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 U.S. Virgin Islands for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to U.S. Virgin Islands 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. U.S. Virgin Islands (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.

Virgin Islands Ear Nose And Throat PC (NPI 1205869260)

Key Findings

Field	Value
Entity Type	Organization
Organization	Virgin Islands Ear Nose And Throat PC
Address	9149 Estate Thomas
City	St Thomas
State	VI
ZIP	00802
Taxonomy	Specialist
NPI Enumerated	July 9, 2006

Payer Source	Total Paid
Medicaid	$1.1M
Medicare	$0

This provider has no Medicare billing on file and is effectively single‑payer in the available claims data, reporting Total Medicaid revenue of $1.1M with no Medicare revenue to offset or diversify that payer mix. Analysts should treat Medicaid as the primary and only measurable public-payer revenue stream for competitive and utilization comparisons.

Revenue concentration is high: the precomputed top 3 Medicaid codes account for 58.6% of this provider’s Medicaid revenue, driven by 99213 ($347.8K, 31.8%), 99203 ($177.6K, 16.3%), and 86003 ($114.7K, 10.5%). This means a majority of income is coming from a small set of E/M and specific allergy-testing services, which amplifies exposure to changes in reimbursement or referral patterns for those codes.

The code mix indicates a clinically focused ENT practice with heavy outpatient evaluation-and-management activity and in‑house diagnostic services: high-volume E/M codes 99213 (5.4K claims) and 99203 (2K claims) sit alongside procedural and diagnostic codes such as 31575 (1.1K claims, flexible laryngoscopy) and 86003 (925 claims, allergen‑specific IgE testing). Combined billing for spirometry (94010), nasal respiratory testing (92512), polysomnography (95810/95811), and CPAP-related DME (E0601, A4604, A7035) suggests the practice performs airway/ENT procedures plus sleep‑and‑respiratory diagnostics and durable medical equipment management.

Competitive standing in-state is mixed by service line: 99203 ranks #1 of 20 providers in-state (100th percentile; characterized as an "extreme outlier, far above typical state volume for this code"), signaling an outsized role in new‑patient E/M visits regionally. By contrast, 99213 ranks #5 of 41 (90th percentile) but is labeled "typical, unremarkable volume for this code," indicating strong but not uniquely dominant established‑patient outpatient volume. Procedural codes such as 31575 rank #1 of 2 (100th percentile; typical, unremarkable volume), so the provider is among the top state performers for scope/laryngoscopy procedures without being the clear single dominant surgical center.

Several high‑revenue services appear unique or without direct state peers in the dataset: 86003, 92512, 83013, and multiple DME and CPAP supply codes are all reported as #1 of 1 with a 0th percentile and a note that no state peer volume comparison is available. These entries should be interpreted as indicating that the provider offers some specialized allergy testing and respiratory/sleep equipment services that are uncommon among other in‑state Medicaid billers in the data.

Operational risk and strategic sensitivity: because 58.6% of Medicaid revenue is concentrated in three codes and the practice shows heavy new‑patient E/M billing (99203) that is an "extreme outlier," policy or referral shifts affecting new‑patient visits, allergy testing, or outpatient E/M reimbursement could materially change the provider’s revenue. Payers and network managers evaluating contract or utilization interventions should prioritize monitoring claims for 99203, 99213, and 86003.

Tenure and stability: the provider’s NPI was enumerated on 2006-07-09 (~20 years ago), indicating long-standing enrollment in public payers; that longevity supports stable presence in the local market even though measurable revenue is concentrated in Medicaid. Historical presence combined with the range of diagnostic and DME codes suggests an established clinical operation rather than a recent entrant.

Service breadth beyond office visits is notable: beyond E/M and laryngoscopy, the provider bills for sleep studies (95810, 95811), pulmonary function testing (94010), allergy and H. pylori laboratory testing (86003, 83013), and CPAP supplies and devices (E0601, A4604, A7035, A7038). This mix implies integrated diagnostic and ancillary revenue streams (testing plus DME) that support continuity of care for ENT, allergy, and sleep‑related conditions within a single practice.

