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

Why is the Medicaid comparison limited to West Virginia 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. West Virginia (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.

Bluestone Health Association, Inc. (NPI 1043387327)

Field	Value
Entity Type	Organization
Organization	Bluestone Health Association, Inc.
Address	5451 Simmons River Road
City	Montcalm
State	WV
ZIP	24737
Taxonomy	Federally Qualified Health Center (FQHC)
NPI Enumerated	November 29, 2006

Payer Source	Total Paid
Medicaid	$1.5M
Medicare	$0

Medicaid: Complete Services Breakdown

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

41 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T1015	Clinic visit/encounter, all-inclusive	12,850	$100	$1.3M
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…	9,360	$10	$74.8K
3008F	No Summary found for this code	3,180	$10	$15.9K
1111F	No Summary found for this code	3,110	$10	$15.5K
3074F	No Summary found for this code	1,810	$10	$10.8K
3078F	No Summary found for this code	1,660	$10	$10K
1160F	No Summary found for this code	1,940	$1	$7.8K
1031F	The provider treats a patient who presents with a diagnosis of asthma. The provider interviews the patient or their primary care giver regarding tobacco use and exposure to secondhand smoke within…	1,130	$10	$6.8K
36415	In this procedure, the provider inserts a needle into a vein to collect a blood sample.	1,050	$10	$5.3K
1033F	A provider determines that a patient who presents with a diagnosis of asthma does not use tobacco and has no exposure to a passive smoking environment. The provider then does not need to discuss…	480	$10	$4.3K

Showing 1–10 of 41

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. West Virginia Distribution

Bluestone Health Association, Inc. — 0 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — West Virginia

Full comparison — all codes billed, vs. West Virginia median

41 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1015	Clinic visit/encounter, all-inclusive	125	390	4,610	$130	$2.2M
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…	227	1,270	1,240	$30	$245K
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…	608	1,030	890	$50	$221K
81001	Urinalysis is used to detect substances or cellular material in the urine associated with different metabolic and kidney disorders. It is used to detect urinary tract infections (UTI) and other…	77	80	2,480	$10	$112.1K
36415	In this procedure, the provider inserts a needle into a vein to collect a blood sample.	144	330	790	$10	$64.1K
J1100	Injection, dexamethasone sodium phosphate, 1 mg	97	100	380	$30	$61.5K
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…	382	440	110	$60	$57.2K
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,…	220	540	320	$20	$43.2K
96372	A therapeutic, prophylactic, or diagnostic substance (a fluid, a drug, etc.) is injected via intramuscular or subcutaneous route into the patient's body. The procedure is performed by the physician…	190	310	490	$20	$42K
J1885	Injection, ketorolac tromethamine, per 15 mg	115	120	290	$20	$41.7K

Showing 1–10 of 41

Related Providers

Other providers that share a Tax Identification Number (TIN) with Bluestone Health Association, Inc., ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Bluestone Health Association, Inc.	WV	Federally Qualified Health Center (FQHC)	$0	$12.1M
Bluestone Health Association, Inc.	WV	Federally Qualified Health Center (FQHC)	$0	$1.9M
Bluestone Health Association, Inc.	WV	Federally Qualified Health Center (FQHC)	$0	$1.8M
Randy Brodnik	WV	Obstetrics & Gynecology Physician	$7.2K	$26.5K
Jenine Ward	WV	Nurse Practitioner	$230	$0

Bluestone Health Association, Inc. — Billing Profile & Reimbursement Data

Sign up for Bluestone Health Association, Inc. — Billing Profile & Reimbursement Data policy alerts

Bluestone Health Association, Inc. — Billing Profile & Reimbursement Data

Sign up for Bluestone Health Association, Inc. — Billing Profile & Reimbursement Data policy alerts

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Related Providers

Frequently Asked Questions

References