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 U.S. Virgin Islands for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to U.S. Virgin Islands 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. U.S. Virgin Islands (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.

Primary Care, PLLC (NPI 1114116951)

Field	Value
Entity Type	Organization
Organization	Primary Care, PLLC
Address	4040 Est La Grande Princess
City	Christiansted
State	VI
ZIP	00820
Taxonomy	Preferred Provider Organization
NPI Enumerated	October 17, 2007

Payer Source	Total Paid
Medicaid	$261.8K
Medicare	$0

Key Findings

This provider effectively operates as a Medicaid-only biller: there is no Medicare billing on file while total Medicaid revenue is $261.8K, indicating a single-payer footprint in the available claims data. Analysts should treat Medicaid patterns as representative of this entity’s commercial activity rather than expecting cross‑payer comparisons.

Revenue is highly concentrated in a very small set of procedure codes: the precomputed top three Medicaid codes account for 97.6% of this provider’s total Medicaid revenue, with 99214 alone bringing in $220K (84.0% of Medicaid revenue). That concentration signals material dependence on routine established‑patient evaluation and management visits for the practice’s revenue base.

The code mix points to a primary care, office‑based operation focused on chronic and follow‑up care: 99214 has 2.1K claims at $105 avg paid/claim and 99213 has 429 claims at $72 avg paid/claim, together making up the vast majority of clinical activity and revenue. Low volumes of high‑complexity and new‑patient codes (for example 99215 at 14 claims and 99203 at 26 claims) suggest the practice handles ongoing established patient management more than episodic high‑acuity or referral intake.

Competitive standing for the top revenue driver is modestly above average in‑state: 99214 ranks #11 of 43 providers in the state (76th percentile) and is described as typical, unremarkable volume, indicating the practice captures a solid share of established‑visit work but is not a dominant statewide center for that code. This position supports the view of a stable local primary care presence rather than a market leader.

Other code-level rankings reinforce a middle‑to‑low competitive profile across ancillary and higher‑complexity services: 99213 ranks #21 of 41 (50th percentile) and is labeled typical, unremarkable volume; 87426 ranks #6 of 6 (0th percentile) and is labeled typical, unremarkable volume, indicating relatively limited COVID testing activity versus in‑state peers; 99215 ranks #17 of 17 (0th percentile) and 99203 ranks #18 of 20 (11th percentile), showing low throughput on high‑complexity and new‑patient visits.

The provider has a long tenure in the NPI registry, enumerated on 2007-10-17 (~19 years ago), which supports continuity of care as an operational characteristic and may explain the heavy skew toward established‑patient visits in the claims mix. Long enumeration paired with concentrated E/M billing suggests an entrenched local practice serving repeat patients.

Operationally, the average payments per visit are modest and aligned with outpatient primary care reimbursement: 99214 pays about $105 per claim and 99213 about $72 per claim, which together drive the practice’s revenue model toward volume of follow‑up visits rather than high‑margin procedures. Payers and analysts should view increases or decreases in 99214 volume as likely to have an outsized impact on total Medicaid revenue.

There are no top codes flagged as extreme outliers in the provided labels; most are described as typical, unremarkable volume, but several codes sit at very low state percentiles (0th–11th) indicating constrained activity in testing, new‑patient intake, and highest‑complexity visits. This pattern suggests stable primary‑care throughput without substantial ancillary service lines or specialty referral volumes to diversify revenue.

Medicaid: Complete Services Breakdown

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

6 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…	2,100	$110	$220K
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…	430	$70	$30.9K
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,…	110	$40	$4.7K
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…	30	$110	$2.9K
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…	10	$160	$2.2K
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…	10	$80	$1.1K

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. U.S. Virgin Islands Distribution

Primary Care, PLLC — 0 of 6 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — U.S. Virgin Islands

Full comparison — all codes billed, vs. U.S. Virgin Islands median

6 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average 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…	11	40	560	$140	$322K
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…	21	40	430	$110	$260.9K
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,…	6	10	260	$120	$95.3K
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…	17	20	200	$150	$93.5K
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…	4	10	110	$80	$45.9K
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…	18	20	80	$90	$27K

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Arakere Prasad	VI	Emergency Medicine Physician	$105.3K	$0
Jennifer Samuel	VI	Physician Assistant	$25.8K	$0
Carmen Cintron	VI	Internal Medicine Physician	$9.8K	$0

Nearby Providers

Other providers in the same ZIP code as Primary Care, PLLC, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
St Croix Vision Center Inc	VI	Optometrist	$0	$3.6M
One Dental Practice LLC	VI	Dentist	$0	$3.2M
Governor Juan F. Luis Hospital & Medical Center	VI	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$3M
Js Therapies, LLC	VI	Occupational Therapist	$0	$2.9M
Healthquest, LLC.	VI	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$2.4M
Department Of Health, Ems Stx	VI	Land Ambulance	$0	$2.2M
Lindsy Wagner LLC	VI	Clinical Social Worker	$0	$2.2M
Ophthalmology Consultants, PC	VI	Ophthalmology Physician	$0	$2.1M
Acute Alternative Medical Group	VI	Emergency Medical Services (Emergency Medicine) Physician	$0	$1.9M
Pediatric Care Center LLC	VI	Pediatrics Physician	$0	$1.7M

Primary Care, PLLC — Billing Profile & Reimbursement Data

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Primary Care, PLLC — 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