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

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

University Of Utah Community Physicians Group (NPI 1124422126)

Key Findings

Field	Value
Entity Type	Organization
Organization	University Of Utah Community Physicians Group
Address	1525 W 2100 S
City	Salt Lake City
State	UT
ZIP	84119
Taxonomy	General Practice Physician
NPI Enumerated	October 20, 2014

Payer Source	Total Paid
Medicaid	$36M
Medicare	$0

This provider is effectively a Medicaid-only biller: Medicare revenue is listed as none (no Medicare billing on file) while total Medicaid revenue is $36M. The NPI was enumerated on 2014-10-20 (~12 years ago), indicating roughly a decade of recorded activity under this identifier.

Revenue is highly concentrated in a very small set of office/outpatient evaluation-and-management codes: the precomputed top-3 Medicaid codes account for 80.8% of the provider’s Medicaid revenue. Those top three are 99214 ($22.1M revenue, 61.9% of Medicaid revenue), 99213 ($4.6M, 12.8%), and 99204 ($2.2M, 6.0%), creating material dependence on E/M visit reimbursement.

The code mix points to a primary-care/general-practice ambulatory operation with heavy emphasis on high-volume established-patient visits and a large new-patient pipeline. Dominant E/M codes (99214 and 99213) plus significant volume in 99204 and other new-patient codes suggest the organization runs a large outpatient clinic platform focused on longitudinal primary care and comprehensive office-based evaluation and management.

Competitive standing within Utah is dominant for core clinic visits: 99214 ranks #1 of 1340 providers in-state at the 100th percentile and is labeled an extreme outlier, while 99213 and 99204 also rank at the top of statewide lists (99213 #3 of 1355, 100th percentile; 99204 #1 of 271, 100th percentile). These rank/percentile positions indicate the provider is a major statewide player for high-volume ambulatory E/M services.

Preventive and pediatric well-care is a visible secondary service line: codes such as 99392 ($986.8K, 2.8%), 99391 ($768.6K, 2.2%), 99393 ($553.6K, 1.6%), 99394 ($334.5K, 0.9%) and several other preventive visit codes rank at or near the top in-state (many at the 99–100th percentile, often labeled extreme outlier or notably above typical). This pattern suggests a substantial preventive care throughput—including well-child visits—supporting the primary-care footprint.

Ancillary services and newer pandemic-era codes appear but contribute modestly to revenue: U0003 (SARS-CoV-2 testing) generated $111K (0.3% of Medicaid revenue) and 91320 (COVID-19 vaccine) produced $20.7K (0.1%), while behavioral-health collaborative care 99493 accounted for $58.8K (0.2%). These line items are present but are small relative to core E/M revenues and mostly fall in typical or unremarkable percentile ranges for the state.

Operational scale is evident from claim volumes on top codes: 99214 shows 302.7K claims and 99213 shows 83.4K claims, indicating extremely high visit volumes that are consistent with a multi-site clinic network or a large group practice managing a substantial Medicaid patient panel. Such volumes imply significant staffing and throughput demands and potential sensitivity to changes in E/M policies or reimbursement rates.

Not all billed codes are exceptional: several lab and minor-service codes (for example 86480 at the 50th percentile, 87491 at the 60th percentile) and some behavioral-health and testing codes fall into typical, unremarkable volume ranges in-state. This mix indicates that while the provider is an outlier on core ambulatory E/M and preventive codes, routine ancillary services are performed at more ordinary levels for the market.

Medicaid: Complete Services Breakdown

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

89 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…	302,700	$70	$22.1M
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…	83,390	$60	$4.6M
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…	21,160	$100	$2.2M
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…	24,930	$70	$1.7M
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…	15,470	$100	$1.5M
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…	12,650	$80	$986.8K
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…	10,830	$70	$768.6K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	7,190	$80	$553.6K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	4,030	$80	$334.5K
99205	The provider sees a new 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 provider…	940	$130	$124.3K

Showing 1–10 of 89

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Utah Distribution

University Of Utah Community Physicians Group — 18 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Utah

Full comparison — all codes billed, vs. Utah median

89 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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…	8	20	270	$40	$334.7K
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…	62	120	1,100	$30	$186.6K
36415	In this procedure, the provider inserts a needle into a vein to collect a blood sample.	125	240	220	$50	$145.2K
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…	1	1,340	200	$80	$144K
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	1,360	190	$70	$125K
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…	2	200	240	$90	$85.8K
96372	A therapeutic, prophylactic, or diagnostic substance (a fluid, a drug, etc.) is injected via intramuscular or subcutaneous route into the patient's body. The procedure is performed by the physician…	83	160	250	$50	$76.9K
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.	70	100	2,770	$10	$75.1K
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…	2	220	200	$80	$74K
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…	2	190	150	$80	$58.1K

Showing 1–10 of 89

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Steven Craig	UT	Podiatrist	$128.7K	$124K
Robert Tashjian	UT	Orthopaedic Surgery Physician	$139.2K	$0
Aubrey Kruisman	UT	Family Nurse Practitioner	$111.2K	$0
Terrence Bjordahl	UT	Nephrology Physician	$98.1K	$1.5K
Kimberly Jensen	NM	Internal Medicine Physician	$91.1K	$0
Jeffrey Olpin	UT	Diagnostic Radiology Physician	$55.4K	$0
Edward Quigley	UT	Diagnostic Radiology Physician	$53.9K	$0
Zachary Krahn	UT	Diagnostic Radiology Physician	$47.5K	$2.1K
Richard Craig	UT	Gastroenterology Physician	$44.3K	$0
Amy Powell	UT	Sports Medicine (Internal Medicine) Physician	$40.3K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Unified Fire Authority-salt Lake	UT	Land Ambulance	$920.5K	$14.6M
C.n.s. Corporation	UT	Home Health Agency	$0	$13.6M
West Valley City	UT	Ambulance	$202.1K	$6.2M
Granger Medical Clinic PC	UT	Multi-Specialty Clinic/Center	$0	$5.1M
Unified Health Services LLC	UT	Community Based Hospice Care Agency	$0	$4.1M
Community Nursing Service	UT	Community Based Hospice Care Agency	$0	$4.1M
Granger Pediatric Dentistry	UT	Dental Clinic/Center	$0	$2.4M
Hans Petersen	UT	Pediatric Dentistry	$0	$1.6M
Standard Optical Co	UT	Optometrist	$0	$1.5M
Community Nursing Service	UT	Home Health Agency	$0	$970.4K

University Of Utah Community Physicians Group — Billing Profile & Reimbursement Data

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University Of Utah Community Physicians Group — 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