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

Why is the Medicaid comparison limited to Unspecified Location 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. Unspecified Location (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.

Kenneth Williams (NPI 1093784449)

NPI 1093784449 · Apo, XX · Certified Registered Nurse Anesthetist

Kenneth Williams is a certified registered nurse anesthetist provider located in Apo, Unspecified Location. This profile covers 1 Medicare and 0 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services. Note: "XX" is a placeholder CMS uses when a provider's practice-location state wasn't reported — not a traditional US state; claims coded under it are grouped and benchmarked here the same way a traditional state would be.

NPI 1093784449 · Apo, XX · Certified Registered Nurse Anesthetist

Provider details (source: NPPES NPI Registry)

Field	Value
Entity Type	Individual
Organization	Kenneth Williams
Address	Psc 103 Box 3527
City	Apo
State	XX (Unspecified Location)
ZIP	AE
Taxonomy	Certified Registered Nurse Anesthetist
NPI Enumerated	March 17, 2006

Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)

Payer Source	Total Paid
Medicare	$1.7K
Medicaid	$0

This provider is a Certified Registered Nurse Anesthetist whose Medicare billing is almost exclusively linked to anesthesia for upper gastrointestinal endoscopic procedures, as evidenced by the presence of code 00731 as the top Medicare code. The code description and mix indicate the professional practice is focused on anesthesia services for endoscopic procedures rather than a broader surgical anesthesia portfolio, suggesting work in endoscopy suites or peri-endoscopic settings.

Medicare revenue is very small in absolute terms at $1.7K, generated across 15 claims with an average paid per claim of $112; the entire Medicare revenue base is concentrated in a single clinical service line. Precomputed code concentration shows the top 3 Medicare codes account for 100.0% of this provider's Medicare revenue, indicating extreme revenue concentration in a narrow set of anesthesia services.

Payer mix is effectively single-payer: Medicare revenue is $1.7K while Medicaid revenue is none — this provider has no Medicaid billing on file. The absence of Medicaid activity suggests either the provider does not participate in Medicaid, does not treat a Medicaid population, or does not submit services to Medicaid, limiting exposure to dual-payer dynamics.

On national competitive standing for the leading code 00731, this provider ranks #27713 of 39088 providers nationally (24th percentile; typical, unremarkable volume for this code). That percentile and rank imply the provider is a modest participant in the Medicare market for this procedure type rather than a dominant or high-volume national performer.

The 00731 line item is explicitly characterized in the source data as "typical, unremarkable volume for this code," which aligns with the low claim count (15 claims) and modest aggregate Medicare revenue. From a utilization analytics perspective, there are no statistical outlier signals in volume for this code — activity levels fall within normal ranges nationally.

The provider’s NPI was enumerated on 2006-03-17 (~20 years ago), indicating a long-tenured enrollment in Medicare even though current billed Medicare dollars are minimal. Longevity on the enrollment file paired with low recent Medicare revenue could reflect limited clinical hours, partial retirement, locum tenens usage, or a narrow scope of billed services.

From an operations and risk perspective, the combination of a narrow CPT mix (00731 dominant), small Medicare revenue ($1.7K), and no Medicaid billing increases sensitivity to changes in reimbursement, credentialing, or referral patterns for endoscopic anesthesia. Any payer, contract, or practice changes affecting endoscopy anesthesia reimbursement or volume could materially alter this provider’s revenue profile given the 100.0% concentration in the top codes.

Medicare revenue breakdown by CPT/HCPCS procedure code.

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

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
00731	The anesthesia provider performs anesthesia services for an unspecified type of upper gastrointestinal endoscopic procedure during which another provider introduces the endoscope to but not beyond…	20	$110	$1.7K

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 1 CPT/HCPCS codes. Note: this provider's state, "XX," is a placeholder CMS uses when a provider's practice-location state wasn't reported — not a traditional US state; the State panel below benchmarks against other providers coded under the same designation.

Full comparison — all codes billed, vs. state median

Kenneth Williams — Billing Profile & Reimbursement Data

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Kenneth Williams — 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

Frequently Asked Questions

References