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

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

Suzanne Sexton (NPI 1104009190)

Field	Value
Entity Type	Individual
Organization	Suzanne Sexton
Address	15675 Avenida Alcachofa Apt B
City	San Diego
State	CA
ZIP	92128
Taxonomy	Clinical Social Worker
NPI Enumerated	December 12, 2007

Payer Source	Total Paid
Medicare	$26.2K
Medicaid	$0

Key Findings

This provider’s Medicare activity is concentrated in psychotherapy and psychiatric evaluation services, with 90837 (long psychotherapy, 53+ minutes) and 90791 (psychiatric evaluation) together accounting for the entirety of recorded Medicare billings. The top-3 Medicare codes are precomputed to account for 100.0% of this provider's total Medicare revenue, underscoring a narrow service mix centered on outpatient behavioral health.

90837 is the dominant revenue driver on Medicare: 284 claims produced $24.4K in revenue, representing 92.9% of this provider's total Medicare revenue, with an average paid per claim of $86. This high share indicates day-to-day operations are primarily long psychotherapy visits rather than a broader set of procedures.

90791 represents a much smaller portion of Medicare revenue: 20 claims generated $1.9K (7.1% of Medicare revenue) with an average paid per claim of $94. The lower claim count relative to 90837 suggests relatively few intake or diagnostic evaluations compared with ongoing therapy follow-ups.

Payer mix is effectively single-payer at the listed levels: total Medicare revenue is $26.2K while there is no Medicaid billing on file. This provider should be treated as operating largely within the Medicare market for the available claims period rather than as a mixed Medicaid/Medicare practice.

Competitive standing on 90837 is modest: the provider ranks #4186 of 15257 providers nationally (72th percentile; typical, unremarkable volume for this code), which indicates a typical volume profile rather than market dominance for that service. Similarly, 90791 ranks #5854 of 11185 providers nationally (45th percentile; typical, unremarkable volume for this code), reinforcing a profile of a modest, locally focused practitioner.

Tenure is long-established: the NPI was enumerated on 2007-12-12 (~19 years ago), indicating sustained presence in the provider market and the potential for an established patient panel that produces recurring psychotherapy visits. This duration supports the observed pattern of recurring long psychotherapy sessions relative to intake evaluations.

Two operational details stand out for analysts: the average paid per claim for 90791 ($94) is higher than for 90837 ($86), suggesting evaluations reimburse slightly more per instance, and yet 90837 drives the bulk of revenue by volume. Combined with 90837’s 284 claims versus 90791’s 20 claims, the practice appears to derive revenue mainly from repeat, longer psychotherapy sessions rather than frequent new-patient evaluations.

Medicare: Complete Services Breakdown

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

2 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
90837	In this service, the provider performs psychotherapy, a series of technique for treating the psychiatric disorders of the patient. The treatment session typically lasts for a minimum of 53 minutes or…	280	$90	$24.4K
90791	In this service, the provider performs a psychiatric evaluation of the patient with the aim of making a diagnosis.	20	$90	$1.9K

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 2 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. California Distribution

Suzanne Sexton — 0 of 2 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — California

Full comparison — all codes billed, vs. state median

2 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
90837	1	1,430	270	$110	$37.7K
90791	1	840	20	$130	$8.4K

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Elizabeth Merryfield	PA	Psychologist	$144.9K	$0
James Jacobs	ME	Clinical Psychologist	$142.4K	$0
Rachel Salerno	FL	Clinical Psychologist	$123.6K	$0
Patricia Greene Hall	MT	Clinical Psychologist	$92.1K	$0
Christina Price	IN	Clinical Social Worker	$86.5K	$0
Kevin Fall	KS	Psychologist	$77.1K	$0
Valerie Modirpour	NV	Psychologist	$71.1K	$0
Sidney Sebastian	KY	Clinical Social Worker	$69.1K	$0
Marni Seyyid	DE	Clinical Social Worker	$59.8K	$0
Gina Porter	AL	Clinical Social Worker	$41.4K	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Laboratory Corporation Of America	CA	Clinical Medical Laboratory	$59.8M	$147.2M
Laboratory Corporation Of America	CA	Clinical Medical Laboratory	$1.1M	$11.4M
Phamatech Incorporated	CA	Clinical Medical Laboratory	$812.9K	$3.2M
Scripps Health	CA	Ambulatory Surgical Clinic/Center	$1.5M	$0
Scripps Clinic Medical Laboratories	CA	Clinical Medical Laboratory	$414.6K	$490
Anil Patel	CA	Cardiovascular Disease Physician	$279.9K	$0
Namee Kim	CA	Cardiovascular Disease Physician	$274K	$0
Malhar Patel	CA	Cardiovascular Disease Physician	$242.4K	$0
Ryan Frederiksen	CA	Diagnostic Radiology Physician	$210.5K	$1.6K
David Lee	CA	Diagnostic Radiology Physician	$141K	$0

Suzanne Sexton — Billing Profile & Reimbursement Data

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Suzanne Sexton — 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