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

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

Graves Gilbert Clinic PLLC (NPI 1114948288)

Key Findings

Field	Value
Entity Type	Organization
Organization	Graves Gilbert Clinic PLLC
Address	201 Park St
City	Bowling Green
State	KY
ZIP	42101
Taxonomy	Specialist
NPI Enumerated	July 22, 2006

Payer Source	Total Paid
Medicaid	$78M
Medicare	$0

GRAVES GILBERT CLINIC PLLC is effectively a Medicaid-focused operator: there is no Medicare billing on file while total Medicaid revenue is $78M, indicating the provider’s commercial/payer footprint is highly concentrated in Medicaid. The lack of Medicare activity suggests payer dependence on state programs rather than federal fee-for-service Medicare revenues.

Revenue concentration is very high: the precomputed top 3 Medicaid codes account for 60.8% of the provider’s total Medicaid revenue, with 99214 alone generating $24.3M (40.0% of Medicaid revenue). This concentration means a small set of office-visit E/M services drive the majority of clinic income.

The code mix shows a high-volume ambulatory practice focused on evaluation and management and preventive care: 99214, 99213, and 99203 together dominate revenue, and preventive codes 99392 and 99391 also contribute meaningfully. Alongside E/M visits, the provider reports large volumes of immunoassays and vaccine administration (87804, 87426, 90471, 90472), indicating integrated testing and immunization workflows embedded in routine outpatient encounters.

State-level competitive standing is dominant for several high-volume codes: 99214 ranks #3 of 2462 providers in-state (100th percentile; extreme outlier) and 99213 ranks #13 of 3339 providers (100th percentile; extreme outlier), showing the practice operates at an unusually large scale for office-based E/M care in Kentucky. Multiple additional codes (87804, 87426, 87880, 99050, 90472) also sit in the 100th percentile or near it, reinforcing the provider’s position as a major statewide volume leader for testing, vaccinations, and after-hours services.

Operational footprint includes substantial point-of-care testing and lab services: 87804 ($2.9M, ranks #2 of 777, 100th percentile; extreme outlier), 87426 ($2.7M, ranks #2 of 396, 100th percentile; extreme outlier), U0003 ($643.9K, ranks #9 of 106, 92th percentile) and broad panel orders (80050, 80053, 80061). This mix suggests in-clinic diagnostic capability and high throughput for infectious-disease and routine lab work that complements the clinic’s high visit volume.

Service breadth extends into imaging and specialty diagnostics at notable levels: 70553 produced $1.1M (ranks #26 of 96, 74th percentile) and 93306 produced $816.8K (ranks #23 of 209, 89th percentile), indicating the clinic either performs or coordinates advanced imaging and cardiac ultrasound services in addition to primary outpatient care. These line items point to a multi-service ambulatory model rather than a narrow single-procedure practice.

Operational nuances point to extended access and high touch outpatient throughput: 99050 (after-hours services) generated $1.3M and ranks #1 of 46 providers in-state (100th percentile; extreme outlier), while high volumes of low-level visit codes such as 99211 and vaccine administration codes (90471, 90472) indicate frequent brief encounters and immunization workflows. Together these patterns are consistent with high patient throughput, extended scheduling, and robust preventive care delivery.

The provider’s tenure is long-standing: the NPI was enumerated on 2006-07-22 (~20 years ago), which, combined with the large Medicaid volumes and top-state ranks, suggests an established regional presence and institutional scale built over multiple years. Given the concentrated Medicaid revenue base and statewide top-percentile ranks on core codes, payers and competitors should treat GRAVES GILBERT CLINIC as a major Medicaid-access node with operational strengths in high-volume ambulatory visits, testing, immunizations, and a meaningful imaging/lab footprint.

