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

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

Docs Medical Inc (NPI 1104362169)

Key Findings

Field	Value
Entity Type	Organization
Organization	Docs Medical Inc
Address	317 Foxon Road 2b
City	East Haven
State	CT
ZIP	06513
Taxonomy	Family Medicine Physician
NPI Enumerated	January 16, 2017

Payer Source	Total Paid
Medicaid	$33.5M
Medicare	$0

DOCS MEDICAL INC reports no Medicare billing on file and $33.5M in lifetime Medicaid revenue, making its public payer footprint effectively single‑payer Medicaid; the provider’s NPI was enumerated on 2017-01-16 (~9 years ago), indicating it has been active under this identifier for several years. This payer concentration should frame any analysis of patient mix, reimbursement risk, and contracting leverage since Medicare data are absent.

Revenue is highly concentrated in ambulatory evaluation-and-management services: the top three Medicaid codes (99213, 99203, 99214) account for 49.6% of the provider’s total Medicaid revenue. Specifically, 99213 generated $7.1M (21.4%), 99203 generated $5.7M (17.1%), and 99214 generated $3.7M (11.1%), signaling that routine office visits drive roughly half of reported Medicaid revenues.

The code mix and taxonomy (Family Medicine Physician) indicate a high-volume primary care/ambulatory clinic model with unusually large new-patient throughput: 99203 (new patient) contributed $5.7M and ranks as an extreme outlier (#3 of 475 providers in-state, 100th percentile). The presence of multiple new-patient codes with substantial revenue — including 99204 ($2.3M, ranks #5 of 476, 99th percentile) and 99202 ($895K, ranks #2 of 177, 99th percentile) — supports an operational profile that prioritizes initial evaluations and intake visits at scale.

DOCS MEDICAL operates significant on-site or affiliated diagnostic testing activity: 87635 contributed $3.4M (10.3%) and ranks #2 of 140 providers in-state (99th percentile; extreme outlier), while 87426 contributed $1.5M (4.6%) and also ranks as an extreme outlier (#2 of 89, 99th percentile). Additional test codes with notable revenue include 0241U ($3.4M, 10.2%, ranks #1 of 38, 100th percentile) and U0002 ($45.9K), indicating a meaningful ancillary testing line (large COVID and multiplex testing volumes).

Allergy-related services form a secondary procedural revenue stream: 95165 (antigen preparation for immunotherapy) generated $1.9M (5.8%) and ranks #3 of 32 providers in-state (94th percentile), and 95004 (percutaneous allergy skin test) produced $258K (0.8%). These code-level revenues suggest the practice includes allergen immunotherapy preparation and testing capabilities beyond routine primary care visits.

Several common, lower-intensity office visit codes show very high claim volumes consistent with a high-throughput clinic workflow: 99212 tallied 44.3K claims for $1.4M (4.1%) and ranks #4 of 577 providers in-state (99th percentile; extreme outlier), while 99211 reported 12.8K claims for $269.6K (0.8%). The mix of very large volumes of brief established-patient visits alongside higher-level new-patient visits points to a business model balancing quick follow-ups and intake encounters.

State-level competitive standing is dominant for multiple codes: 99213 ranks #20 of 1714 in-state (99th percentile; labeled an extreme outlier, far above typical state volume), 0241U ranks #1 of 38 (100th percentile; extreme outlier), and several test codes (87635, 87426) also rank in the top 2 within their peer sets. Collectively, these ranks indicate DOCS MEDICAL is a major Medicaid volume generator in Connecticut for both ambulatory E&M and certain diagnostic services.

For payer strategy and risk assessment, the absence of Medicare revenue paired with concentrated Medicaid exposure (total $33.5M) means payer negotiations, utilization management, and any quality or cost metrics will be highly sensitive to Medicaid policy changes and coding mix. The provider’s ~9-year NPI tenure suggests an established operation, but analysts should treat Medicare-level benchmarking as inapplicable due to no Medicare billing on file.

