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

Why is the Medicaid comparison limited to New Mexico 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. New Mexico (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.

Presbyterian Healthcare Services (NPI 1104802354)

Key Findings

Field	Value
Entity Type	Organization
Organization	Presbyterian Healthcare Services
Address	5901 Harper Dr Ne
City	Albuquerque
State	NM
ZIP	87109
Taxonomy	Internal Medicine Physician
NPI Enumerated	December 20, 2005

Payer Source	Total Paid
Medicaid	$240.8M
Medicare	$0

PRESBYTERIAN HEALTHCARE SERVICES shows effectively single-payer billing activity: there is no Medicare revenue on file while Medicaid revenue totals $240.8M. This profile indicates the organization’s patient mix or billing focus is concentrated in Medicaid populations rather than traditional Medicare beneficiaries, which has operational implications for reimbursement levels, care management programs, and payer contracting priorities.

Revenue concentration is high: the top 3 Medicaid codes by revenue account for 56.0% of the provider’s total Medicaid revenue, indicating that a relatively small set of services—primarily office/outpatient E/M and high-acuity ED care—drive the majority of its Medicaid billing. This concentration suggests operational dependence on ambulatory established-patient visits and emergency/acute care E/M services for financial performance.

The single largest Medicaid revenue source is 99214 (office/outpatient established patient, moderate complexity), generating $66.5M or 33.9% of the provider’s Medicaid revenue and ranking #1 of 963 in-state at the 100th percentile; the dataset explicitly labels this as an extreme outlier. That dominance shows the organization operates at very high volume for routine established-patient primary care visits relative to in-state peers, implying a large ambulatory network or system-scale primary care footprint that services Medicaid enrollees intensively.

99213 (established patient, lower complexity) is also a major driver with $30.1M (15.3% of Medicaid revenue) and a #1 in-state ranking at the 100th percentile (extreme outlier). The paired prominence of 99214 and 99213 indicates a heavy emphasis on longitudinal outpatient management and high visit volumes across both moderate- and low-complexity established visit levels, reinforcing a primary care–centric operational model.

Emergency and high-acuity services are material but less dominant: 99285 (high complexity ED E/M) contributes $13.3M (6.8% of Medicaid revenue) and ranks #3 in-state (97th percentile, notably above typical state volume), while 99284 (moderate ED E/M) and 99283 (low ED E/M) appear lower in rank. These data indicate the provider also operates significant ED or acute-care throughput, positioning it as both a major ambulatory primary care provider and a substantial emergency services provider for Medicaid patients.

The provider is a statewide dominant competitor on many routine and preventive pediatric and adult preventive codes (for example 99391, 99392, 99393, 99394) and on multiple procedural and diagnostic items (e.g., 93306 echo, 87635 COVID PCR testing, 87651 Strep testing, and vaccine administration codes 90471/90472/90461), almost all ranking at the 100th percentile in-state and labeled as extreme outliers. This pattern indicates system-scale preventive care, immunization, and ambulatory diagnostic capacity that outpaces most in-state peers, consistent with a large integrated health system footprint.

Several high-cost injectable or biologic items appear in the mix (J0585 onabotulinumtoxina at $7.2M, ranked #1 in-state; J2357 omalizumab at $2.3M, ranked #2 of 3). The presence of these specialty drug codes alongside broad primary care and ED volume suggests the organization provides both routine outpatient services and selected specialty or procedure-based services at scale, including clinic-administered injections and biologic therapies.

Tenure on file is long: the NPI was enumerated ~21 years ago (2005-12-20), indicating an established operational history. Combined with the extremely high in-state ranks across many codes, this longevity supports the view that the provider represents a mature, large-scale healthcare delivery entity rather than a new or niche practice.

Overall competitive standing in-state is dominant for Medicaid: multiple top codes are at the 100th percentile and labeled as extreme outliers, and the provider holds top ranks across primary care E/M, preventive services, diagnostics, and certain specialty injections. The absence of Medicare billing limits cross-payer comparisons, but within Medicaid this entity appears to be a major system-level provider with concentrated revenue exposure to a narrow set of high-volume E/M and preventive codes.

