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.

Prime Healthcare, PC (NPI 1184819302)

Prime Healthcare, PC is a internal medicine physician provider located in Wethersfield, Connecticut. This profile covers 0 Medicare and 80 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	Prime Healthcare, PC
Address	30 Jordan Ln
City	Wethersfield
State	CT
ZIP	06109
Taxonomy	Internal Medicine Physician
NPI Enumerated	September 11, 2007

Payer Source	Total Paid
Medicaid	$4.3M
Medicare	$0

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

80 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…	42,170	$50	$2.1M
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…	32,970	$40	$1.2M
99308	The provider sees a patient for a subsequent nursing facility care visit involving evaluation and management (E/M). The visit involves a low level of medical decision making and/or the provider…	6,860	$40	$247.1K
99349	The provider sees an established patient for a home or residence visit involving evaluation and management (E/M). The visit involves moderate medical decision making or the provider spends at least…	5,410	$40	$189.4K
99305	The provider sees a patient for an initial nursing facility care visit involving evaluation and management (E/M). The visit involves moderate medical decision making or the provider spends at least…	1,080	$70	$71.3K
99309	The provider sees a patient for a subsequent nursing facility care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or the provider…	1,220	$50	$59.8K
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…	1,020	$50	$49.8K
99307	The provider sees a patient for a subsequent nursing facility care visit involving evaluation and management (E/M). The visit involves a straightforward level of medical decision making or the…	2,440	$20	$43.8K
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…	530	$70	$35.7K
99336	N/A	930	$30	$30.8K

Showing 1–10 of 80

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

Prime Healthcare, PC — 7 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

80 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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.	79	80	990	$260	$592K
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…	37	1,590	740	$50	$331.8K
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…	66	1,710	750	$30	$243.3K
99309	The provider sees a patient for a subsequent nursing facility care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or the provider…	48	140	330	$20	$194.5K
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…	59	170	260	$20	$183.2K
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…	77	100	340	$30	$172.2K
90460	In this procedure, the provider administers a single live attenuated vaccine through a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age.	184	240	1,560	$20	$159.4K
76770	A retroperitoneal ultrasound is a noninvasive procedure used to assess the body parts within the abdomen (i.e.Kidneys, urinary bladder, and aorta). This particular code is used when the ultrasound is…	26	60	750	$60	$141.7K
99244	The provider sees a patient for an office or other outpatient consultation involving evaluation and management (E/M). The E/M involves a moderate level of medical decision making or the provider…	39	70	320	$110	$129K
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…	272	480	200	$60	$112.1K

Showing 1–10 of 80

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
NPI 1457647281	—	—	$306.9K	$0
Sarah Yiznitsky	CT	Family Nurse Practitioner	$171.6K	$0
Hollie Smith	CT	Adult Health Nurse Practitioner	$159.4K	$0
Tapas Bandyopadhyay	CT	Pulmonary Disease Physician	$149.1K	$0
G Trono	CT	Urology Physician	$144K	$0
William Preskenis	CT	Pulmonary Disease Physician	$133.6K	$0
Janine Wilcox	CT	Gerontology Nurse Practitioner	$131.8K	$0
Patrene Rhoden	CT	Nurse Practitioner	$125.5K	$0
Leeanne Shaw-quinn	CT	Gerontology Nurse Practitioner	$125K	$0
Aida Becker	CT	Family Medicine Physician	$109K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Caregiver Homes Of Connecticut, Inc	CT	Case Management Agency	$0	$112.5M
Hartford Healthcare Medical Group, Inc	CT	Surgery Physician	$0	$22.4M
Medical Management Plus	CT	Home Health Agency	$0	$21.5M
Hartford Healthcare At Home, Inc	CT	Home Health Agency	$0	$19.2M
Connecticut Imaging Partners, LLC	CT	Diagnostic Radiology Physician	$0	$4.6M
1271972 LLC	CT	Urgent Care Clinic/Center	$0	$4M
Dr. James Hai T. Nguyen, LLC	CT	General Practice Dentistry	$0	$1.5M
Dr. Nguyen Associates LLC	CT	Optometrist	$0	$1.4M
Minds Cornerstone LLC	CT	Community/Behavioral Health Agency	$0	$1.3M
Laura Miner	CT	Pediatric Dentistry	$0	$1.3M

Prime Healthcare, PC — Billing Profile & Reimbursement Data

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Prime Healthcare, PC — 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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