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

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

Direct Care Prenatal LLC (NPI 1184100240)

Field	Value
Entity Type	Organization
Organization	Direct Care Prenatal LLC
Address	11805 W Hampton Ave Ste 103
City	Milwaukee
State	WI
ZIP	53225
Taxonomy	Case Management Agency
NPI Enumerated	July 12, 2018

Payer Source	Total Paid
Medicaid	$1.9M
Medicare	$0

Medicaid: Complete Services Breakdown

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

3 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T1016	Case management, each 15 minutes	24,660	$80	$1.9M
H1002	Prenatal care, at risk enhanced service; care coordination	20	$50	$830
H1000	Prenatal care, at-risk assessment	20	$40	$680

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Wisconsin Distribution

Direct Care Prenatal LLC — 0 of 3 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Wisconsin

Full comparison — all codes billed, vs. Wisconsin median

3 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1016	Case management, each 15 minutes	55	220	7,110	$70	$1.7M
H1000	Prenatal care, at-risk assessment	27	30	90	$40	$15.7K
H1002	Prenatal care, at risk enhanced service; care coordination	27	30	70	$40	$11.5K

Nearby Providers

Other providers in the same ZIP code as Direct Care Prenatal LLC, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Regal Home Health Services	WI	Home Health Agency	$0	$6.6M
Bundle Of Love Prenatal LLC	WI	Case Management Agency	$0	$4.6M
Hope Services Wisconsin	WI	Case Management Agency	$0	$4.4M
Total Renal Care Inc	WI	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$1.7M
Aja Enterprise LLC	WI	Case Management Agency	$0	$1.5M
Herslof's, Inc	WI	Optician	$0	$1.2M
Rachel Garrett	WI	Speech-Language Pathologist	$21.4K	$0

Direct Care Prenatal LLC — Billing Profile & Reimbursement Data

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Direct Care Prenatal LLC — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Nearby Providers

Frequently Asked Questions

References