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

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

Erika Alford (NPI 1043403447)

Key Findings

Field	Value
Entity Type	Individual
Organization	Erika Alford
Address	1244 N Marine Corps Dr
City	Tamuning
State	GU
ZIP	96913
Taxonomy	Endocrinology, Diabetes & Metabolism Physician
NPI Enumerated	August 20, 2007

Payer Source	Total Paid
Medicare	$109.8K
Medicaid	$0

This provider’s Medicare activity is concentrated and modest in scale: Total Medicare revenue is $109.8K while Medicaid shows none (no Medicaid billing on file), meaning the practice is effectively single‑payer through Medicare rather than a mixed Medicare/Medicaid operation. The NPI was enumerated on 2007-08-20 (~19 years ago), so this pattern reflects nearly two decades of potential billing history but current filings are limited to Medicare.

Revenue is highly concentrated in a very small set of E/M and preventive codes: the precomputed top 3 Medicare codes by revenue account for 87.2% of this provider’s total Medicare revenue, led overwhelmingly by 99214 which alone accounts for $82.5K (75.2% of this provider's total Medicare revenue). This concentration indicates most Medicare dollars come from established patient office visits rather than procedural or facility-based services.

The code mix points to an outpatient endocrinology practice focused on longitudinal diabetes care and routine preventive services: high volume of 99214 (1K claims) and measurable use of diabetes-specific services such as 95251 (101 claims, $2.7K revenue) and A1C testing 83036 (28 claims, $252 revenue). Vaccination administration also contributes to the revenue mix through G0008 (170 claims, $5.4K) and vaccine product 90688 (170 claims, $3.4K), consistent with office-based preventive care offerings that complement chronic disease management.

Competitive standing is mixed by code: for the practice’s dominant code 99214 the provider ranks #10921 of 479517 providers nationally (98th percentile; notably above typical national volume for this code), indicating unusually high national volume on that specific E/M code. Conversely, other E/M codes such as 99215 (22 claims, $3.2K) rank at the 28th percentile and 99213 ranks at the 26th percentile, which positions the provider as a specialist with concentrated strength in moderate-level established visits rather than across the full spectrum of visit complexity.

There are clear statistical outliers in the vaccine and monitoring categories: 90688 is described as an "extreme outlier, far above typical national volume for this code" and ranks #67 of 3096 providers (98th percentile), signaling atypically high billing of that specific influenza vaccine product relative to peers. At the same time, G0008 ranks in the 85th percentile (typical, unremarkable volume) so the influenza-related activity is a mix of routine administration and unusually high use of a specific vaccine product.

Operational profile implied by unit economics and claim counts: 99214 shows 1K claims with an average paid/claim of $81 generating $82.5K, while the next-highest code 99204 shows 70 claims at $110 avg paid/claim generating $7.7K. This spread — very high claim count but moderate average payment for the top code — is consistent with a practice that manages a steady panel of established Medicare patients with frequent follow-up visits rather than high-reimbursement procedures.

The absence of any Medicaid billing on file (none below) means the provider has no recorded participation in state Medicaid programs; combined with the Medicare-only revenue of $109.8K, this suggests the provider’s payer mix and revenue exposure are concentrated almost entirely on Medicare beneficiaries. For payers or health systems evaluating network coverage or referral opportunities, this profile signals limited Medicaid footprint and a primary orientation to Medicare outpatient care.

Medicare: Complete Services Breakdown

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

10 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…	1,020	$80	$82.5K
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…	70	$110	$7.7K
G0008	Administration of influenza virus vaccine	170	$30	$5.4K
90688	This code represents a vaccine product administered into the muscle to protect against four strains of influenza (flu). It uses split virus technology and is given as a 0.5 mL dose.	170	$20	$3.4K
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…	20	$140	$3.2K
95251	A provider analyzes and interprets data from a patient’s continuous glucose monitor (CGM) and writes a report based on interpretation. This code represents the professional component of the service…	100	$30	$2.7K
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…	30	$60	$1.9K
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.	100	$20	$1.8K
95249	In this procedure, the provider measures the interstitial glucose levels at regular intervals via subcutaneously implanted sensors for a minimum of 72 hours. Use this code to report sensor placement,…	20	$50	$770
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).…	30	$10	$250

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Thomas Lee	GU	Dentist	$0	$10.9M
Guam Memorial Hospital	GU	General Acute Care Hospital	$0	$3.5M
Rsa - Tumon, LLC	GU	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$2.9M
Robert Yang	GU	Dentist	$0	$2.4M
Antonio Garcia	GU	Pediatrics Physician	$0	$2.2M
Ma Gladys Linsangan	GU	Pediatrics Physician	$0	$2.2M
Ari Katerelos	GU	Radiation Oncology Physician	$2.1M	$0
Guam X-ray	GU	Vascular & Interventional Radiology Physician	$0	$2.1M
Sarah Clegg	GU	General Practice Dentistry	$0	$1.7M
Peter Kh Go	GU	Surgery Physician	$152.8K	$1.5M

Erika Alford — 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

Nearby Providers

Frequently Asked Questions

References

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99214	8	90	140	$90	$25.7K
99215	12	20	40	$120	$14.6K
99213	73	100	100	$60	$10.6K
99204	14	50	30	$110	$6.7K
95251	1	10	100	$30	$2.7K
G0008	5	40	30	$30	$2.1K
90688	5	30	30	$20	$1.4K
99211	1	10	60	$20	$1K
95249	1	10	20	$50	$770
83036	7	10	40	$10	$720