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

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

Southwestern Vermont Medical Center Inc. (NPI 1184994162)

Key Findings

Field	Value
Entity Type	Organization
Organization	Southwestern Vermont Medical Center Inc.
Address	140 Hospital Dr
City	Bennington
State	VT
ZIP	05201
Taxonomy	Internal Medicine Physician
NPI Enumerated	January 6, 2012

Payer Source	Total Paid
Medicaid	$2.9M
Medicare	$0

This entity has no Medicare billing on file and reports $2.9M in lifetime Medicaid revenue, making its public claims profile effectively single‑payer (Medicaid) in scale. Analysts should treat comparisons and competitive positioning as Medicaid‑focused because there is no Medicare footprint to balance the payer mix.

Revenue is highly concentrated: the precomputed top 3 Medicaid codes account for 77.4% of the provider's total Medicaid revenue. Those top contributors are 99213 ($995K, 34.9%), 99214 ($965.4K, 33.8%), and 99391 ($249.3K, 8.7%), indicating a narrow set of codes driving most dollars.

The procedure mix—dominated by 99213 and 99214 plus strong volumes of preventive codes like 99391 and 99392—is consistent with an internal medicine / primary care outpatient operation that focuses on high throughput of established‑patient office visits and routine preventive care. High counts of vaccination administration codes (90471, 90472) and well‑visit codes (99391/99392/99393) further point to robust immunization and wellness visit activity, including pediatric/adolescent preventive care.

Competitive standing within Vermont is unusually strong on core primary care codes: 99213 ranks #6 of 319 providers in‑state (98th percentile; extreme outlier) and 99214 ranks #9 of 323 providers (98th percentile; notably above typical state volume). The provider also ranks #1 of 42 for 99392 (100th percentile) and #2 of 88 for 90471 (99th percentile), signaling that for multiple primary‑care and vaccine services this organization is a leading Medicaid provider in the state.

Operational throughput is visible in raw claims: 99213 has 49.8K claims with an average paid/claim of $20 and 99214 has 37.1K claims with an average paid/claim of $26, showing heavy visit volumes coupled with modest per‑claim reimbursement. Those volumes are consistent with a high‑capacity clinic model that relies on large numbers of routine visits rather than high‑value single encounters.

Preventive services and immunizations are a clear revenue and service-line emphasis: 99391 ($249.3K) and 99392 ($109.3K) together capture meaningful revenue and 90471 ($96.3K) and 90472 ($64.7K) rank at or near the top of state peers, reflecting systematic delivery of vaccinations and well visits. Presence of 99393 and 99394 among the top codes also indicates regular child and adolescent preventive care activity.

The provider performs on‑site diagnostic and point‑of‑care testing that complements the primary care mix: notable Medicaid revenue items include 93306 ($39.8K) for echocardiography, 94010 ($10K) for spirometry, 93000 ($4.6K) for ECGs, and molecular/antigen testing codes like 87635 ($37.5K), 87880 and 87804 for respiratory infections. This blend suggests capacity to deliver both basic ambulatory procedures and immediate diagnostic testing within the clinic setting.

The NPI was enumerated on 2012-01-06 (~14 years ago), indicating a long‑tenured billing presence in the state. Coupled with the high Medicaid volumes and top‑tier state rankings on core codes, the data support the view that this provider is an established Medicaid primary‑care anchor in its local market rather than a newer or marginal participant.

Medicaid: Complete Services Breakdown

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

75 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…	49,750	$20	$995K
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…	37,130	$30	$965.4K
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…	3,280	$80	$249.3K
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…	4,750	$20	$109.3K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	16,050	$10	$96.3K
99215	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the…	2,020	$40	$88.8K
90472	This code represents each injection of a vaccine after the first; list this code in addition to the code for the first injection.	6,470	$10	$64.7K
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…	1,580	$30	$52.2K
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…	1,810	$20	$39.8K
99212	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,…	2,840	$10	$39.7K

Showing 1–10 of 75

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Vermont Distribution

Southwestern Vermont Medical Center Inc. — 8 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Vermont

Full comparison — all codes billed, vs. Vermont median

75 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average 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…	9	320	680	$30	$146.1K
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…	6	320	760	$20	$88.2K
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…	12	50	50	$80	$50K
99215	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the…	7	110	170	$70	$38.6K
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…	4	10	640	$20	$37.1K
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…	6	70	70	$50	$36K
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…	4	40	170	$40	$31.6K
93010	The provider interprets and reports on the results of a routine 12–lead (or more) electrocardiogram.	12	20	1,990	$1	$20.9K
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…	1	40	280	$20	$19.5K
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.	4	20	170	$10	$17.3K

Showing 1–10 of 75

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Martin Memorial Medical Center Inc	FL	General Acute Care Hospital	$0	$26M
Southwestern Vermont Medical Center Inc.	VT	General Acute Care Hospital	$0	$5.1M
Bluewater Emergency Partners Of Brunswick, LLC	ME	Emergency Medicine Physician	$0	$3.8M
Julie Bell	FL	Anatomic Pathology & Clinical Pathology Physician	$3.3M	$0
Brattleboro Memorial Hospital	VT	General Acute Care Hospital	$0	$2.4M
Arley Peter	FL	Cardiovascular Disease Physician	$1.8M	$0
Refat Baridi	IL	Hematology & Oncology Physician	$1.7M	$27.6K
Prasad Chalasani	FL	Cardiovascular Disease Physician	$1.4M	$0
Amy Eversole	FL	Cardiovascular Disease Physician	$1.3M	$0
Joseph Mcclure	FL	Medical Oncology Physician	$1.2M	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
United Counseling Service Of Bennington County, Inc.	VT	Developmental Disabilities Clinic/Center	$0	$72.5M
Vermont Permanency Initiative, Inc.	VT	Emotionally Disturbed Childrens' Residential Treatment Facility	$0	$27.9M
Savida Health, PC	VT	Addiction Medicine (Internal Medicine) Physician	$0	$12M
Sunrise Family Resource Center	VT	Social Worker	$0	$7M
Seall Inc	VT	Emotionally Disturbed Childrens' Residential Treatment Facility	$0	$6.6M
United Counseling Service Of Bennington County, Inc.	VT	Clinic/Center	$0	$6M
Town Of Bennington Rescue Squad, Inc.	VT	Land Ambulance	$683.4K	$2.7M
Oral And Facial Surgery Associates,plc	VT	Oral and Maxillofacial Surgery (Dentist)	$0	$1.8M
Brookside Pediatrics & Adolescent Medicine PLLC	VT	Pediatrics Physician	$0	$1.2M
Vermont Family Dental Plc	VT	Dental Clinic/Center	$0	$1.1M

Southwestern Vermont Medical Center Inc. — 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