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

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

Anthony Gamboa (NPI 1194969196)

Anthony Gamboa is a gastroenterology physician provider located in Nashville, Tennessee. This profile covers 18 Medicare and 0 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.

Provider details (source: NPPES NPI Registry)

Medicare: Complete Services Breakdown

Field	Value
Entity Type	Individual
Organization	Anthony Gamboa
Address	1301 Medical Center Dr
City	Nashville
State	TN
ZIP	37232
Taxonomy	Gastroenterology Physician
NPI Enumerated	April 22, 2009

Payer Source	Total Paid
Medicare	$58.3K
Medicaid	$0

The CPT/HCPCS codes generating the most Medicare revenue for this provider.

18 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
43274	The physician performs an ERCP (a diagnostic procedure that combines upper endoscopy and retrograde (reverse or backward) injection of contrast material, a type of dye, into the biliary ducts to…	40	$300	$10.6K
43237	The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum; he also inserts an ultrasound transducer through the scope to examine these same…	60	$130	$7.9K
43276	Endoscopic retrograde cholangiopancreatography (ERCP) is endoscopic inspection of the duodenum, the papilla of vater, followed by radiologic assessment of the pancreatic duct and the biliary…	30	$290	$7.1K
45385	The provider examines the colon and rectum using a colonoscope, a long, thin flexible tubular instrument with a light source and camera. He removes one or more tumors, polyps, or other lesions with a…	20	$180	$4.1K
99222	The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	40	$100	$3.8K
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.	80	$40	$3.1K
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…	50	$70	$3.1K
43264	The provider performs a diagnostic procedure that combines upper endoscopy and retrograde (reverse) injection of contrast material, a type of dye, into the biliary ducts to obtain fluoroscopic images…	30	$90	$2.9K
43275	Endoscopic retrograde cholangiopancreatography (ERCP) is endoscopic inspection of the duodenum, the papilla of vater, followed by radiologic assessment of the pancreatic duct and the biliary…	10	$220	$2.9K
43238	The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum where he carries out an ultrasound–guided, intramural or transmural fine needle…	20	$130	$2.4K

Showing 1–10 of 18

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
45385	263	320	60	$260	$27.1K
99214	8,559	11,370	120	$80	$16.6K
45380	224	320	40	$190	$15.3K
43239	161	340	70	$110	$11.2K
43249	48	80	30	$230	$8.6K
99215	2,466	2,710	40	$110	$8.3K
99213	9,125	11,030	80	$50	$8K
43276	2	10	30	$300	$7.9K
43274	4	20	20	$320	$6.6K
99204	3,679	5,490	30	$100	$5.3K

Anthony Gamboa — Billing Profile & Reimbursement Data

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Medicare: Total Revenue Breakdown by CPT/HCPCS Code

Medicare: Complete Services Breakdown

Medicare: Competitive Analysis & Benchmarks

Frequently Asked Questions

References