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

Why is the Medicaid comparison limited to South Dakota 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. South Dakota (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.

Timothy Irwin (NPI 1063622801)

Field	Value
Entity Type	Individual
Organization	Timothy Irwin
Address	1104 W 8th St
City	Yankton
State	SD
ZIP	57078
Taxonomy	Cardiovascular Disease Physician
NPI Enumerated	May 23, 2007

Payer Source	Total Paid
Medicare	$383.8K
Medicaid	$0

Key Findings

This profile is effectively single-payer: Total Medicare revenue is $383.8K and there is no Medicaid billing on file. The absence of any Medicaid claims indicates the provider operates almost exclusively in the Medicare market, so analyses of payer mix, network participation, and commercial/Medicaid partnerships should recognize Medicare as the dominant revenue source.

Revenue is highly concentrated in a small set of services: the precomputed top three Medicare codes account for 58.5% of this provider’s Medicare revenue, led by 99214 at 29.1%, 93306 at 23.6%, and 99215 at 5.8%. This concentration means a majority of the practice’s revenue flows from office-based evaluation & management and cardiac imaging, so changes in reimbursement or utilization for those codes would materially affect overall revenue.

The code mix points to an outpatient cardiology practice built around echocardiography and in-clinic visits: 93306 (1.4K claims, $86.2K revenue, 23.6% of Medicare revenue) and 99214 (1.2K claims, $106.4K revenue, 29.1% of Medicare revenue) together drive the bulk of billed services. High volumes of these codes suggest substantial on-site imaging capacity and a steady panel of established patients requiring ongoing cardiology follow-up.

Several codes mark this provider as a regional/national volume leader in specific services. 93306 ranks #106 of 24624 providers nationally (100th percentile; extreme outlier) and 99214 ranks #7006 of 479517 providers nationally (99th percentile; extreme outlier), indicating unusually high national volumes for transthoracic echo and established-patient office visits respectively. These standings imply the provider is a dominant deliverer of those services relative to national peers.

The practice also appears to use contrast imaging and remote monitoring at elevated rates: Q9950 shows 724 claims with $10.1K revenue (2.8%) and ranks #1 of 114 providers nationally (100th percentile; extreme outlier), while 93248 has 222 claims with $4.2K revenue (1.2%) and ranks #96 of 5736 providers nationally (98th percentile; extreme outlier). High utilization of Q9950 and 93248 indicates routine use of contrast agents for imaging and substantial ambulatory/remote ECG monitoring activity.

Cardiac device management is a meaningful ancillary service line: 93288 (163 claims, $6.4K revenue) and 93289 (70 claims, $3.6K revenue) appear on the top codes list, reflecting both device interrogation/adjustment and interpretation services. The presence of these device codes alongside high echo volumes suggests a comprehensive cardiology workflow that includes imaging, monitoring, and device follow-up.

Onsite diagnostics and basic lab services support the clinical workflow: 36415 (1.5K claims, $11.8K revenue, 3.2%) and 93010 (1K claims, $6.1K revenue, 1.7%) rank in high percentiles for claim volumes and point to frequent blood draws and ECG interpretation performed or ordered by the provider. These ancillary services likely improve throughput for high-volume office visits and imaging sessions.

This provider has been enumerated for an extended period (NPI enumerated 2007-05-23, ~19 years ago), which, combined with concentrated Medicare revenue and repeated high-volume code outlier status, suggests an established practice with stable referral patterns and operational routines centered on echocardiography and outpatient cardiology care. Analysts should treat recent utilization shifts in the top codes as potentially material to the business given the practice’s longevity and specialization.

Medicare: Complete Services Breakdown

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

52 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…	1,210	$90	$106.4K
93306	The provider uses transducers to obtain two–dimensional (2D) images of the heart structures through the chest wall. He evaluates the anatomy and function of all four heart chambers, valves, adjacent…	1,390	$60	$86.2K
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…	160	$130	$21.2K
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…	130	$120	$15.7K
99223	The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	110	$130	$14.1K
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…	140	$90	$12.8K
36415	In this procedure, the provider inserts a needle into a vein to collect a blood sample.	1,480	$10	$11.8K
Q9950	Injection, sulfur hexafluoride lipid microspheres, per ml	720	$10	$10.1K
85025	A complete blood count (better known as a CBC) is a blood test request by a doctor that provides detailed information about various types of cells in a patient's blood. Usually a pathologist or a…	1,200	$10	$9.6K
93880	Duplex scanning of arteries for the evaluation of blood flow is a type of non–invasive vascular diagnostic process. A physician can visualize and selectively assess the flow patterns of peripheral…	70	$130	$9.4K

Showing 1–10 of 52

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 52 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. South Dakota Distribution

Timothy Irwin — 10 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — South Dakota

Full comparison — all codes billed, vs. state median

52 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
93306	3	60	250	$50	$21.4K
99214	6	1,660	90	$70	$11.4K
99233	87	290	60	$90	$10.8K
Q9950	1	10	720	$10	$10.5K
78452	18	40	140	$60	$8.6K
99223	40	340	40	$130	$7.5K
99215	45	450	40	$100	$7.5K
93351	2	10	40	$100	$5.9K
71275	53	60	70	$60	$5.1K
99204	52	670	30	$100	$5.1K

Showing 1–10 of 52

Related Providers

Other providers that share a Tax Identification Number (TIN) with Timothy Irwin, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Yankton Medical Clinic PC	SD	Internal Medicine Physician	$0	$6.3M
Chad Laurich	SD	Vascular Surgery Physician	$3.2M	$0
NPI 1588636484	—	—	$3.2M	$0
Ryan Geraets	SD	Ophthalmology Physician	$3M	$0
John Bormes	SD	Ophthalmology Physician	$2.6M	$0
Elizabeth Atchison	SD	Ophthalmology Physician	$1.7M	$0
Ashar Luqman	IA	Nephrology Physician	$1.4M	$0
Taylor Slingsby	SD	Retina Specialist (Ophthalmology) Physician	$1.4M	$0
Ty Hanson	SD	Dermatology Physician	$1.2M	$0
Alexander Ringeisen	MN	Retina Specialist (Ophthalmology) Physician	$1.1M	$0

Nearby Providers

Other providers in the same ZIP code as Timothy Irwin, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Ability Building Services, Inc.	SD	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$39.2M
Lewis & Clark Behavioral Health Services, Inc.	SD	Community/Behavioral Health Agency	$0	$24M
Yankton Ph	SD	Assisted Living Facility (Mental Illness)	$0	$4.1M
Cedar Vilage Assisted Living Center	SD	Assisted Living Facility (Mental Illness)	$0	$2.4M
Heartland Psychological Services	SD	Psychiatry Physician	$0	$1.3M
Avera At Home	SD	Home Health Agency	$0	$1M
Sacred Heart Health Services	SD	Rural Acute Care Hospital	$0	$942.8K
Mary Lee Villanueva	SD	Hematology & Oncology Physician	$788.7K	$0
Sacred Heart Health Services	SD	Emergency Care Clinic/Center	$0	$766.6K
Kore Cares In Home Services, LLC	SD	In Home Supportive Care Agency	$0	$700.6K

Timothy Irwin — 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

Related Providers

Nearby Providers

Frequently Asked Questions

References