Medicaid: Complete Services Breakdown

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

542 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…	792,010	$80	$66.5M
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…	469,940	$60	$30.1M
99285	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a high level of medical decision making.	96,720	$140	$13.3M
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…	81,460	$110	$8.8M
J0585	Injection, onabotulinumtoxina, 1 unit	16,460	$440	$7.2M
99391	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	70,540	$100	$7.2M
99284	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making.	65,120	$100	$6.4M
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…	127,040	$50	$6.4M
99392	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	60,540	$100	$6.1M
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…	36,850	$130	$4.9M

Showing 1–10 of 542

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. New Mexico Distribution

Presbyterian Healthcare Services — 22 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — New Mexico

Full comparison — all codes billed, vs. New Mexico median

542 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99284	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making.	7	80	12,050	$160	$3.9M
99285	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a high level of medical decision making.	3	70	6,920	$210	$3.5M
J0178	Injection, aflibercept, 1 mg	3	10	480	$1,280	$3.2M
99283	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a low level of medical decision making.	10	80	10,650	$130	$2.4M
J0585	Injection, onabotulinumtoxina, 1 unit	1	20	810	$520	$1.6M
J2357	Injection, omalizumab, 5 mg	2	10	1,200	$1,770	$1.4M
99480	The provider directs the care of a recovering low birth weight infant, whose current weight is between 2501 and 5000 grams.	5	10	6,420	$120	$1.1M
87636	The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, and influenza B using a multiplex amplified nucleic…	12	30	3,760	$120	$900.7K
76819	The provider performs a biophysical profile test to measure the health of the baby during pregnancy using only ultrasound and not a nonstress test.	19	30	380	$100	$796.5K
93303	The provider performs a complete transthoracic echocardiography to obtain images of the heart structures through the chest wall in patients born with heart defects. This study includes visualization…	2	10	1,400	$190	$748.4K

Showing 1–10 of 542

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Heritage Home Healthcare Services, Inc.	NM	Home Health Agency	$0	$141.5M
Home Medical Equipment Specialists LLC	NM	Durable Medical Equipment & Medical Supplies	$0	$100M
The New Beginnings LLC	NM	Adult Day Care Clinic/Center	$0	$85.1M
We Care Agency, Inc.	NM	In Home Supportive Care Agency	$0	$60.1M
Lovelace Health System, LLC	NM	General Acute Care Hospital	$0	$57.7M
Adelante Development Center, Inc.	NM	Personal Care Attendant	$0	$57M
Eye Associates Of New Mexico Ltd	NM	Ophthalmology Physician	$0	$46.9M
Southwest Labs LLC	NM	Clinical Medical Laboratory	$1.1M	$41.5M
Southwest Medical Associates, LLC	NM	General Practice Physician	$0	$41.4M
Tspc-nm, LLC	NM	Nursing Care Agency	$0	$28.9M

Presbyterian Healthcare Services — Billing Profile & Reimbursement Data

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Presbyterian Healthcare Services — 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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Presbyterian Healthcare Services	NM	General Acute Care Hospital	$0	$345.3M
Centra Medical Group, LLC	VA	Family Medicine Physician	$0	$60.1M
Presbyterian Healthcare Services	NM	Rural Acute Care Hospital	$0	$47.6M
Presbyterian Healthcare Services	NM	Rural Acute Care Hospital	$0	$40.9M
Presbyterian Healthcare Services	NM	Critical Access Hospital	$0	$33.1M
Presbyterian Healthcare Services	NM	General Acute Care Hospital	$0	$21.6M
Presbyterian Healthcare Services	NM	Critical Access Hospital	$0	$20.6M
Presbyterian Healthcare Services	NM	Critical Access Hospital	$0	$8.5M
Christopher Roybal	NM	Ophthalmology Physician	$3.8M	$0
Presbyterian Healthcare Services	NM	Home Health Agency	$0	$3.3M