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

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

Wellmont Medical Associates Inc (NPI 1174808216)

Wellmont Medical Associates Inc is a family medicine physician provider located in Big Stone Gap, Virginia. This profile covers 0 Medicare and 160 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	Wellmont Medical Associates Inc
Address	323 Cloverleaf Sq
City	Big Stone Gap
State	VA
ZIP	24219
Taxonomy	Family Medicine Physician
NPI Enumerated	October 20, 2011

Payer Source	Total Paid
Medicaid	$24.6M
Medicare	$0

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

160 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…	161,700	$50	$8.4M
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…	116,410	$60	$7.2M
0241U	N/A	11,270	$120	$1.3M
87635	Using an amplified nucleic acid probe technique, the lab analyst performs the necessary steps to identify the nucleic acids from the severe acute respiratory syndrome coronavirus 2 (SARS–COV–2) virus…	16,210	$40	$713.4K
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…	7,040	$80	$549.4K
87651	The lab analyst performs a test for the bacteria Streptococcus, group A, using amplified nucleic acid probe technique. Strep A commonly causes acute pharyngitis, or strep throat.	16,160	$30	$533.4K
87502	The lab analyst performs a test to determine the presence of multiple types or subtypes of influenza virus through nucleic acid detection using multiplex amplified probe technique and possibly…	6,110	$80	$482.8K
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…	6,480	$70	$453.5K
87804	The analyst performs an immunoassay with direct optical, meaning visual, observation to detect influenza, also called flu, in a patient sample, typically a throat or nasal swab or nasal washings.	33,130	$10	$430.7K
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…	5,310	$70	$366.6K

Showing 1–10 of 160

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Virginia Distribution

Wellmont Medical Associates Inc — 12 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Virginia

Full comparison — all codes billed, vs. Virginia median

160 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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…	324	400	1,910	$50	$412.6K
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…	196	210	920	$140	$367.6K
0241U	N/A	7	90	1,840	$80	$306.3K
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…	21	3,520	370	$70	$280.7K
95165	In this procedure, the provider mixes and prepares the antigens for allergen immunotherapy. Use this code when the provider prepares one or more antigens.	57	60	140	$250	$272.2K
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,…	37	60	110	$530	$242.3K
59025	In this procedure, the provider measures the fetal heart rate of the fetus in response to its own movements.	100	130	340	$110	$210.5K
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	4,010	290	$50	$199.8K
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	400	370	$30	$162.2K
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…	109	290	360	$50	$160.1K

Showing 1–10 of 160

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Wellmont Medical Associates Inc	TN	Pulmonary Disease Physician	$0	$27.8M
Takoma Regional Hospital Inc	TN	General Acute Care Hospital	$0	$20.1M
Blue Ridge Medical Management Corporation	TN	Family Nurse Practitioner	$0	$8M
Wellmont Cardiology Services	TN	Cardiovascular Disease Physician	$0	$3.1M
Blue Ridge Medical Management Corporation	TN	Pediatrics Physician	$0	$2.9M
Blue Ridge Medical Management Corporation	TN	Internal Medicine Physician	$0	$2.8M
Blue Ridge Medical Managgement Corporation	TN	Internal Medicine Physician	$0	$2.2M
Sos Nalghranyan	FL	Hematology & Oncology Physician	$1.1M	$0
Harsha Vardhana	TN	Medical Oncology Physician	$941.1K	$66.6K
Martin Palmeri	NC	Hematology & Oncology Physician	$931.8K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Wellmont Health System	VA	General Acute Care Hospital	$0	$33.7M
Frontier Health	VA	Developmentally Disabled Services Day Training Agency	$0	$11.9M
Karen Stallard	VA	Family Nurse Practitioner	$58.1K	$5.3K
Robert Botts	VA	Optometrist	$38.9K	$5.4K
Joshua Dalton	VA	Neuromusculoskeletal Medicine & OMM Physician	$34.4K	$0
Ginger Collins	VA	Nurse Practitioner	$32.7K	$0

Wellmont Medical Associates Inc — 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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