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

Why is the Medicaid comparison limited to New York 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. New York (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.

North Shore-lij Medical PC (NPI 1053688572)

Key Findings

Field	Value
Entity Type	Organization
Organization	North Shore-lij Medical PC
Address	1010 Northern Blvd Ste 110
City	Great Neck
State	NY
ZIP	11021
Taxonomy	Urology Physician
NPI Enumerated	November 29, 2011

Payer Source	Total Paid
Medicaid	$388.1M
Medicare	$0

This provider has no Medicare billing on file and is effectively a Medicaid-centric billing entity, reporting Total Medicaid revenue of $388.1M. The NPI was enumerated on 2011-11-29 (~15 years ago), indicating more than a decade of sustained billing activity under this enrollment.

Revenue is highly concentrated: the precomputed top three Medicaid codes (99214, 99284, 99285) account for 51.1% of the provider's total Medicaid revenue. Those three codes individually represent $61M (19.9%) for 99214, $51.1M (16.7%) for 99284, and $44.5M (14.5%) for 99285, demonstrating that a small set of E/M services drive the majority of Medicaid dollars.

The code mix is dominated by high-volume evaluation-and-management (E/M) and emergency services, with 99214 (office established visit) and the ED codes 99284 and 99285 among the top revenue drivers. Coupled with substantial volumes in hospital inpatient follow-up codes (99232, 99233, 99223) and critical care (99291), the pattern suggests the provider operates at scale across outpatient clinics, emergency care, and inpatient settings rather than as a narrow, low-volume specialty practice.

Diagnostic imaging and procedure codes also contribute meaningfully to revenue: high-state rankings on 74177 (CT abdomen/pelvis), 70450 (CT head), 71045 (single-view chest x-ray), and echocardiography codes 93306/93303 indicate an integrated diagnostic footprint. Obstetric ultrasound codes (76816, 76811, 76819, 76818) and pathology 88305 further signal broad service lines beyond urology-specialty procedures, consistent with a large multi-service practice or facility-level billing profile.

The provider is a dominant statewide volume leader for many high-revenue codes: several top codes rank at #1 in-state and are reported at the 100th percentile (labeled “extreme outlier”), including 99284 (#1 of 2210), 99285 (#1 of 2333), 74177 (#1 of 814), 70450 (#1 of 970), and 71045 (#1 of 1607). Even where not #1, codes such as 99214 rank #4 of 16554 providers while still being characterized as extreme outliers, indicating this entity is far above typical state volume across numerous service lines.

Multiple codes are explicitly flagged as statistical outliers in the dataset; the report labels many top codes as “extreme outlier” or in the 100th percentile, and a few codes are noted as “notably above typical” (for example 31231). These labels, combined with very large claim counts (e.g., 544.8K claims for 99214 and 447.7K claims for 99213), point to unusually high throughput that will materially affect Medicaid utilization and budgeting.

For payer negotiations and utilization management, the concentration in a small number of E/M and ED codes suggests targeted interventions (network design, ED utilization programs, and site-of-service reviews) could influence a large share of spend. Given the absence of Medicare billing, Medicaid is the sole lever for payer relationships with this entity, and strategies should focus on the high-volume codes and associated facilities or practice sites that generate these claims.

From a risk and contracting perspective, this provider’s Medicaid-only revenue scale and repeated top-state rankings create both a negotiation challenge and an opportunity: they can exert significant network leverage due to volume, while payers can also prioritize a small set of codes (the top three representing 51.1% of Medicaid revenue) for performance, rate, or care-pathway initiatives to achieve concentrated impact.

