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

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

Nextcare Arizona LLC (NPI 1043371826)

Key Findings

Field	Value
Entity Type	Organization
Organization	Nextcare Arizona LLC
Address	914 N Scottsdale Rd Ste 104
City	Tempe
State	AZ
ZIP	85288
Taxonomy	Urgent Care Clinic/Center
NPI Enumerated	December 13, 2006

Payer Source	Total Paid
Medicaid	$161.7M
Medicare	$0

NEXTCARE ARIZONA LLC is effectively a Medicaid-focused provider: the profile shows Total Medicaid revenue of $161.7M and no Medicare billing on file, indicating a single-payer (Medicaid) revenue footprint in the available claims data. This concentration on Medicaid should frame any payer-mix or network analysis.

Revenue is extremely concentrated in office/outpatient evaluation-and-management services: the precomputed top-3 Medicaid codes account for 90.5% of the provider's total Medicaid revenue, driven by 99214 (43.9%), 99213 (28.3%), and 99203 (18.4%). This means nearly all reported Medicaid dollars flow through a very small set of E/M codes.

The code mix aligns with an urgent care/clinic service model: the top revenue drivers are 99214 and 99213 (established-patient E/M visits) and 99203 (new-patient E/M), which together point to high-volume outpatient evaluation and management encounters rather than imaging, durable medical equipment, or high-revenue procedures. Given the provider taxonomy of Urgent Care Clinic/Center, the pattern is consistent with an urgent/retail clinic delivering frequent office visits of low-to-moderate complexity.

State-level competitive standing is dominant for the top E/M codes: 99214 ranks #1 of 3041 providers in-state (100th percentile; extreme outlier), 99213 ranks #3 of 2775 (100th percentile; extreme outlier), and 99203 ranks #1 of 1025 (100th percentile; extreme outlier). These rank/percentile positions characterize the provider as an outlier and a major statewide volume leader for those specific codes.

Ancillary testing and procedural codes contribute negligible revenue despite nontrivial claim volumes: 87426 shows 21.9K claims but only $43.7K revenue and ranks #1 of 172 (100th percentile; extreme outlier), U0002 has 18.1K claims and $18.1K revenue (rank #2 of 82, 99th percentile; extreme outlier), and 99000 records 29K claims with $0 avg paid/claim (rank #2 of 299, 100th percentile; extreme outlier). These data indicate the business generates many specimen/testing encounters but derives almost all dollars from E/M visits rather than testing reimbursements.

Coding mix suggests emphasis on mid-to-high level E/M encounters: the provider reports far larger revenue from 99214 (43.9%) and 99213 (28.3%) than from lower-level codes such as 99212 (0.2% of Medicaid revenue, 3.1K claims, ranks #82 of 852, 90th percentile). This tilt toward higher-level established-patient codes should be considered when benchmarking visit complexity, staffing, and reimbursement expectations.

The provider is long-tenured in the NPI file (NPI enumerated 2006-12-13, ~20 years ago) and operates in TEMPE, AZ; that duration combined with outsized statewide ranks for core E/M codes implies an established operational presence and scale in the Arizona Medicaid market. Analysts should interpret current volumes in the context of a long-running, high-capacity outpatient operation.

Given the heavy revenue concentration (90.5% from three E/M codes) and multiple statewide extreme-outlier rankings, this profile merits targeted attention for payer teams focused on contracting, utilization benchmarking, and capacity planning. Specifically, the provider’s dominance on 99214/99213/99203 makes it an important candidate for network strategy discussions and utilization reviews focused on outpatient E/M services.

Medicaid: Complete Services Breakdown

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

39 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…	716,340	$100	$70.9M
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…	435,340	$110	$45.7M
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…	294,320	$100	$29.7M
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…	141,990	$100	$14.6M
99212	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,…	3,060	$100	$315.4K
99202	The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves straightforward medical decision making, and/or the provider…	2,580	$100	$252.3K
87426	The lab analyst performs an immunoassay to qualitatively or semiquantitatively evaluate the patient blood specimen for antigens of severe acute respiratory syndrome coronavirus such as SARS–CoV–2,…	21,860	$1	$43.7K
U0002	2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc	18,110	$1	$18.1K
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…	170	$100	$17K
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.	80	$100	$8.1K

Showing 1–10 of 39

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Arizona Distribution

Nextcare Arizona LLC — 6 of 17 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Arizona

Full comparison — all codes billed, vs. Arizona median

39 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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.	254	400	200	$120	$403K
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…	1	3,040	750	$50	$343.9K
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…	3	2,780	600	$50	$267K
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…	1	1,030	130	$70	$134.1K
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…	494	930	200	$70	$97.7K
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…	1	1,160	150	$90	$96.5K
99212	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,…	82	850	230	$40	$72.5K
71046	In this diagnostic procedure, the provider performs a minimum of two radiological views of the chest. He performs this study for the assessment of conditions affecting the chest, its contents, and…	226	300	600	$10	$62.6K
87635	Using an amplified nucleic acid probe technique, the lab analyst performs the necessary steps to identify the nucleic acids from the severe acute respiratory syndrome coronavirus 2 (SARS–COV–2) virus…	32	210	420	$20	$43.1K
83036	Sugar in the bloodstream can get attached to the hemoglobin in red blood cells. Once the sugar is attached, it stays there for the lifetime of the red blood cell (around 120 days or over 3 months).…	218	250	440	$1	$35.8K

Showing 1–10 of 39

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Elissa Gartenberg	AZ	Family Medicine Physician	$90K	$0
Suzanne Russell	AZ	Medical Physician Assistant	$78.7K	$0
Zachary Leonard	AZ	Physician Assistant	$75.8K	$0
Katelyn Sherbondy	AZ	Medical Physician Assistant	$69K	$0
Adam Roberts	AZ	Physician Assistant	$67.9K	$0
Yolanda Smith	AZ	Family Nurse Practitioner	$64.5K	$0
Kevin Kon	AZ	Nurse Practitioner	$57.9K	$0
Earl Nordby	AZ	Family Nurse Practitioner	$51.7K	$0
Taylor Sehorn	AZ	Physician Assistant	$47.1K	$0
Todd Page	AZ	Medical Physician Assistant	$44.6K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Nationwide Optometry P.C.	AZ	Optometrist	$0	$33.6M
Lema Clinic LLC	AZ	Community/Behavioral Health Agency	$0	$16.2M
Kimberlee Wilson	AZ	Psychiatry Physician	$137.2K	$0
Kelly Dunican	AZ	Diagnostic Radiology Physician	$84.8K	$0
Meredith Johnson	AZ	Psychiatric/Mental Health Nurse Practitioner	$48.1K	$0
Brandon Chuman	AZ	Clinical Neuropsychologist	$37.1K	$0
Marie Grace De Leon	AZ	Psychiatric/Mental Health Nurse Practitioner	$24.5K	$0
Salaheddine Tomeh	AZ	Specialist	$15.8K	$0

Nextcare Arizona LLC — Billing Profile & Reimbursement Data

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Nextcare Arizona 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