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

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

The Pearl Clinic, LLC (NPI 1144528308)

The Pearl Clinic, LLC is a internal medicine physician provider located in Millsboro, Delaware. This profile covers 0 Medicare and 21 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.

Medicaid: Complete Services Breakdown

Field	Value
Entity Type	Organization
Organization	The Pearl Clinic, LLC
Address	28539 Dupont Blvd
City	Millsboro
State	DE
ZIP	19966
Taxonomy	Internal Medicine Physician
NPI Enumerated	March 11, 2011

Payer Source	Total Paid
Medicaid	$282.4K
Medicare	$0

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

21 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…	2,830	$60	$158.4K
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…	2,550	$40	$112.3K
99396	The provider performs an established well–patient visit for a patient who is between the ages of 40 and 64.	70	$80	$5.1K
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…	90	$50	$4.3K
99442	N/A	20	$40	$860
99212	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,…	10	$40	$560
99457	The provider manages treatment using data from remote physiologic monitoring. The service requires at least one real–time interactive communication with the patient or caregiver during the month and…	20	$30	$470
90674	This code represents a flu vaccine product that protects against four strains of influenza. It is derived from cell cultures, contains no preservatives or antibiotics, and is administered as a 0.5 mL…	20	$20	$290
90688	This code represents a vaccine product administered into the muscle to protect against four strains of influenza (flu). It uses split virus technology and is given as a 0.5 mL dose.	20	$1	$40
96127	The provider performs a brief emotional/behavioral assessment of the patient using a standardized instrument (such as a recognized form). The provider scores and documents the assessment.	10	$1	$40

Showing 1–10 of 21

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Delaware Distribution

The Pearl Clinic, LLC — 0 of 10 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Delaware

Full comparison — all codes billed, vs. Delaware median

21 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…	169	500	1,130	$50	$235.1K
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…	172	540	1,100	$40	$185.3K
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…	116	180	220	$90	$101.5K
99457	The provider manages treatment using data from remote physiologic monitoring. The service requires at least one real–time interactive communication with the patient or caregiver during the month and…	13	10	220	$40	$49.9K
99396	The provider performs an established well–patient visit for a patient who is between the ages of 40 and 64.	38	50	170	$70	$41.4K
99212	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,…	169	180	180	$20	$24.4K
99442	N/A	54	70	110	$30	$14.1K
96127	The provider performs a brief emotional/behavioral assessment of the patient using a standardized instrument (such as a recognized form). The provider scores and documents the assessment.	111	110	270	$1	$11.4K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	76	100	230	$1	$6.7K
90674	This code represents a flu vaccine product that protects against four strains of influenza. It is derived from cell cultures, contains no preservatives or antibiotics, and is administered as a 0.5 mL…	17	20	60	$10	$2.5K

Showing 1–10 of 21

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Sherin Howett	DE	Sleep Medicine (Internal Medicine) Physician	$121.4K	$0
Rhonda Davis	DE	Adult Health Nurse Practitioner	$117.7K	$0
Kimberly Brasure	DE	Nurse Practitioner	$67.2K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
National Mentor Healthcare, LLC	DE	Intellectual & Developmental Disabilities Psychologist	$0	$108.7M
Coras Wellness And Behavioral Health, LLC	DE	Substance Use Disorder Rehabilitation Clinic/Center	$703K	$18.2M
Peninsula Dental, LLC	DE	General Practice Dentistry	$0	$12.3M
Sleepy Tooth Orthodontics LLC	DE	Orthodontics and Dentofacial Orthopedics Dentistry	$0	$8.3M
Ctm Medical Associates LLC	DE	Surgery Physician	$0	$1.9M
Green Valley Terrace Snf LLC	DE	Skilled Nursing Facility	$0	$822K
Georges Dahr	DE	Cardiovascular Disease Physician	$763.7K	$0
Millsboro Fire Company Inc.	DE	Land Ambulance	$517.4K	$165.3K
Mid Sussex Rescue Squad Inc.	DE	Ambulance	$497.1K	$178K
William Singleton	DE	Addiction (Substance Use Disorder) Counselor	$0	$636.8K

The Pearl Clinic, LLC — Billing Profile & Reimbursement Data

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The Pearl Clinic, LLC — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

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