Medicaid: Complete Services Breakdown

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

512 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…	544,790	$110	$61M
99284	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making.	415,280	$120	$51.1M
99285	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a high level of medical decision making.	256,010	$170	$44.5M
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…	447,690	$80	$37.2M
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…	88,050	$170	$15.2M
99283	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a low level of medical decision making.	149,910	$70	$10M
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…	54,030	$160	$8.5M
76816	The provider reexamines the fetus to follow up on a prior abnormal transabdominal ultrasound.	73,900	$110	$8.4M
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…	67,670	$120	$8.1M
74177	The provider performs computed tomography of the abdomen and pelvis with contrast material to diagnose the cause of abdominal or pelvic pain or other abnormalities of the internal organs.	91,080	$90	$7.9M

Showing 1–10 of 512

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. New York Distribution

North Shore-lij Medical PC — 24 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — New York

Full comparison — all codes billed, vs. New York median

512 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J1745	Injection, infliximab, excludes biosimilar, 10 mg	9	20	730	$2,870	$3.5M
J3380	Injection, vedolizumab, intravenous, 1 mg	18	20	120	$5,050	$1.9M
59400	In this global service, the provider and nonphysician healthcare providers in the practice provide all of the antepartum care, admission to the hospital for delivery, labor management, including…	8	40	70	$3,040	$1.5M
90832	In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere…	1,089	1,510	1,010	$110	$1.1M
21086	The provider fabricates an auricular prosthesis by taking an impression, or negative imprint, of the patient's ear. An auricular prosthesis replaces an ear that is partially or totally missing due to…	1	10	400	$2,620	$1M
90937	Hemodialysis is a procedure that involves drawing blood via an intraarterial or intravenous catheter, then sieving it through a semipermeable membrane to remove the impurities and finally transfusing…	72	80	3,680	$40	$919.1K
90834	In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere…	1,280	2,200	1,010	$130	$892.2K
99472	The provider performs follow up care of a critically ill infant or young child, 29 days through 24 months of age, in an inpatient setting.	7	10	1,530	$400	$755.8K
99283	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a low level of medical decision making.	5	1,420	90	$130	$715.2K
99282	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a straightforward level of medical decision making.	65	450	370	$170	$674.1K

Showing 1–10 of 512

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Sun River Health Inc.	NY	Federally Qualified Health Center (FQHC)	$0	$546.7M
Premium Health Inc	NY	Federally Qualified Health Center (FQHC)	$0	$85.4M
Prisma Health Medical Group-midlands	SC	Orthopaedic Surgery Physician	$0	$8.7M
Edward Bennett	NY	Internal Medicine Physician	$152.7K	$6.7M
Eric Berkowitz	NY	Vascular & Interventional Radiology Physician	$2.6M	$1.2M
Eric Shakin	NY	Ophthalmology Physician	$3.3M	$291.7K
Lynda Piboon	NY	Obstetrics & Gynecology Physician	$62.2K	$3.1M
Long Island Digestive Endoscopy Center, LLC	NY	Ambulatory Surgical Clinic/Center	$1.6M	$1.4M
Stuart Weinerman	NY	Endocrinology, Diabetes & Metabolism Physician	$2.3M	$2.3K
Jason Karp	NY	Pulmonary Disease Physician	$2.1M	$35.2K

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
C And T Homecare Services LLC	NY	In Home Supportive Care Agency	$0	$847.7M
First Choice Home Care Inc	NY	Home Health Agency	$0	$28M
Welllife Network Inc.	NY	Clinic/Center	$0	$22M
Regioncare Inc.	NY	Home Infusion Agency	$40.1K	$9.4M
Jonathan Jonisch	NY	Ophthalmology Physician	$6.4M	$940.9K
Kenneth Graham	NY	Ophthalmology Physician	$5.6M	$64.5K
Brett Rosenblatt	NY	Ophthalmology Physician	$5.5M	$9.3K
David Poon	NY	Ophthalmology Physician	$4.1M	$796.1K
Jeffrey Shakin	NY	Ophthalmology Physician	$4.4M	$82.4K
David Fastenberg	NY	Ophthalmology Physician	$4.4M	$31.2K

North Shore-lij Medical PC — 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