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.

Stamford Health Medical Group Inc (NPI 1154633980)

Key Findings

Field	Value
Entity Type	Organization
Organization	Stamford Health Medical Group Inc
Address	One Omega Drive
City	Stamford
State	CT
ZIP	06907
Taxonomy	General Practice Physician
NPI Enumerated	July 9, 2010

Payer Source	Total Paid
Medicaid	$23.5M
Medicare	$0

This provider is effectively single-payer on file for federal programs: there is no Medicare billing on file while total Medicaid revenue is $23.5M. The absence of Medicare activity means payers and network planners should treat the entity as largely Medicaid-exposed rather than split across Medicare/Medicaid revenue streams.

Revenue concentration is very high: the precomputed top 3 Medicaid codes account for 71.0% of the provider's total Medicaid revenue. In particular, 99214 represents $8.9M (46.3% of Medicaid revenue) and 99213 contributes $3.9M (20.3%), indicating a heavy dependence on a small set of E/M visit codes.

The code mix signals a core ambulatory primary-care and hospital follow-up operation: the dominant codes are E/M office visits (99214, 99213) plus substantial hospital subsequent care codes (99233, 99232, 99231). This pattern—high-volume established outpatient visits combined with inpatient/subsequent care—suggests integrated clinical workflows that span clinic and inpatient settings rather than a narrow procedural specialty.

Several individual codes place the provider well above typical state volumes, indicating competitive strength in multiple service lines. 99214 ranks #12 of 1589 providers in-state (99th percentile; extreme outlier, far above typical state volume), 99213 ranks #27 of 1714 (98th percentile; notably above typical state volume), and 99233 ranks #5 of 103 (96th percentile; notably above typical state volume), which together underscore dominance in high-volume E/M activity.

Beyond E/M, the provider shows notable statewide presence in diagnostic and procedure categories consistent with system-level capabilities. High ranks include 93000 at #4 of 204 providers (99th percentile; notably above typical state volume), 76641 at #2 of 61 providers (98th percentile; notably above typical state volume), and 95912 at #1 of 6 providers (100th percentile; notably above typical state volume), pointing to substantial volumes in EKGs, breast ultrasound, and nerve conduction studies.

There are service-line signals of renal and critical care involvement: 90960 (ESRD monthly management) appears with $392.3K revenue and ranks #6 of 21 providers (75th percentile; typical, unremarkable volume), and 99291 (critical care) contributes $230.5K and ranks #15 of 80 providers (82nd percentile; typical, unremarkable volume). These entries suggest the provider bills for ongoing dialysis-related management and some level of critical care services in addition to ambulatory care.

Several procedure codes are extreme or top percentile outliers that merit operational attention for capacity and utilization management. For example, 20552 (trigger point injection) is #1 of 19 providers in-state (100th percentile; extreme outlier, far above typical state volume), and 99214’s extreme-outlier status indicates both very high patient-volume and potential concentration risk if utilization patterns shift.

The provider has established tenure in the NPI registry, enumerated 2010-07-09 (~16 years ago), indicating a long-standing presence; combined with the high Medicaid volumes and multiple top-state rankings, this suggests an entrenched local operator with significant Medicaid-facing scale to influence payer negotiations or network design decisions.

Medicaid: Complete Services Breakdown

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

278 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…	156,080	$60	$8.9M
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…	97,340	$40	$3.9M
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…	34,580	$30	$864.5K
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…	27,110	$20	$460.8K
90960	The provider manages all the services associated with the monthly care of a patient who is 20 years old or older and has a condition known as end stage renal disease or ESRD. For this service, the…	6,540	$60	$392.3K
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…	4,990	$80	$383.9K
77067	The provider takes two X–ray views of each breast for routine screening and may use specially designed computer software to help identify any potential abnormalities within the images; the software…	18,330	$20	$366.5K
99231	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a straightforward or low level of medical…	21,780	$10	$304.9K
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.	7,360	$40	$265K
77063	The provider captures three dimensional images of the breast using X–rays at various angles for routine checkup. He checks for the presence of any abnormality within the breasts. Tomosynthesis…	18,220	$10	$255.1K

Showing 1–10 of 278

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

Stamford Health Medical Group Inc — 9 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

278 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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.	76	110	1,520	$140	$3.4M
J0585	Injection, onabotulinumtoxina, 1 unit	3	20	1,530	$380	$1M
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.	31	70	4,950	$110	$980.4K
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,…	44	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…	15	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…	31	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.	46	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…	12	100	1,120	$120	$564.2K
97110	Therapeutic exercise is a form of physical therapy that utilizes specially designed exercises and activities to help patients gain better mobility and fitness levels. Normally used on patients with…	219	350	1,820	$40	$537.3K
78815	PET and CT scans are both standard imaging tools that allow doctors to evaluate the location and metabolic actions of tumors or cancer inside the body before beginning an active treatment regimen.…	21	20	730	$470	$525K

Showing 1–10 of 278

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Imaging Subspecialists Of North Jersey, LLC	NJ	Diagnostic Radiology Physician	$0	$7.5M
Praveen Reddy	TX	Hematology & Oncology Physician	$1.8M	$0
Ammar Taha	WI	Diagnostic Radiology Physician	$410.5K	$380K
Vivek Sehgal	NJ	Diagnostic Radiology Physician	$281.4K	$265.1K
Edmund Harris	NJ	Diagnostic Radiology Physician	$421.5K	$65.4K
Abbas Chamsuddin	IL	Diagnostic Radiology Physician	$368.8K	$114.2K
Joshua Lader	CT	Clinical Cardiac Electrophysiology Physician	$431.6K	$0
Sandhya Dhruvakumar	CT	Clinical Cardiac Electrophysiology Physician	$359.1K	$0
Isaac George	NY	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	$355.3K	$0
Anatoliy Tsirlin	CT	Endocrinology, Diabetes & Metabolism Physician	$333.8K	$0

Stamford Health 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