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

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

Bayhealth Emergency Physicians LLC (NPI 1073012696)

Key Findings

Field	Value
Entity Type	Organization
Organization	Bayhealth Emergency Physicians LLC
Address	640 S State St
City	Dover
State	DE
ZIP	19901
Taxonomy	Emergency Medicine Physician
NPI Enumerated	February 9, 2018

Payer Source	Total Paid
Medicaid	$16.7M
Medicare	$0

This entity bills exclusively to Medicaid in the available file set: there is no Medicare revenue on record and total Medicaid revenue is $16.7M, so the provider functions, for this dataset, as effectively a single-payer (Medicaid) operation. The absence of Medicare billing on file should be considered when comparing to mixed-payer peers, since national Medicare footprints and benchmarks will not apply.

Revenue is highly concentrated in three emergency/critical-care codes: 99285 ($7.7M, 46.3%), 99284 ($5.9M, 35.1%) and 99291 ($1.4M, 8.3%), which together account for 89.7% of the provider's Medicaid revenue. This concentration implies that a small set of high-acuity ED and critical-care services drive nearly all billed Medicaid dollars, making overall revenue sensitive to utilization shifts or reimbursement changes for those codes.

The code mix and descriptions indicate an emergency-department–focused service line with heavy high-acuity care and on-site critical interventions. High volumes of 99285 (84.1K claims, $92 avg paid/claim) and 99284 (86.4K claims, $68 avg paid/claim) show routine handling of complex and moderately complex ED cases, while 99291 (11.2K claims, $124 avg paid/claim) signals meaningful delivery of documented critical care services in emergency settings. Ancillary procedure codes such as 31500 (434 claims, $59 avg paid/claim) and wound-repair codes (12001, 12011) further support an operational profile centered on acute, procedural emergency care.

Competitive standing for the highest-acuity ED visits is strong: 99285 ranks #2 of 31 providers in-state and sits in the 97th percentile, characterized in the source as "notably above typical state volume for this code." That ranking indicates this provider is a major statewide participant for very high–complexity ED evaluations and is likely a go-to option for severe emergency presentations relative to peers.

For moderate-complexity ED visits the provider is also a top performer: 99284 ranks #3 of 35 providers in-state and is in the 94th percentile, again labeled "notably above typical state volume for this code." This suggests the group handles a large share of moderate-acuity emergency work in-state and competes near the top of peers for that service line.

Critical care delivery (99291) is another pronounced strength: the code ranks #2 of 24 providers in-state and is in the 96th percentile, described as "notably above typical state volume for this code." This elevated position for 99291, together with substantial 99285 and 99284 volumes, confirms the practice's role in managing patients with life‑threatening conditions and delivering time‑intensive critical interventions.

Lower-acuity ED visits and smaller procedural items account for only a small portion of revenue but are present and consistent with an ED practice that also handles minor procedures. For example, 99283 generates $1.1M (6.4% of Medicaid revenue) and ranks #7 of 26 (76th percentile; typical), while wound-repair and incision-and-drainage codes such as 12001 ($62.6K), 12011 ($53.4K) and 10061 ($63.9K) rank as high as #1 in-state for their categories but together represent a modest share of total revenue. These datapoints indicate routine provision of lower-acuity procedural care in addition to the dominant high-acuity services.

The provider's NPI was enumerated on 2018-02-09 (~8 years ago), indicating a multi-year presence in the market. Combined with the high statewide ranks on key ED and critical-care codes, this tenure supports a picture of an established emergency medicine group with substantial market penetration in Delaware Medicaid emergency services.

