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

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

Spectrum Health Primary Care Partners (NPI 1235188673)

Field	Value
Entity Type	Organization
Organization	Spectrum Health Primary Care Partners
Address	1840 Wealthy St Se
City	Grand Rapids
State	MI
ZIP	49506
Taxonomy	Internal Medicine Physician
NPI Enumerated	May 10, 2006

Payer Source	Total Paid
Medicaid	$219.9M
Medicare	$0

Key Findings

This entity is effectively single‑payer in scope: there is no Medicare billing on file while Medicaid lifetime revenue totals $219.9M, indicating the provider’s billed activity in available claims data is dominated by Medicaid. Analysts should treat Medicare comparisons as unavailable for this NPI when assessing payer mix or cross‑payer performance.

Revenue concentration is high within a small set of evaluation‑and‑management (E/M) codes: the precomputed top three Medicaid codes (99214, 99213, 99215) account for 42.9% of the provider’s total Medicaid revenue. Those top three contributions are 99214 $33.2M (23.5%), 99213 $19.3M (13.6%), and 99215 $8.2M (5.8%), which signals a heavy dependence on routine and higher‑complexity office E/M visits for revenue.

The code mix points to a broad primary care and hospital‑based practice footprint: extremely high volumes of outpatient E/M (99214, 99213, 99215) combined with large volumes of inpatient/subsequent hospital care codes (99232, 99233, 99223) and critical care (99291) suggest the group provides both ambulatory primary care and substantial inpatient services. The presence of high‑volume preventive codes (99392, 99395, 99396) and well‑visit codes (99391) further supports a comprehensive primary care service line with prevention and chronic‑care management.

This provider is a dominant statewide participant for many high‑revenue codes: 99214 ranks #1 of 4380 providers in‑state (100th percentile; extreme outlier) and 99213 ranks #1 of 4766 providers in‑state (100th percentile; extreme outlier), indicating volumes far above typical state peers for core primary care visit codes. Multiple other codes also show top‑state ranks (for example 99215 #1 of 1166 providers, 99232 #1 of 947 providers, 99291 #1 of 274 providers), reinforcing a pattern of exceptionally high Medicaid billing presence across both outpatient and inpatient E/M services.

Specialty and procedure mix includes notable inpatient obstetrics, high‑cost injectables, and addiction treatment: 59400 (global vaginal delivery) generated $4.4M and ranks #1 of 16 providers in‑state (100th percentile; extreme outlier), while J0585 (onabotulinumtoxina) produced $6.3M and ranks #3 of 43 providers in‑state (95th percentile; notably above typical state volume). Buprenorphine extended‑release injections Q9991 and Q9992 together account for multi‑million dollar revenue ($3.1M and $2.4M respectively) and both rank at or near the top in‑state, indicating a meaningful role in medication‑assisted treatment.

Several codes are flagged explicitly as statistical outliers in the state dataset; many of the provider’s highest‑revenue codes are labeled “extreme outlier” or “notably above typical state volume.” That consistent outlier status across a broad set of E/M, inpatient, preventive, and procedure codes signals unusually high throughput relative to in‑state peers rather than isolated spikes in a single code.

The provider’s competitive strengths appear concentrated in ambulatory primary care and hospital‑based E/M: very large claim counts for 99214 (503.4K claims) and 99213 (394.4K claims) with state‑leading ranks imply scale in routine chronic care and follow‑up visits, while high rankings in inpatient/subsequent care and discharge management (e.g., 99233, 99239) indicate parallel scale in inpatient management. For payer negotiations or network planning, these patterns suggest the entity will be a major Medicaid volume partner for both outpatient primary care and associated inpatient services.

NPI tenure indicates long‑standing activity: the NPI was enumerated on 2006‑05‑10 (~20 years ago), which provides historical continuity when considering credentialing, contracting longevity, or longitudinal utilization trends in Medicaid claims data.

