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

Why is the Medicaid comparison limited to New Mexico 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. New Mexico (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.

National Sinus Institute PLLC (NPI 1194968081)

National Sinus Institute PLLC is a otolaryngology physician provider located in Los Alamos, New Mexico. This profile covers 0 Medicare and 29 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	National Sinus Institute PLLC
Address	3917 West Rd
City	Los Alamos
State	NM
ZIP	87544
Taxonomy	Otolaryngology Physician
NPI Enumerated	April 8, 2009

Payer Source	Total Paid
Medicaid	$6.1M
Medicare	$0

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

29 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	15,530	$120	$1.8M
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…	19,910	$80	$1.7M
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…	11,820	$60	$697.1K
31231	In this procedure, the provider inserts an endoscope into the nasal cavity to examine the structures of the nasal cavity on one or both sides.	3,760	$140	$529.7K
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.	970	$430	$414.2K
31295	The provider passes an endoscope into the nasal cavity of the patient. He also dilates the ostium, or opening, of the maxillary sinus. The approach is either through the nose or via a depression on…	130	$1,760	$231.7K
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…	2,110	$90	$181.6K
69436	This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia.	670	$160	$107.2K
70486	The provider uses computed tomography, or CT, to examine the maxillofacial area, such as the upper jaw or face structures. The provider does not administer contrast for this exam.	840	$110	$88.2K
95117	The provider injects the patient with allergenic extracts to desensitize the patient to the allergen; the patient receives 2 or more injections at a single visit.	8,820	$10	$70.6K

Showing 1–10 of 29

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. New Mexico Distribution

National Sinus Institute PLLC — 4 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — New Mexico

Full comparison — all codes billed, vs. New Mexico median

29 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average 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…	100	930	910	$80	$521.6K
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…	41	960	1,010	$90	$490K
95004	The provider performs a percutaneous test with allergenic extracts to determine which substances (allergens) trigger an allergic reaction in the patient.	12	30	100	$770	$447.8K
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.	9	30	340	$250	$395.7K
42820	The provider removes the tonsils and adenoids in a patient younger than 12 years old.	13	20	310	$1,070	$373.1K
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,…	315	380	220	$160	$273.9K
31295	The provider passes an endoscope into the nasal cavity of the patient. He also dilates the ostium, or opening, of the maxillary sinus. The approach is either through the nose or via a depression on…	1	10	130	$1,750	$231.6K
69436	This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia.	2	10	160	$760	$201.1K
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…	55	360	220	$90	$134.7K
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…	23	30	100	$160	$133.4K

Showing 1–10 of 29

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Matthew Hinsley	OR	Otolaryngology Physician	$112.4K	$0
Ian Alexander	TX	Otolaryngology Physician	$111.9K	$0
Peter Shepard	OR	Otolaryngology/Facial Plastic Surgery Physician	$71.8K	$0
Seema Sabu	NM	Physician Assistant	$68.4K	$0
Joe Tumalad	NM	Nurse Practitioner	$58.8K	$0
Stacey King	NM	Family Nurse Practitioner	$58.1K	$0
Byron Erstine	NM	Otolaryngology/Facial Plastic Surgery Physician	$52.2K	$0
Stephen Janway	NM	Family Nurse Practitioner	$44.3K	$0
Kami Daily	NM	Family Nurse Practitioner	$41.3K	$0
Jesse Knight	UT	Otolaryngology Physician	$40.3K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Phc-los Alamos Inc	NM	Rural Acute Care Hospital	$0	$2.6M
Incorporated County Of Los Alamos	NM	Land Ambulance	$183.7K	$49.7K
Ann Linnebur	NM	Cardiovascular Disease Physician	$231.9K	$0
Molly Vosburg	NM	Internal Medicine Physician	$184.1K	$0
James Ziomek	NM	Internal Medicine Physician	$161.8K	$0
Michelle Carr	NM	Family Medicine Physician	$153K	$0
Lori Whitley	NM	Dermatology Physician	$135.1K	$0
Madhavi Garimella	NM	Endocrinology, Diabetes & Metabolism Physician	$131.7K	$0
Timothy Johnson	NM	Optometrist	$129.9K	$0
Richard Honsinger	NM	Allergy & Immunology Physician	$100.3K	$0

National Sinus Institute PLLC — Billing Profile & Reimbursement Data

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National Sinus Institute PLLC — 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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