Medicaid: Complete Services Breakdown

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

421 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…	486,600	$50	$24.3M
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…	278,390	$40	$9.7M
87804	The analyst performs an immunoassay with direct optical, meaning visual, observation to detect influenza, also called flu, in a patient sample, typically a throat or nasal swab or nasal washings.	195,590	$20	$2.9M
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,…	101,220	$30	$2.7M
87880	The analyst performs an immunoassay with direct optical, meaning visual, observation to detect Streptococcus, group A, in a patient sample, typically a throat swab.	155,630	$20	$2.3M
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…	21,270	$80	$1.6M
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…	22,910	$70	$1.5M
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…	19,510	$70	$1.3M
99050	In this procedure, the provider renders services to a patient in his office at a time when that office would otherwise be closed.	22,690	$60	$1.3M
99244	The provider sees a patient for an office or other outpatient consultation involving evaluation and management (E/M). The E/M involves a moderate level of medical decision making or the provider…	9,880	$130	$1.2M

Showing 1–10 of 421

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Kentucky Distribution

Graves Gilbert Clinic PLLC — 20 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Kentucky

Full comparison — all codes billed, vs. Kentucky median

421 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
97535	A healthcare provider is required to give proper instruction to a person especially in cases of recovery from acute disease.	128	310	830	$120	$3.7M
G0483	Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but…	59	70	1,650	$100	$2M
74177	The provider performs computed tomography of the abdomen and pelvis with contrast material to diagnose the cause of abdominal or pelvic pain or other abnormalities of the internal organs.	156	180	1,870	$280	$1.5M
96413	Chemotherapy is a therapeutic procedure used for the treatment of cancer via the use of chemical agents. These chemical agents (drugs) work on the cancerous cells of the body to destroy them. These…	17	50	2,340	$200	$829.7K
80307	The lab analyst performs presumptive drug test(s) via instrumented chemistry analyzers to screen for any number of drug classes on a single date.	283	340	2,700	$40	$673.3K
96365	The provider administers the initial intravenous infusion of a medication or other substance for a period up to one hour to prevent, treat, or diagnose a condition or disease.	87	100	5,870	$70	$670.3K
96375	Following the administration of a drug or other substance via intravenous, or IV, push, the provider sequentially infuses a different medication or medications, also via IV push. He administers the…	90	110	5,850	$50	$572.9K
93306	The provider uses transducers to obtain two–dimensional (2D) images of the heart structures through the chest wall. He evaluates the anatomy and function of all four heart chambers, valves, adjacent…	23	210	1,340	$160	$568K
U0003	Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high…	9	110	2,280	$50	$552.6K
93458	In this procedure, the provider performs imaging supervision and interpretation for a coronary angiography with left heart catheterization and intraprocedural injections for left ventriculography. He…	34	60	170	$780	$500.2K

Showing 1–10 of 421

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Vidya Seshadri	KY	Hematology & Oncology Physician	$2.1M	$0
Neha Pansuria	KY	Rheumatology Physician	$663.6K	$0
Nirav Sheth	KY	Internal Medicine Physician	$620.2K	$0
Johnathon Edge	KY	MOHS-Micrographic Surgery Physician	$559.9K	$0
Wilfred Lumbang	NH	MOHS-Micrographic Surgery Physician	$524.1K	$0
Jerry Roy	KY	Interventional Cardiology Physician	$361.3K	$0
Ronak Chaudhari	KY	Endocrinology, Diabetes & Metabolism Physician	$347.5K	$0
Sandeep Chhabra	KY	Interventional Cardiology Physician	$341.4K	$0
Sherryl Reed	KY	Internal Medicine Physician	$335.7K	$0
Robert Wesley	KY	Family Medicine Physician	$335.5K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Bowling Green-warren County Community Hospital Corporation	KY	General Acute Care Hospital	$0	$112.1M
District 4 Cdo Program	KY	Supports Brokerage Agency	$0	$54.7M
Encore Of Bowlng Green Adhc LLC	KY	Adult Day Care Clinic/Center	$0	$23.9M
Journeypure Bowling Green LLC	KY	Substance Abuse Rehabilitation Facility	$0	$16.1M
Ky Steps LLC	KY	Community/Behavioral Health Agency	$0	$13.7M
Tj & L Consulting, LLC	KY	Community/Behavioral Health Agency	$0	$11.3M
Julie Gaskill	KY	Oral and Maxillofacial Surgery (Dentist)	$0	$8.9M
Medical Center Ems, L.L.C.	KY	Ambulance	$1.8M	$6.5M
United Seating And Mobility LLC	KY	Customized Equipment (DME)	$0	$7.3M
Commonwealth Health Corporation	KY	Adult Day Care Clinic/Center	$0	$6.8M

Graves Gilbert Clinic 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