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

Why is the Medicaid comparison limited to Rhode Island 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. Rhode Island (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.

Michael Prodromou (NPI 1093009086)

Key Findings

Field	Value
Entity Type	Individual
Organization	Michael Prodromou
Address	593 Eddy St
City	Providence
State	RI
ZIP	02903
Taxonomy	Internal Medicine Physician
NPI Enumerated	June 7, 2011

Payer Source	Total Paid
Medicare	$252.1K
Medicaid	$0

This provider’s Medicare billing is concentrated in office and hospital E/M care: the top three Medicare codes (99214, 99232, 99223) together account for 68.4% of total Medicare revenue, indicating the practice’s revenue is driven primarily by evaluation-and-management encounters across outpatient and inpatient settings. The mix (established outpatient visits, subsequent and initial hospital inpatient/observation visits) suggests a clinician working both clinic and inpatient service-lines rather than a procedure-focused practice.

Revenue scale is modest but meaningful: lifetime Medicare revenue is reported as $252.1K while there is no Medicaid billing on file. This pattern makes the provider effectively single-payer (Medicare) in the available data, with no recorded Medicaid contribution to revenue.

99214 dominates the provider’s Medicare mix with $93K in revenue (36.8% of Medicare revenue) and 802 claims, and is described as "notably above typical national volume for this code" (96th percentile). That percentile position and claim volume indicate the provider sees a high volume of established outpatient visits relative to national peers, consistent with a strong outpatient panel or regular primary care follow-up practice.

The provider’s inpatient E/M billing is also substantial: 99232 accounts for $51.6K (20.4% of Medicare revenue) and 697 claims, ranking in the 95th percentile nationally for this code and labeled as typical/unremarkable volume by the dataset. Combined with 99223 at $28K (11.1% of Medicare revenue, 92nd percentile), these codes show the clinician provides both initial and subsequent inpatient care at levels above many peers, supporting a mixed ambulatory-inpatient role.

Several pulmonary function testing codes (94729, 94726, 94060, 94010) appear in the top codes list, collectively contributing a nontrivial share of revenue (individual revenues range from $10.6K to $2.3K). Their presence suggests the provider’s practice includes respiratory testing services (DLCO, full PFTs, spirometry with bronchodilator), either performed in-office or via an aligned testing service, which diversifies revenue beyond E/M visits.

Competitive standing by national rank is mixed: for the highest-volume outpatient code 99214 the provider is in the 96th percentile and described as notably above typical national volume, indicating a strong standing nationally for that service line. Other high-volume codes like 99232 and 99223 sit in the 95th and 92nd percentiles respectively and are characterized as typical or unremarkable volume even at those percentiles, reflecting that while the provider is comparatively high-volume, these are common services with many high-volume peers.

Tenure data show the provider’s NPI was enumerated on 2011-06-07, approximately 15 years ago, indicating a stable, long-established presence in the market. That tenure aligns with the steady flow of E/M encounters and the development of ancillary testing lines such as PFTs reflected in the billing mix.

There is no Medicaid billing on file (dataset states "none below" for Medicaid codes), so any analysis of payer mix must note an absence of Medicaid activity. For payer strategy or network contracting, this provider would be treated operationally as a Medicare-focused billing entity in the available records.

Low-value and ancillary services generate only a small fraction of reported revenue: codes such as 36415 (blood draw) and several spirometry entries appear at the bottom of the top-25 list with individual revenues under $3K, confirming the practice’s primary revenue drivers remain E/M visits rather than minor ancillary procedures.

Medicare: Complete Services Breakdown

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

13 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…	800	$120	$93K
99232	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	700	$70	$51.6K
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…	170	$160	$28K
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…	160	$160	$25.3K
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…	100	$170	$16.8K
94729	In this add on procedure, the provider tests the lungs’ diffusing capacity, the ability to exchange gases, moving oxygen into the bloodstream and letting in carbon dioxide from the bloodstream.	190	$60	$10.6K
94726	The provider performs a pulmonary function test, or PFT, to determine the patient’s lung volumes, such as total lung capacity, residual volume, and functional residual capacity. The testing also may…	190	$50	$9.7K
99205	The provider sees a new 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 provider…	30	$210	$6.2K
94060	The spirometry test is performed with a spirometer. The instrument displays a graphical representation, known as a spirogram, of the test results. The basic forced volume vital capacity (FVC) test is…	100	$40	$3.6K
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…	30	$110	$2.8K

Showing 1–10 of 13

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Ron Rosen	NY	Nuclear Medicine Physician	$2.4M	$8.9K
Sherif Heiba	NY	Nuclear Medicine Physician	$1.7M	$18.5K
Joshua Harris	NY	Hematology & Oncology Physician	$1.6M	$62.3K
Jahan Aghalar	NY	Internal Medicine Physician	$1.6M	$26.8K
Sunil Mehra	NY	Pulmonary Disease Physician	$393.1K	$1.1M
Todd Coven	NY	MOHS-Micrographic Surgery Physician	$1.5M	$0
Elizabeth Small	NY	Ophthalmology Physician	$1.2M	$0
Alyssa Rehm	NY	Neurology Physician	$1.2M	$0
Gurmohan Syali	NY	Medical Oncology Physician	$1.1M	$69.2K
Evan Diamond	NY	Hematology & Oncology Physician	$1.1M	$3.7K

Michael Prodromou — Billing Profile & Reimbursement Data

Sign up for Michael Prodromou — Billing Profile & Reimbursement Data policy alerts

Michael Prodromou — Billing Profile & Reimbursement Data

Sign up for Michael Prodromou — Billing Profile & Reimbursement Data policy alerts

Key Findings

Medicare: Total Revenue Breakdown by CPT/HCPCS Code

Medicare: Complete Services Breakdown

Medicare: Competitive Analysis & Benchmarks

Related Providers

Frequently Asked Questions

References

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99214	15	1,950	100	$80	$11.7K
36415	40	50	60	$10	$9.8K
99233	365	470	60	$90	$9.1K
99232	6	650	70	$60	$7.7K
99223	15	540	30	$130	$6.4K
99215	57	460	30	$110	$5.7K
99204	12	740	30	$110	$4.6K
99205	60	200	20	$150	$4.2K
94729	7	40	60	$20	$2.6K
94726	4	30	50	$30	$2.4K