Medicaid: Complete Services Breakdown

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

14 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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.	84,140	$90	$7.7M
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.	86,390	$70	$5.9M
99291	Critical care services include the treatment of vital organ failure or prevention of further life–threatening conditions. Delivering medical care in a moment of crisis and in time of emergency is…	11,200	$120	$1.4M
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.	34,600	$30	$1.1M
99053	The provider renders overnight services at a 24 hour facility.	45,380	$10	$363.1K
10061	The provider incises the area of abscess and drains the collection of pus, such as those related to a carbuncle, hidradenitis, cyst, furuncle, or paronychia, with the help of surgical instruments. A…	680	$90	$63.9K
12001	This CPT code is used for the simple repair of superficial wounds to the scalp, neck, axillae, external genitalia, trunk, and/or extremities (including the hands and feet) that are 2.5 cm or less in…	1,460	$40	$62.6K
12011	This CPT code is used for the simple repair of superficial wounds to the face, ears, eyelids, nose, lips, and/or mucous membranes, that are 2.5 cm or less in size.	1,160	$50	$53.4K
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.	1,840	$20	$40.4K
31500	The provider inserts a flexible tube into the trachea (windpipe) typically via the mouth in an emergency situation to maintain an open airway in a patient with a compromised airway.	430	$60	$25.6K

Showing 1–10 of 14

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Delaware Distribution

Bayhealth Emergency Physicians LLC — 7 of 14 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Delaware

Full comparison — all codes billed, vs. Delaware median

14 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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.	7	30	11,180	$110	$3.4M
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.	3	40	770	$110	$1.9M
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.	2	30	1,350	$110	$1.5M
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.	11	20	4,570	$120	$1.4M
99291	Critical care services include the treatment of vital organ failure or prevention of further life–threatening conditions. Delivering medical care in a moment of crisis and in time of emergency is…	2	20	1,350	$120	$348.4K
99053	The provider renders overnight services at a 24 hour facility.	1	10	21,310	$10	$165.1K
99292	Critical care services include the treatment of vital organ failure or prevention of further life–threatening conditions. Delivering medical care in a moment of crisis and in time of emergency is…	2	10	190	$150	$97.4K
10061	The provider incises the area of abscess and drains the collection of pus, such as those related to a carbuncle, hidradenitis, cyst, furuncle, or paronychia, with the help of surgical instruments. A…	2	10	490	$90	$60K
12011	This CPT code is used for the simple repair of superficial wounds to the face, ears, eyelids, nose, lips, and/or mucous membranes, that are 2.5 cm or less in size.	1	10	740	$80	$45.6K
31500	The provider inserts a flexible tube into the trachea (windpipe) typically via the mouth in an emergency situation to maintain an open airway in a patient with a compromised airway.	2	10	380	$60	$24.2K

Showing 1–10 of 14

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Tyler Yerkes	DE	Physician Assistant	$1.1M	$0
Sharad Patel	DE	Family Medicine Physician	$337.6K	$0
Islam Al Junaidi	DE	Internal Medicine Physician	$222.6K	$0
Adam Corman	GA	Emergency Medicine Physician	$39.9K	$161.9K
Alvaro Toledo Rivera	PA	Internal Medicine Physician	$201.4K	$0
Bryan Choi	RI	Emergency Medicine Physician	$77.9K	$58.9K
Emily Sluzas	DE	Emergency Medicine Physician	$135.2K	$0
Robert Fumento	DE	Emergency Medicine Physician	$129.3K	$0
Scott Schaeffer	DE	General Practice Physician	$125.4K	$0
Lindsay Albanese	DE	Emergency Medicine Physician	$119.2K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Bayhealth Medical Center, Inc.	DE	General Acute Care Hospital	$0	$79.3M
Ahl And O'connor Orthodontics, LLC	DE	Orthodontics and Dentofacial Orthopedics Dentistry	$0	$12.5M
Bayhealth Medical Center, Inc	DE	Colon & Rectal Surgery Physician	$0	$12.4M
State Of Delaware	DE	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$8.2M
The Children's Secret Garden	DE	Medically Fragile Infants and Children Day Care	$0	$8.1M
Apogee Medical Group, Delaware, Inc	DE	Internal Medicine Physician	$0	$7.9M
First State Oral And Maxillofacial Surgery Corp	DE	Oral and Maxillofacial Surgery (Dentist)	$0	$5M
Jamie Ahl	DE	Orthodontics and Dentofacial Orthopedics Dentistry	$0	$4.9M
Kent Diagnostic Radiology Associates PA	DE	Diagnostic Radiology Physician	$0	$4.6M
The Mind And Body Consortium, LLC.	DE	Psychiatry Physician	$0	$3.9M

Bayhealth Emergency Physicians LLC — 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