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 Mary's Medical Group, LLC (NPI 1164852539)

Key Findings

Field	Value
Entity Type	Organization
Organization	St Mary's Medical Group, LLC
Address	3700 Washington Ave
City	Evansville
State	IN
ZIP	47750
Taxonomy	Family Medicine Physician
NPI Enumerated	November 20, 2013

Payer Source	Total Paid
Medicaid	$31.1M
Medicare	$0

This provider is effectively a Medicaid-only biller at scale: there is no Medicare billing on file while lifetime Medicaid revenue is $31.1M, so Medicaid dominates its payer mix and financial footprint. The absence of Medicare activity indicates the practice’s patient population and contracts are concentrated in state Medicaid programs rather than Medicare beneficiaries.

Revenue is heavily concentrated in a very small set of primary-care E/M codes: the precomputed top three Medicaid codes (99213, 99214, 99391) account for 65.8% of the provider’s total Medicaid revenue. Specifically, 99213 represents 212.4K claims, $46 avg paid/claim, $9.8M revenue (33.6%); 99214 represents 139.5K claims, $56 avg paid/claim, $7.8M revenue (26.9%); and 99391 represents 18.8K claims, $82 avg paid/claim, $1.5M revenue (5.3%).

The code mix signals a core family medicine and comprehensive outpatient primary care operation: extremely high volumes of established-patient office visits (99213 and 99214) plus preventive medicine codes (99391, 99392) indicate routine longitudinal care and annual/well visits are central to the practice. High counts for vaccine administration codes (90471, 90472) and pediatric well visit codes (99393, 99394) further suggest the group provides mixed-age family care with an emphasis on prevention and immunization.

State-level competitive standing is dominant for core primary-care codes: 99213 ranks #11 of 2377 providers in-state and is labeled an "extreme outlier" (100th percentile, far above typical state volume), while 99214 ranks #13 of 2122 providers and is also an "extreme outlier" (99th percentile). Preventive code 99391 ranks #6 of 278 providers (98th percentile) and is described as "notably above typical state volume," together indicating the group is a major Medicaid primary-care provider in Indiana for these services.

Beyond office E/M, the practice bills substantial hospital and obstetric E/M and procedure codes, implying inpatient and prenatal care capabilities. Examples include 99232 with 63.7K claims, $22 avg paid/claim, $1.4M revenue (4.8%); 59426 with 14.6K claims, $75 avg paid/claim, $1.1M revenue (3.8%); and 99223 with 7.7K claims, $68 avg paid/claim, $525.2K revenue (1.8%), showing meaningful revenue from inpatient/antepartum-related services.

Preventive and pediatric services are a visible revenue contributor and area of above-typical activity: 99392 posts 17.3K claims, $86 avg paid/claim, $1.5M revenue (5.1%) and 99393 posts 7.4K claims, $86 avg paid/claim, $639.8K revenue (2.2%), both with high in-state ranks. Vaccine administration codes 90472 (24.9K claims, $26 avg paid/claim, $648.6K revenue, 2.2%) and 90471 (35.6K claims, $12 avg paid/claim, $427.2K revenue, 1.5%) are ranked notably above typical state volume, reinforcing a prevention-focused pediatric and family-medicine service line.

The provider’s NPI has been enumerated since 2013-11-20 (~13 years ago), indicating an established practice presence; combined with the high claim volumes and top-state ranks, this tenure supports the likelihood of mature operational capacity and entrenched referral or panel relationships within the Medicaid network. Analysts should interpret future growth or contracting moves through the lens of an established Medicaid-centered primary care platform rather than a Medicare-facing practice.

Medicaid: Complete Services Breakdown

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

217 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	212,420	$50	$9.8M
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…	139,540	$60	$7.8M
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…	18,840	$80	$1.5M
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…	17,340	$90	$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…	63,670	$20	$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…	14,600	$80	$1.1M
90472	This code represents each injection of a vaccine after the first; list this code in addition to the code for the first injection.	24,950	$30	$648.6K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	7,440	$90	$639.8K
59425	This service is considered a mini global code for the provider who provides only four to six of the patient’s antepartum visits. This can happen when the patient transfers out of the practice prior…	8,680	$60	$529.6K
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…	7,720	$70	$525.2K

Showing 1–10 of 217

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 Mary's Medical Group, LLC — 14 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

217 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
93005	The provider records the electrical conduction of the heart to examine any abnormality in its functioning, based on signals from at least 12 leads, wires that connect the recording device to…	97	130	3,770	$60	$617.7K
90834	In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere…	493	580	710	$60	$582.9K
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…	13	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…	325	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.	26	140	430	$220	$413.2K
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…	11	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…	3	20	730	$130	$348.3K
99480	The provider directs the care of a recovering low birth weight infant, whose current weight is between 2501 and 5000 grams.	21	20	250	$100	$344.7K
99479	The provider directs the care of a recovering low birth weight infant, whose current weight is between 1500 and 2500 grams.	13	20	250	$100	$308.8K
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…	8	160	1,390	$70	$294.8K

Showing 1–10 of 217

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
St. Vincent Medical Group, Inc.	IN	Orthopaedic Surgery Physician	$0	$70.4M
St. Vincent Medical Group, Inc.	IN	Rural Health Clinic/Center	$0	$10.2M
St. Vincent Medical Group, Inc.	IN	Rural Health Clinic/Center	$0	$3M
Douglas Debenham	IN	Radiation Oncology Physician	$1.8M	$0
Michael Watterson	NC	Rheumatology Physician	$669.3K	$2.6K
Vijay Bhasin	IN	Nephrology Physician	$539.9K	$0
Umang Patel	IN	Clinical Cardiac Electrophysiology Physician	$356.2K	$0
Neelu Kalra	KS	Allergy & Immunology Physician	$343.8K	$0
Vishal Bhatia	IN	Endocrinology, Diabetes & Metabolism Physician	$268.3K	$0
Ashwani Bedi	IN	Clinical Cardiac Electrophysiology Physician	$257.9K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
St. Mary's Health, Inc.	IN	General Acute Care Hospital	$0	$34.6M
Lori Lynch	IN	Anatomic Pathology & Clinical Pathology Physician	$353.6K	$0
Robert Franklin	IN	Anatomic Pathology & Clinical Pathology Physician	$85.9K	$0
Robert Vogt	IN	Vascular & Interventional Radiology Physician	$67K	$0
Anthony Funke	IN	Anesthesiology Physician	$35.8K	$0
Scott Hardigree	IN	Anesthesiology Physician	$30.2K	$0
Aaron Gries	IN	Anesthesiology Physician	$28.5K	$0
Tommy Symreng	IN	Anesthesiology Physician	$24.8K	$0
Hongyu Yang	IN	Anatomic Pathology & Clinical Pathology Physician	$21.6K	$0
Randy Lance	IN	Anesthesiology Physician	$17.5K	$0

St Mary's Medical Group, 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