meghan Beck	OH	Physician Assistant	$381.5K	$0
Mandar Joshi	OH	Retina Specialist (Ophthalmology) Physician	$369.1K	$0
Brian Chinavare	OH	Ophthalmology Physician	$339.9K	$0
Hooman Harooni	OH	Ophthalmology Physician	$323.6K	$0
Satheesh Ramineni	OH	Adult Reconstructive Orthopaedic Surgery Physician	$314.9K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Rfs Charitable Foundation	OH	Community/Behavioral Health Agency	$0	$49.6M
Mercy Health Physicians-north LLC	OH	Family Medicine Physician	$0	$42.1M
Pathology Laboratories, Inc.	OH	Clinical Medical Laboratory	$3.1M	$25M
Primary Care Solutions Of Ohio Incorporated	OH	Community/Behavioral Health Agency	$0	$17.6M
A Renewed Mind	OH	Community/Behavioral Health Agency	$0	$15.3M
Promedica Central Corporation Of Michigan	OH	Family Medicine Physician	$0	$14.2M
A Renewed Mind	OH	Community/Behavioral Health Agency	$0	$13.4M
Mercy Health Physicians North Specialty Care LLC	OH	Surgery Physician	$0	$13.1M
Mercy Health - Life Flight Network LLC	OH	Ambulance	$3.3M	$3.2M
Lucas County Auditor	OH	Ambulance	$811.6K	$4.6M

Promedica Central Physicians — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

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