Medicaid: Complete Services Breakdown

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

692 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…	503,380	$70	$33.2M
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…	394,390	$50	$19.3M
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…	95,180	$90	$8.2M
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…	194,890	$40	$7.2M
99291	Critical care services include the treatment of vital organ failure or prevention of further life–threatening conditions. Delivering medical care in a moment of crisis and in time of emergency is…	58,940	$110	$6.6M
J0585	Injection, onabotulinumtoxina, 1 unit	7,920	$800	$6.3M
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…	115,240	$50	$6.2M
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…	73,170	$90	$6.2M
59400	In this global service, the provider and nonphysician healthcare providers in the practice provide all of the antepartum care, admission to the hospital for delivery, labor management, including…	2,170	$2,050	$4.4M
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…	41,160	$100	$4M

Showing 1–10 of 692

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Michigan Distribution

Spectrum Health Primary Care Partners — 23 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Michigan

Full comparison — all codes billed, vs. Michigan median

692 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J2350	Injection, ocrelizumab, 1 mg	5	10	60	$18,390	$4.9M
99285	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a high level of medical decision making.	371	400	1,510	$190	$2.6M
99472	The provider performs follow up care of a critically ill infant or young child, 29 days through 24 months of age, in an inpatient setting.	4	20	1,000	$340	$2.5M
99469	The provider evaluates and manages the subsequent care of a newborn or infant less than 28 days of age in a neonatal critical care setting, after the first day.	18	20	2,940	$340	$1.8M
99284	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making.	248	480	1,350	$110	$1.7M
99283	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a low level of medical decision making.	239	450	1,540	$90	$1.3M
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	129	150	7,610	$90	$1.2M
J2357	Injection, omalizumab, 5 mg	9	10	450	$720	$1M
42820	The provider removes the tonsils and adenoids in a patient younger than 12 years old.	6	50	150	$1,300	$889.5K
J2315	Injection, naltrexone, depot form, 1 mg	13	30	310	$1,140	$869.9K

Showing 1–10 of 692

Related Providers

Other providers that share a Tax Identification Number (TIN) with Spectrum Health Primary Care Partners, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Spectrum Health Hospitals	MI	General Acute Care Hospital	$0	$243.2M
Newaygo County General Hospital Association	MI	Critical Access Hospital	$0	$27M
Spectrum Health Hospitals	MI	Hospitalist Physician	$0	$25.2M
Pennock Hospital	MI	Critical Access Hospital	$0	$15.2M
Spectrum Health Primary Care Partners	MI	Urgent Care Clinic/Center	$0	$14.5M
Memorial Medical Center Of West Michigan	MI	General Acute Care Hospital	$0	$11.8M
Spectrum Health Hospitals	MI	Air Ambulance	$413.8K	$1.1M
Bachar Hamad	IL	Gastroenterology Physician	$325.3K	$829.9K
Zhe Liang	MI	Rheumatology Physician	$1M	$14.6K
Jeremiah Johns	MI	Emergency Medicine Physician	$432.1K	$0

Nearby Providers

Other providers in the same ZIP code as Spectrum Health Primary Care Partners, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Counseling Center Of West Michigan, LLC	MI	Mental Health Counselor	$0	$12.3M
Kent Residential Centers, Inc	MI	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$12M
Edward Lee	MI	Radiation Oncology Physician	$393.4K	$0
Byron Slaton	MI	Nephrology Physician	$245.5K	$0
Michael Unruh	MI	Nephrology Physician	$237.5K	$0
Brett Plattner	MI	Nephrology Physician	$206.1K	$0
Matthew Villerot	MI	Pain Medicine (Anesthesiology) Physician	$119.1K	$0
Carl Hinshaw	MI	Pain Medicine (Anesthesiology) Physician	$85.4K	$0
Yijia Chu	MI	Pain Medicine (Anesthesiology) Physician	$78.7K	$0
Hopemarie Hower	MI	Occupational Therapist	$52.7K	$0

Spectrum Health Primary Care Partners — 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