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

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

Prospect Ct Medical Foundation, Inc. (NPI 1144677568)

Key Findings

Field	Value
Entity Type	Organization
Organization	Prospect Ct Medical Foundation, Inc.
Address	71 Haynes St
City	Manchester
State	CT
ZIP	06040
Taxonomy	Family Medicine Physician
NPI Enumerated	May 16, 2016

Payer Source	Total Paid
Medicaid	$34M
Medicare	$0

This provider is effectively single-payer Medicaid: total Medicaid revenue is $34M and there is no Medicare billing on file, so all reported lifetime revenue in our dataset is Medicaid-based. That concentration means payer-facing analyses should treat Medicaid rules, rates, and network dynamics as primary drivers of financial and utilization behavior for this entity.

Revenue is highly concentrated in a small set of outpatient evaluation-and-management codes: the precomputed top three Medicaid codes (99214, 99213, J0585) account for 66.0% of this provider's total Medicaid revenue. Specifically, 99214 alone generates $10.2M (34.0% of Medicaid revenue) and 99213 generates $8.1M (26.9%), indicating that office-based established-patient visits are the dominant revenue streams.

Operational profile implied by the code mix: heavy primary care and ambulatory management. The prominence of 99214 and 99213 (196.7K and 196.8K claims respectively) indicates very high-volume established primary care visits consistent with Family Medicine taxonomy, while substantial line items for preventive services (99391, 99392, 99393, 99394, 99395) and vaccinations (90460) point to an integrated primary care safety-net model that manages both well visits and routine immunizations.

Competitive standing in-state for core primary care codes is dominant: 99214 ranks #8 of 1589 providers in Connecticut (100th percentile; extreme outlier) and 99213 ranks #10 of 1714 providers (99th percentile; extreme outlier). These rankings place the provider far above typical state volumes for ambulatory E/M services, signaling market leadership in Medicaid primary care visits.

There are notable specialty and institutional service lines embedded in the billing mix. The presence of J0585 (onabotulinumtoxina) with $1.5M in revenue and 3.6K claims suggests a procedural injectables line, while inpatient and observation E/M codes (99231–99233, 99239) and nursing facility codes (99305, 99308) show meaningful activity across hospital and long-term care settings, implying a broader continuum-of-care operation rather than a narrow outpatient clinic.

Several codes are statistical outliers relative to peers, reinforcing the provider's unique footprint: 90791 (psychiatric evaluation) reports $411.6K and ranks #7 of 559 in-state (99th percentile; extreme outlier), and 99305 (initial nursing facility care) is #1 of 58 (100th percentile; extreme outlier). These high-percentile ranks indicate unusually large volumes in behavioral health evaluation and nursing-facility initiation compared with typical Connecticut providers.

While the top E/M codes dominate revenue, many other service lines show high absolute volumes but typical payer rates: for example, 90460 (vaccination administration) has 25.1K claims and $902.7K revenue and ranks in the 94th percentile statewide, and 93010 (ECG interpretation) has 73.2K claims with $292.8K revenue at the 92nd percentile. These entries underscore that the provider pairs very high visit volumes with common ancillary services that support primary care operations.

Tenure is established but not long-standing relative to some systems: the NPI was enumerated on 2016-05-16 (~10 years ago). Given the concentrated Medicaid footprint and the mix of ambulatory, procedural, behavioral health, inpatient, and nursing-facility codes, this 10-year presence has scaled into a high-volume Medicaid-focused delivery organization within the state.

Medicaid: Complete Services Breakdown

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

256 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…	196,700	$50	$10.2M
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…	196,800	$40	$8.1M
J0585	Injection, onabotulinumtoxina, 1 unit	3,620	$420	$1.5M
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…	49,360	$20	$987.1K
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…	8,240	$110	$930.9K
90460	In this procedure, the provider administers a single live attenuated vaccine through a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age.	25,070	$40	$902.7K
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…	7,290	$120	$838.5K
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.	15,280	$50	$733.5K
99285	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a high level of medical decision making.	10,790	$70	$723.1K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	4,230	$110	$465K

Showing 1–10 of 256

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Connecticut Distribution

Prospect Ct Medical Foundation, Inc. — 6 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Connecticut

Full comparison — all codes billed, vs. Connecticut median

256 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99285	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a high level of medical decision making.	42	130	520	$330	$5.9M
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.	44	130	690	$180	$4.7M
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.	48	110	1,520	$140	$3.4M
J2357	Injection, omalizumab, 5 mg	12	10	470	$830	$1.1M
J0585	Injection, onabotulinumtoxina, 1 unit	6	20	1,530	$380	$1M
95810	Polysomnography refers to the continuous and simultaneous monitoring and recording of various physiological and pathophysiological parameters of sleep for six or more hours with physician review,…	18	50	870	$510	$687.2K
99291	Critical care services include the treatment of vital organ failure or prevention of further life–threatening conditions. Delivering medical care in a moment of crisis and in time of emergency is…	42	80	790	$240	$650K
45380	The provider examines the rectum and colon using a flexible colonoscope, a tubular instrument with a light source and camera, to look for the cause of a patient's symptoms, which may include…	27	70	570	$480	$626.7K
43239	The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum where he removes one or more tissue biopsy specimens for diagnostic analysis.	29	80	990	$260	$592K
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…	25	100	1,120	$120	$564.2K

Showing 1–10 of 256

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Muhammad Ijaz	NJ	Internal Medicine Physician	$852.8K	$0
Parveen Khanna	CT	Cardiovascular Disease Physician	$469.3K	$0
Jody Gerard	CT	Family Medicine Physician	$378.2K	$0
Hazar Dahhan	CT	Cardiovascular Disease Physician	$318.1K	$0
Kostas Papamarkakis	MA	Nephrology Physician	$281.2K	$3.5K
William Gray	CT	Internal Medicine Physician	$275.5K	$0
Amirhossein Zangiabadi	CA	Neurology Physician	$274.7K	$0
Mansoor Zaidi	MA	Internal Medicine Physician	$147.4K	$114.1K
Marc Raad	CT	Internal Medicine Physician	$252.2K	$0
Sagar Phatak	CT	Urology Physician	$242.6K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Prospect Manchester Hospital, Inc.	CT	General Acute Care Hospital	$0	$69.2M
Columbia Oral Maxillofacial Imaging LLC	CT	Dentist	$0	$19.4M
Eastern Connecticut Cardiology Associates LLC	CT	Cardiovascular Disease Physician	$0	$8.5M
Abuelos Care Inc.	CT	Home Health Agency	$0	$7M
Eastern Connecticut Pathology Consultants, PC	CT	Anatomic Pathology & Clinical Pathology Physician	$0	$4M
Emergency Care Services Of Connecticut, P.C.	CT	Emergency Medicine Physician	$0	$3.4M
Abc Pediatrics LLC	CT	Pediatrics Physician	$0	$1.7M
Advanced Psychological Services, LLC	CT	Clinical Psychologist	$0	$1.7M
Dr. Dental Of Manchester, PC	CT	Dentist	$0	$1.4M
Anjum Khera	CT	Specialist	$0	$1.3M

Prospect Ct Medical Foundation, Inc. — Billing Profile & Reimbursement Data

Sign up for Prospect Ct Medical Foundation, Inc. — Billing Profile & Reimbursement Data policy alerts

Prospect Ct Medical Foundation, Inc. — Billing Profile & Reimbursement Data

Sign up for Prospect Ct Medical Foundation, Inc. — Billing Profile & Reimbursement Data policy alerts

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