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

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

St. Vincent Medical Group, Inc. (NPI 1144513375)

Key Findings

Field	Value
Entity Type	Organization
Organization	St. Vincent Medical Group, Inc.
Address	409 E Greenville Ave
City	Winchester
State	IN
ZIP	47394
Taxonomy	Orthopaedic Surgery Physician
NPI Enumerated	May 20, 2011

Payer Source	Total Paid
Medicaid	$70.4M
Medicare	$0

This provider has no Medicare billing on file and reports $70.4M in lifetime Medicaid revenue, effectively making its billed footprint exclusively Medicaid in the available data. The absence of Medicare activity suggests payer concentration risk and that analyses of market share and utilization should be centered on Medicaid flows rather than dual‑payer behavior.

Revenue is highly concentrated in a few outpatient evaluation-and-management and preventive codes: the precomputed top three codes account for 67.6% of Medicaid revenue, led by 99214 ($24.2M, 36.9%), 99213 ($16.9M, 25.9%), and 99392 ($3.2M, 4.8%). This concentration indicates that a small set of visit-based services drives the majority of the provider’s Medicaid dollars.

Although the provider’s listed taxonomy is Orthopaedic Surgery Physician, the billed code mix (high volumes of 99214/99213 office E/M, pediatric/adolescent preventive codes 99392/99391/99393/99394, maternal codes 59426/59425/59430, and large vaccination codes 90471/90472) is more characteristic of a multispecialty ambulatory clinic or a large primary care/pediatrics practice with obstetric and vaccination programs. The pattern suggests the organization operates broad outpatient and preventive services and potentially bills multiple specialties or a group practice under this NPI.

On competitive standing for Medicaid within the state, this provider is a dominant outlier for its top visit codes: 99214 ranks #5 of 2122 providers in-state (100th percentile; extreme outlier) and 99213 ranks #5 of 2377 providers (100th percentile; extreme outlier), while 99392 ranks #4 of 294 providers (99th percentile; extreme outlier). These rankings indicate the provider is a major statewide participant for high-volume office visits and well/pediatric preventive care, far above typical state volumes for those codes.

The practice shows very large immunization throughput: 90471 appears with 125K claims and $1.4M revenue (rank #4 of 656, 100th percentile; extreme outlier) and 90472 with 62.9K claims and $1.4M revenue (rank #4 of 385, 99th percentile; extreme outlier). High vaccine claim counts alongside pediatric preventive visits point to significant clinic-based vaccination programs or large pediatric panels contributing materially to Medicaid revenue.

Hospital-based and higher-acuity services are also present in the mix, with substantial volumes of subsequent and initial inpatient/observation E/M: 99232 (57.3K claims, $1.8M, rank #16 of 527, 97th percentile; notably above typical), 99233 (32.7K claims, $1.4M, rank #11 of 355, 97th percentile; notably above typical), and critical care 99291 (9.9K claims, $960.8K, rank #5 of 140, 97th percentile; notably above typical). This indicates the organization provides considerable hospital coverage or consultative services in addition to ambulatory care.

Unit economics on the top visit drivers are low-to-moderate per‑claim payments: 99214 averages $58 paid/claim, 99213 averages $44 paid/claim, and 99392 averages $85 paid/claim. The combination of modest avg paid/claim and extremely high claim volumes appears to be the primary mechanism producing the $70.4M Medicaid lifetime revenue rather than high unit prices.

The provider’s NPI was enumerated on 2011-05-20 (~15 years ago), indicating an established presence in the market; coupled with its extreme-outlier ranks across multiple high-volume Medicaid codes, the data are consistent with a long-standing, high-capacity ambulatory operation with both outpatient and inpatient service lines. Analysts should treat this entity as a significant Medicaid provider in-state when evaluating capacity, network impact, and competitive positioning.

Medicaid: Complete Services Breakdown

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

342 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…	416,690	$60	$24.2M
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…	384,720	$40	$16.9M
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…	37,270	$90	$3.2M
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…	36,940	$80	$2.9M
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…	57,300	$30	$1.8M
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…	20,540	$80	$1.6M
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	18,240	$80	$1.5M
99233	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	32,730	$40	$1.4M
59426	This service is considered a mini global code for the provider who provides seven or more antepartum visits. This can happen when the patient transfers out of the practice prior to delivery or the…	26,290	$50	$1.4M
90472	This code represents each injection of a vaccine after the first; list this code in addition to the code for the first injection.	62,940	$20	$1.4M

Showing 1–10 of 342

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Indiana Distribution

St. Vincent Medical Group, Inc. — 21 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Indiana

Full comparison — all codes billed, vs. Indiana median

342 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.	209	380	2,470	$100	$1.5M
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.	174	360	3,490	$110	$1.5M
J0585	Injection, onabotulinumtoxina, 1 unit	12	30	280	$820	$992.2K
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…	5	2,120	870	$60	$450.6K
90837	In this service, the provider performs psychotherapy, a series of technique for treating the psychiatric disorders of the patient. The treatment session typically lasts for a minimum of 53 minutes or…	321	690	1,070	$80	$422.3K
11042	The provider uses surgical instruments to remove the dead tissue in skin down to the subcutaneous layer and including the epidermis and dermis, up to the first 20 cm2.	115	140	430	$220	$413.2K
97530	The provider uses various activities during direct contact with the patient to improve the patient’s functional performance. Use this code for each 15 minutes of activity.	326	400	1,100	$40	$382.2K
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…	5	2,380	920	$50	$376.8K
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	20	730	$130	$348.3K
42820	The provider removes the tonsils and adenoids in a patient younger than 12 years old.	22	30	60	$840	$335.8K

Showing 1–10 of 342

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
St Mary's Medical Group, LLC	IN	Family Medicine Physician	$0	$31.1M
St. Vincent Medical Group, Inc.	IN	Rural Health Clinic/Center	$0	$10.2M
Decatur County Memorial Hospital	IN	Critical Access Hospital	$0	$8.2M
St. Vincent Medical Group, Inc.	IN	Rural Health Clinic/Center	$0	$3M
Douglas Debenham	IN	Radiation Oncology Physician	$1.8M	$0
Adam Olmsted	OH	Diagnostic Radiology Physician	$1.1M	$0
Ayad Agha	AZ	Diagnostic Radiology Physician	$1M	$0
Gilbert Maulsby	OH	Diagnostic Radiology Physician	$932.5K	$0
Tarek Kteleh	IN	Rheumatology Physician	$674.3K	$0
Michael Watterson	NC	Rheumatology Physician	$669.3K	$2.6K

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
St. Vincent Randolph Hospital, Inc.	IN	Critical Access Hospital	$0	$4.1M
David Davis	IN	Chiropractor	$42.2K	$0
Stephanie Eckerle	IN	Surgical Physician Assistant	$34.5K	$0
Kenneth Madler	IN	Audiologist-Hearing Aid Fitter	$2.1K	$0

St. Vincent Medical Group, Inc. — Billing Profile & Reimbursement Data

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St. Vincent Medical Group, 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