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NPI 1104054261 · Providence, RI · Family Medicine Physician
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Sheldon Malcolm is a family medicine physician provider located in Providence, Rhode Island. This profile covers 2 Medicare and 26 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.
Provider details (source: NPPES NPI Registry)
| Field | Value |
|---|---|
| Entity Type | Individual |
| Organization | Sheldon Malcolm |
| Address | 355 Prairie Ave |
| City | Providence |
| State | RI |
| ZIP | 02905 |
| Taxonomy | Family Medicine Physician |
| NPI Enumerated | June 29, 2009 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $416.1K |
| Medicare | $350 |
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
2 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 83036 | Sugar in the bloodstream can get attached to the hemoglobin in red blood cells. Once the sugar is attached, it stays there for the lifetime of the red blood cell (around 120 days or over 3 months).… | 30 | $10 | $270 |
| 82962 | Blood glucose monitoring at home with small electronic devices is an easy method to check blood sugar level on a daily basis. The patient himself can perform the procedure and the result is obtained… | 30 | $1 | $80 |
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 2 CPT/HCPCS codes.
Medicaid revenue breakdown by year and by CPT/HCPCS procedure code, including monthly billing trends and the top codes driving revenue.
View: By Year1 / 3
Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.
26 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… | 2,820 | $60 | $180.2K |
| 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… | 3,680 | $40 | $161.7K |
| 99212 | The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,… | 600 | $30 | $17.3K |
| 99396 | The provider performs an established well–patient visit for a patient who is between the ages of 40 and 64. | 170 | $70 | $11.5K |
| G0467 | Federally qualified health center (fqhc) visit, established patient; a medically-necessary, face-to-face encounter (one-on-one) between an established patient and a fqhc practitioner during which… | 60 | $180 | $10.7K |
| T1015 | Clinic visit/encounter, all-inclusive | 60 | $160 | $9.2K |
| 77067 | The provider takes two X–ray views of each breast for routine screening and may use specially designed computer software to help identify any potential abnormalities within the images; the software… | 40 | $120 | $5.3K |
| 83036 | Sugar in the bloodstream can get attached to the hemoglobin in red blood cells. Once the sugar is attached, it stays there for the lifetime of the red blood cell (around 120 days or over 3 months).… | 490 | $10 | $2.9K |
| 90471 | In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route. | 330 | $10 | $2.9K |
| 93000 | The provider records the electrical conduction of the heart to examine any abnormality in its functioning, based on signals from at least 12 leads, wires that connect the recording device to… | 170 | $20 | $2.6K |
Showing 1–10 of 26
How this provider's Medicaid billing volume and revenue compare to other Rhode Island providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Rhode Island median
26 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| T1015 | Clinic visit/encounter, all-inclusive | 86 | 120 | 400 | $130 | $896.9K |
| 80050 | The lab analyst performs testing for the specific group of clinical laboratory procedures in the general health panel. Payers typically consider 80050 to apply only when the clinician orders the… | 43 | 50 | 50 | $50 | $168.1K |
| 77067 | The provider takes two X–ray views of each breast for routine screening and may use specially designed computer software to help identify any potential abnormalities within the images; the software… | 40 | 50 | 450 | $70 | $152.4K |
| 80053 | The lab analyst performs a comprehensive metabolic panel, or CMP test in which he measures the blood level of 14 chemicals the code descriptor lists for the panel. | 110 | 140 | 140 | $30 | $99.7K |
| 85025 | A complete blood count (better known as a CBC) is a blood test request by a doctor that provides detailed information about various types of cells in a patient's blood. Usually a pathologist or a… | 127 | 290 | 100 | $30 | $88K |
| 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… | 117 | 1,730 | 220 | $70 | $75.2K |
| 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… | 147 | 2,050 | 300 | $50 | $72.3K |
| 77063 | The provider captures three dimensional images of the breast using X–rays at various angles for routine checkup. He checks for the presence of any abnormality within the breasts. Tomosynthesis… | 36 | 50 | 430 | $30 | $47K |
| 82962 | Blood glucose monitoring at home with small electronic devices is an easy method to check blood sugar level on a daily basis. The patient himself can perform the procedure and the result is obtained… | 15 | 50 | 110 | $60 | $42K |
| 99203 | The provider sees a new 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 provider… | 292 | 350 | 80 | $90 | $40.5K |
Showing 1–10 of 26
Other providers in the same ZIP code as Sheldon Malcolm, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Women & Infants Hospital Of Rhode Island | RI | General Acute Care Hospital | $0 | $132.1M |
| Elmwood Home Care, Inc. | RI | Home Health Agency | $0 | $38.6M |
| H&t Medicals, Inc | RI | Home Health Agency | $0 | $14.8M |
| R.i.s.a.t., LLC | RI | Methadone Clinic | $321.1K | $14M |
| Meeting Street Center | RI | Early Intervention Provider Agency | $0 | $13.8M |
| Rhode Island Hospital | RI | End-Stage Renal Disease (ESRD) Treatment Clinic/Center | $0 | $13.2M |
| Women And Infants Hospital | RI | General Acute Care Hospital | $0 | $12.6M |
| Renaissance Adhc, LLC | RI | Adult Day Care Clinic/Center | $0 | $7.4M |
| Catherine Allen | RI | Mental Health Counselor | $0 | $7.4M |
| University Orthopedics, Inc. | RI | Orthopaedic Surgery Physician | $0 | $5.3M |
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