Medicaid: Complete Services Breakdown

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

80 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	137,470	$50	$7.1M
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…	74,930	$80	$5.7M
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…	42,910	$90	$3.7M
87635	Using an amplified nucleic acid probe technique, the lab analyst performs the necessary steps to identify the nucleic acids from the severe acute respiratory syndrome coronavirus 2 (SARS–COV–2) virus…	76,560	$50	$3.4M
0241U	N/A	29,970	$110	$3.4M
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…	16,310	$140	$2.3M
95165	In this procedure, the provider mixes and prepares the antigens for allergen immunotherapy. Use this code when the provider prepares one or more antigens.	10,880	$180	$1.9M
87426	The lab analyst performs an immunoassay to qualitatively or semiquantitatively evaluate the patient blood specimen for antigens of severe acute respiratory syndrome coronavirus such as SARS–CoV–2,…	54,430	$30	$1.5M
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,…	44,280	$30	$1.4M
99202	The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves straightforward medical decision making, and/or the provider…	16,890	$50	$895K

Showing 1–10 of 80

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Connecticut Distribution

Docs Medical Inc — 13 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Connecticut

Full comparison — all codes billed, vs. Connecticut median

80 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
95004	The provider performs a percutaneous test with allergenic extracts to determine which substances (allergens) trigger an allergic reaction in the patient.	11	30	530	$320	$553.7K
0241U	N/A	1	40	1,300	$110	$523.5K
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…	36	1,590	740	$50	$331.8K
71046	In this diagnostic procedure, the provider performs a minimum of two radiological views of the chest. He performs this study for the assessment of conditions affecting the chest, its contents, and…	87	130	600	$30	$329.2K
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…	20	1,710	750	$30	$243.3K
87637	The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, influenza B, and respiratory syncytial virus (RSV)…	22	40	790	$100	$237.2K
95165	In this procedure, the provider mixes and prepares the antigens for allergen immunotherapy. Use this code when the provider prepares one or more antigens.	3	30	1,490	$60	$213.6K
87635	Using an amplified nucleic acid probe technique, the lab analyst performs the necessary steps to identify the nucleic acids from the severe acute respiratory syndrome coronavirus 2 (SARS–COV–2) virus…	2	140	780	$40	$163.2K
90460	In this procedure, the provider administers a single live attenuated vaccine through a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age.	214	240	1,560	$20	$159.4K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	161	180	710	$70	$151.2K

Showing 1–10 of 80

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Evan Levine	CT	Cardiovascular Disease Physician	$135.7K	$450
Janki Sharma	CT	Family Medicine Physician	$101.7K	$0
Rohit Ramanath	NJ	General Practice Physician	$89.1K	$0
Jasdeep Sidana	CT	Pulmonary Disease Physician	$77.6K	$2.9K
Rex Mahnensmith	CT	Internal Medicine Physician	$64.9K	$0
James Marshall	CT	Internal Medicine Physician	$43.5K	$0
Hillary Iweorah	CT	Physician Assistant	$20.1K	$0
Deborah Branco	MA	Medical Physician Assistant	$14.9K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
American Medical Response Of Connecticut Incorporated	CT	Ambulance	$13.2M	$129.5M
Fair Haven Community Health Clinic Inc	CT	Federally Qualified Health Center (FQHC)	$0	$83.7M
Utopia Home Care Inc	CT	Home Health Agency	$0	$81.4M
Utopia Assisted Living Services	CT	Assisted Living Facility	$0	$5.3M
Fair Haven Community Health Clinic, Inc	CT	Federally Qualified Health Center (FQHC)	$0	$3.1M
New Haven Family Dental Group LLC	CT	Dentist	$0	$2M
Dr. Dental Of East Haven, PC	CT	General Practice Dentistry	$0	$1.8M
Catholic Charities, Inc. - Archdiocese Of Hartford	CT	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$1.6M
The Mary Wade Home, Incorporated	CT	Skilled Nursing Facility	$0	$1.5M
Holistic Health & Healing Center LLC	CT	Clinical Social Worker	$0	$1.4M

Docs Medical Inc — 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