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

Why is the Medicaid comparison limited to New Mexico 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. New Mexico (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.

Southwest Medical Associates, LLC (NPI 1164491072)

Key Findings

Field	Value
Entity Type	Organization
Organization	Southwest Medical Associates, LLC
Address	6701 Jefferson St Ne
City	Albuquerque
State	NM
ZIP	87109
Taxonomy	General Practice Physician
NPI Enumerated	March 14, 2006

Payer Source	Total Paid
Medicaid	$41.4M
Medicare	$0

This provider is effectively single‑payer in the available data: there is no Medicare billing on file and all documented government reimbursement is Medicaid, totaling $41.4M in lifetime Medicaid revenue. That concentration means analysis and risk for this entity should be framed around Medicaid policy and in‑state payer dynamics rather than Medicare trends.

Revenue is highly concentrated in a small set of Medicaid codes: the top three Medicaid codes — 99214 ($7M, 18.5%), J0585 ($5.4M, 14.4%), and 99213 ($4.7M, 12.4%) — together account for 45.3% of the provider’s Medicaid revenue. This degree of concentration signals that changes in reimbursement or utilization for these specific services could materially affect the provider’s topline.

The service mix points to a dual outpatient procedural and high‑volume primary care operation. Large volumes of established‑patient office visits (99214 with 85.2K claims and 99213 with 76.6K claims) indicate heavy ambulatory management, while J0585 (9.9K claims, onabotulinumtoxina) and 64615 suggest a substantial injection/chemodenervation practice consistent with chronic migraine or similar indications described by those codes.

In parallel, the provider reports very large volumes of inpatient/observation E/M codes, which implies significant hospital‑based activity: 99233 (46.7K claims, $3.5M, 9.4% of Medicaid revenue) and 99223 (15.1K claims, $2.2M, 5.8% of Medicaid revenue) are prominent on the ledger. Several of these inpatient codes are described as "notably above typical" or "extreme outlier," pointing to an operational footprint that includes substantial inpatient care or hospitalist‑style services in addition to clinic work.

Competitive standing inside New Mexico is strong for numerous high‑revenue codes. For example, 99214 ranks #8 of 963 providers (99th percentile), 99233 ranks #3 of 93 providers (98th percentile), and 99223 ranks #1 of 89 providers (100th percentile), indicating the provider is a dominant in‑state participant for several core E/M services. These rank/percentile positions suggest market leadership on volume for many of the top Medicaid revenue drivers.

Throughput metrics underline scale of operations: 85.2K claims for 99214, 76.6K claims for 99213, and 73.7K claims for 93010 show very high encounter and testing volumes, which would require substantial clinical staffing and scheduling capacity to support. High claim counts paired with the large Medicaid revenue base imply the organization handles a high patient load rather than relying on a small number of very high‑value procedures.

The provider’s billing mix also includes a broad set of ancillary procedural services beyond primary E/M and injections, reflecting a multi‑service clinical footprint. Examples include 93306 echocardiography (15.4K claims, $798.5K), 76801 first‑trimester ultrasound (4.2K claims, $657.2K), 43239 EGD with biopsy (4.3K claims, $624.2K), and 45380 colonoscopy with biopsy (1.8K claims, $396K), demonstrating capability across cardiology imaging, obstetric imaging, and endoscopy.

This entity has established tenure in the market, with the NPI enumerated on 2006-03-14 (~20 years ago). That longevity, combined with the high volumes and in‑state rank positions, is consistent with a long‑standing, high‑capacity provider that has developed multiple service lines and referral relationships in New Mexico’s Medicaid market.

Medicaid: Complete Services Breakdown

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

227 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…	85,230	$80	$7M
J0585	Injection, onabotulinumtoxina, 1 unit	9,910	$550	$5.4M
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…	76,590	$60	$4.7M
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…	46,670	$80	$3.5M
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…	17,970	$130	$2.3M
99223	The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	15,050	$150	$2.2M
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…	41,010	$50	$2.1M
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…	18,910	$90	$1.7M
99239	The provider sees a patient for hospital inpatient or observation discharge day management, involving evaluation and management (E/M). The provider spends more than 30 minutes on the service on the…	14,820	$80	$1.2M
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…	15,360	$50	$798.5K

Showing 1–10 of 227

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. New Mexico Distribution

Southwest Medical Associates, LLC — 13 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — New Mexico

Full comparison — all codes billed, vs. New Mexico median

227 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0585	Injection, onabotulinumtoxina, 1 unit	2	20	810	$520	$1.6M
76820	The provider performs Doppler ultrasonography for fetal surveillance to determine the velocity of blood flow through the umbilical artery. This test determines the timing of labor induction and when…	13	20	2,780	$90	$1.3M
76819	The provider performs a biophysical profile test to measure the health of the baby during pregnancy using only ultrasound and not a nonstress test.	16	30	380	$100	$796.5K
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…	10	930	910	$80	$521.6K
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…	8	960	1,010	$90	$490K
G0439	Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	23	20	50	$110	$463.7K
95004	The provider performs a percutaneous test with allergenic extracts to determine which substances (allergens) trigger an allergic reaction in the patient.	32	30	100	$770	$447.8K
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.	8	50	300	$260	$436.4K
96375	Following the administration of a drug or other substance via intravenous, or IV, push, the provider sequentially infuses a different medication or medications, also via IV push. He administers the…	46	50	4,450	$50	$422.6K
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…	3	90	570	$80	$392.6K

Showing 1–10 of 227

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Yubao Wang	CA	Hematology & Oncology Physician	$612K	$0
Paul Brittain	NM	Hematology & Oncology Physician	$398.9K	$0
Kader Abdelerahman	NM	Neurology Physician	$369.7K	$0
Scott Herbert	NM	Hematology & Oncology Physician	$312.4K	$0
Odinaka Nnanna	NM	Internal Medicine Physician	$306.4K	$0
Radu Butuc	NM	Internal Medicine Physician	$287.9K	$0
Michael Hoskins	NM	Clinical Cardiac Electrophysiology Physician	$254.2K	$0
Michael Bestawros	NM	Clinical Cardiac Electrophysiology Physician	$251.8K	$0
Sean Mazer	NM	Clinical Cardiac Electrophysiology Physician	$251.7K	$0
Bechara Mezher	AZ	Gastroenterology Physician	$166.7K	$73.7K

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Presbyterian Healthcare Services	NM	Internal Medicine Physician	$0	$240.8M
Heritage Home Healthcare Services, Inc.	NM	Home Health Agency	$0	$141.5M
Home Medical Equipment Specialists LLC	NM	Durable Medical Equipment & Medical Supplies	$0	$100M
The New Beginnings LLC	NM	Adult Day Care Clinic/Center	$0	$85.1M
We Care Agency, Inc.	NM	In Home Supportive Care Agency	$0	$60.1M
Lovelace Health System, LLC	NM	General Acute Care Hospital	$0	$57.7M
Adelante Development Center, Inc.	NM	Personal Care Attendant	$0	$57M
Eye Associates Of New Mexico Ltd	NM	Ophthalmology Physician	$0	$46.9M
Southwest Labs LLC	NM	Clinical Medical Laboratory	$1.1M	$41.5M
Tspc-nm, LLC	NM	Nursing Care Agency	$0	$28.9M

Southwest Medical Associates, LLC — 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