Medicaid: Complete Services Breakdown

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

28 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…	5,440	$60	$347.8K
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…	2,000	$90	$177.6K
86003	The lab analyst performs the technical lab test to analyze a specimen such as serum for allergen–specific immunoglobulin E (IgE), using a crude allergen extract. The test result is quantitative or…	930	$120	$114.7K
31575	The provider uses a flexible laryngoscope to look inside the larynx, or voice box, to detect the presence of any abnormalities. This code applies to diagnostic services.	1,090	$90	$102.2K
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…	430	$150	$64.7K
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…	600	$110	$63.8K
92512	The provider uses this diagnostic test to evaluate the respiratory function of the nose by measuring the airflow during inhalation and exhalation as well as the air pressure in the nose.	990	$50	$50.4K
83013	The lab analyst tests multiple breath samples for the presence of an isotope that indicates the presence of the H. pylori bacteria. This organism can cause irritation and ulcers of the stomach lining.	910	$50	$44.3K
95810	Polysomnography refers to the continuous and simultaneous monitoring and recording of various physiological and pathophysiological parameters of sleep for six or more hours with physician review,…	80	$490	$40.3K
94010	The provider or technician administers a spirometry test to assess the patient's respiratory function. The spirometer is attached to a computer that records the total and timed vital capacity…	770	$20	$16.9K

Showing 1–10 of 28

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. U.S. Virgin Islands Distribution

Virgin Islands Ear Nose And Throat PC — 7 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — U.S. Virgin Islands

Full comparison — all codes billed, vs. U.S. Virgin Islands median

28 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
36415	In this procedure, the provider inserts a needle into a vein to collect a blood sample.	10	20	1,920	$110	$858.9K
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…	20	40	560	$140	$322K
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…	5	40	430	$110	$260.9K
86003	The lab analyst performs the technical lab test to analyze a specimen such as serum for allergen–specific immunoglobulin E (IgE), using a crude allergen extract. The test result is quantitative or…	1	10	930	$120	$114.4K
31575	The provider uses a flexible laryngoscope to look inside the larynx, or voice box, to detect the presence of any abnormalities. This code applies to diagnostic services.	1	10	560	$90	$52.1K
99211	An established patient presents for an office or other outpatient visit that may not require the presence of a physician or other qualified healthcare professional.	11	10	470	$40	$51.6K
92512	The provider uses this diagnostic test to evaluate the respiratory function of the nose by measuring the airflow during inhalation and exhalation as well as the air pressure in the nose.	1	10	990	$50	$50.4K
83013	The lab analyst tests multiple breath samples for the presence of an isotope that indicates the presence of the H. pylori bacteria. This organism can cause irritation and ulcers of the stomach lining.	1	10	910	$50	$44.3K
95810	Polysomnography refers to the continuous and simultaneous monitoring and recording of various physiological and pathophysiological parameters of sleep for six or more hours with physician review,…	1	10	60	$510	$30.7K
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…	3	30	80	$150	$27K

Showing 1–10 of 28

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Duanne Jones	VI	Public Health Dentistry	$0	$33.2M
Vi Government Hospital And Health Facilities Corp	VI	General Acute Care Hospital	$0	$23.6M
The St Thomas East End Medical Center Corporation	VI	Federal Public Health Clinic/Center	$0	$12.8M
Aac-air Ambulance Caribbean Inc.	VI	Air Ambulance	$2M	$8.6M
Vi Relocation Services And Rentals LLC	VI	Land Ambulance	$0	$6.8M
Alicia Prentice	VI	Home Health Aide	$0	$3.9M
Stretcher Plus, LLC	VI	Non-emergency Medical Transport (VAN)	$0	$2.8M
Cog Restore, LLC	VI	Rehabilitation Clinic/Center	$0	$2.1M
Dept Of Health, Govt Of Vi Ems St Thomas	VI	Land Ambulance	$0	$1.5M
Vi Oral Surgery, Inc	VI	Oral and Maxillofacial Surgery (Dentist)	$0	$1.4M

Virgin Islands Ear Nose And Throat PC — Billing Profile & Reimbursement Data

Sign up for Virgin Islands Ear Nose And Throat PC — Billing Profile & Reimbursement Data policy alerts

Virgin Islands Ear Nose And Throat PC — Billing Profile & Reimbursement Data

Sign up for Virgin Islands Ear Nose And Throat PC — Billing Profile & Reimbursement Data policy alerts

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Joseph Smolarz	VI	Specialist	$69.5K	$0
Jessica Hamilton	VI	Audiologist	$1.1K	$0