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

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

Upstream Family Medicine Inc (NPI 1063833937)

Upstream Family Medicine Inc is a family medicine physician provider located in Soldotna, Alaska. This profile covers 0 Medicare and 10 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.

Medicaid: Complete Services Breakdown

Field	Value
Entity Type	Organization
Organization	Upstream Family Medicine Inc
Address	35743 Kenai Spur Hwy Ste A
City	Soldotna
State	AK
ZIP	99669
Taxonomy	Family Medicine Physician
NPI Enumerated	December 19, 2013

Payer Source	Total Paid
Medicaid	$777.2K
Medicare	$0

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

10 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	5,490	$100	$532.4K
99391	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	1,050	$140	$145.3K
90460	In this procedure, the provider administers a single live attenuated vaccine through a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age.	1,280	$20	$27K
90461	In this procedure, the provider administers an additional live attenuated vaccine either via a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age after the…	750	$30	$21.1K
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…	120	$150	$17.4K
99392	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	100	$160	$15.4K
96110	The provider screens the patient for a developmental disorder using a standardized instrument (such as a recognized form) focused on areas such as developmental milestones and age–appropriate…	1,200	$10	$13.2K
99460	The provider evaluates and manages the care of a normal newborn infant, typically immediately after birth, in a hospital or birthing center.	40	$100	$3.6K
99238	The provider sees a patient for hospital inpatient or observation discharge day management, involving evaluation and management (E/M). The provider spends 30 minutes or less on the service on the…	20	$80	$1.7K
36415	In this procedure, the provider inserts a needle into a vein to collect a blood sample.	90	$0	$0

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Alaska Distribution

Upstream Family Medicine Inc — 0 of 9 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Alaska

Full comparison — all codes billed, vs. Alaska median

10 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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…	72	490	680	$260	$1M
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…	328	440	580	$170	$458.7K
99391	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	10	30	330	$200	$189K
99392	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	23	50	100	$220	$134.3K
36415	In this procedure, the provider inserts a needle into a vein to collect a blood sample.	93	130	250	$20	$83.8K
99460	The provider evaluates and manages the care of a normal newborn infant, typically immediately after birth, in a hospital or birthing center.	2	10	30	$140	$59.2K
90460	In this procedure, the provider administers a single live attenuated vaccine through a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age.	7	30	420	$30	$43.7K
99238	The provider sees a patient for hospital inpatient or observation discharge day management, involving evaluation and management (E/M). The provider spends 30 minutes or less on the service on the…	19	20	180	$80	$33.3K
90461	In this procedure, the provider administers an additional live attenuated vaccine either via a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age after the…	5	20	430	$30	$31.7K
96110	The provider screens the patient for a developmental disorder using a standardized instrument (such as a recognized form) focused on areas such as developmental milestones and age–appropriate…	5	20	230	$10	$15.7K

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Central Peninsula General Hospital Inc.	AK	Rural Acute Care Hospital	$0	$58.4M
Hope Community Resources Inc	AK	Respite Care	$0	$42.9M
Frontier Community Services	AK	Developmentally Disabled Services Day Training Agency	$0	$41.8M
Peninsula Community Health Services Of Alaska, Inc.	AK	Federally Qualified Health Center (FQHC)	$0	$17.1M
Riverside Assisted Living Soldotna, Inc.	AK	Assisted Living Facility	$0	$11.2M
Central Peninsula General Hospital, Inc	AK	Community/Behavioral Health Agency	$0	$5.9M
Riverquest Group Home, Inc.	AK	Respite Care	$0	$4.4M
Aaa Alaska Cab, Inc.	AK	Taxi	$0	$3.8M
Central Peninsula General Hospital, Inc	AK	Community/Behavioral Health Agency	$0	$2.6M
Kenai Peninsula Borough	AK	Land Ambulance	$780K	$1.4M

Upstream Family Medicine Inc — Billing Profile & Reimbursement Data

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Upstream Family Medicine Inc — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

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