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

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

Mercy Clinic Springfield Communities (NPI 1245277631)

Key Findings

Field	Value
Entity Type	Organization
Organization	Mercy Clinic Springfield Communities
Address	3231 S National Ave Ste 220
City	Springfield
State	MO
ZIP	65807
Taxonomy	Family Medicine Physician
NPI Enumerated	June 2, 2006

Payer Source	Total Paid
Medicaid	$51.5M
Medicare	$0

This provider is effectively a Medicaid-only biller in the available dataset: there is no Medicare billing on file and lifetime Medicaid revenue is reported at $51.5M. That extreme payer concentration means analyses and network strategies should treat MERCY CLINIC SPRINGFIELD COMMUNITIES as a Medicaid-dominant entity rather than a mixed Medicare/Medicaid operator.

Revenue is heavily concentrated in a small set of E/M codes: 99214 accounts for $11.1M (26.9% of Medicaid revenue), 99213 accounts for $9.9M (23.9%), and 99232 accounts for $2.3M (5.5%); the precomputed top-3 share is 56.2% of total Medicaid revenue. This concentration implies operational dependence on ambulatory and subsequent inpatient E/M services for the majority of billed Medicaid dollars.

The claim volumes and code mix point to a broad, high-throughput primary care and hospital-facing operation rather than a small outpatient clinic. High-claim counts such as 163.2K claims for 99214 and 156.6K claims for 99213, combined with significant coding for inpatient/subsequent care (99232, 99233, 99223) and critical care (99291), indicate capacity across outpatient, inpatient, and acute-care settings.

Competitive standing within Missouri is dominant for many codes: 99214 ranks #3 of 3166 providers in-state (100th percentile; extreme outlier, far above typical state volume), 99213 ranks #2 of 4312 providers in-state (100th percentile; extreme outlier, far above typical state volume), and 99291 ranks #1 of 153 providers in-state (100th percentile; extreme outlier, far above typical state volume). These rank and percentile positions identify the provider as a major statewide volume leader for both routine and higher-acuity Medicaid services.

Beyond E/M codes, the provider reports high volumes across preventive pediatric visits (99391, 99392, 99393), imaging (74177 CT abdomen/pelvis, 70450 CT head, 70553 MRI brain), and pathology (88305). Many of these non-E/M codes also sit in the 98th–100th percentile statewide (noted as extreme outliers or far above typical state volume), suggesting co-located or closely affiliated diagnostic and procedural capabilities that materially contribute to Medicaid revenue.

Despite the large claim counts, Medicaid reimbursement per encounter is modest on top codes: 99214 shows $68 avg paid/claim, 99213 $63 avg paid/claim, and 99232 $37 avg paid/claim. This combination of very high volume and relatively low per-claim payments is characteristic of high-throughput primary care and hospital follow-up business models operating primarily in the Medicaid payer space.

The presence of high-acuity hospital codes (99223, 99233) and critical care (99291) alongside routine outpatient E/M and preventive pediatrics implies integrated service lines spanning ambulatory, inpatient, and acute care settings. While taxonomy is Family Medicine Physician, the code mix and statewide rank positions are more consistent with a system-level clinic or large multi-site practice that manages both primary care and hospital-based encounters.

The provider has a long-standing NPI enumeration date of 2006-06-02 (~20 years ago), which supports the plausibility of entrenched referral networks and sustained high volumes. That tenure, combined with repeated 98th–100th percentile rankings across many codes, suggests these activity patterns are established rather than transient.

Medicaid: Complete Services Breakdown

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

350 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…	163,190	$70	$11.1M
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…	156,590	$60	$9.9M
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…	61,170	$40	$2.3M
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…	18,170	$100	$1.8M
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…	12,600	$120	$1.5M
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…	10,690	$140	$1.4M
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…	14,630	$100	$1.4M
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…	15,400	$80	$1.3M
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…	23,040	$50	$1.1M
74177	The provider performs computed tomography of the abdomen and pelvis with contrast material to diagnose the cause of abdominal or pelvic pain or other abnormalities of the internal organs.	16,470	$60	$938.8K

Showing 1–10 of 350

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Missouri Distribution

Mercy Clinic Springfield Communities — 25 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Missouri

Full comparison — all codes billed, vs. Missouri median

350 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
80053	The lab analyst performs a comprehensive metabolic panel, or CMP test in which he measures the blood level of 14 chemicals the code descriptor lists for the panel.	59	240	1,740	$40	$353.4K
85025	A complete blood count (better known as a CBC) is a blood test request by a doctor that provides detailed information about various types of cells in a patient's blood. Usually a pathologist or a…	69	320	980	$40	$352.7K
42820	The provider removes the tonsils and adenoids in a patient younger than 12 years old.	4	30	110	$1,230	$229.7K
81001	Urinalysis is used to detect substances or cellular material in the urine associated with different metabolic and kidney disorders. It is used to detect urinary tract infections (UTI) and other…	114	160	720	$60	$218.3K
0241U	N/A	52	80	330	$110	$192.3K
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.	41	40	100	$330	$144.9K
80076	The lab analyst performs a hepatic function panel test in which he measures the blood levels of total protein, albumin, alkaline phosphatase, bilirubin, both total and direct, and liver enzymes.	28	40	70	$70	$144.3K
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.	13	90	120	$250	$141.3K
45380	The provider examines the rectum and colon using a flexible colonoscope, a tubular instrument with a light source and camera, to look for the cause of a patient's symptoms, which may include…	27	30	90	$340	$140.3K
95811	During the study, the physician monitors the sleep pattern of the patient, along with different bodily functions during the sleep cycle extending over a period of six hours or more.	3	30	50	$650	$137.5K

Showing 1–10 of 350

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Mercy Hospital Springfield	MO	General Acute Care Hospital	$0	$64.5M
Mercy Hospital Joplin	MO	General Acute Care Hospital	$0	$46.7M
Mercy Hospital Springfield	MO	Land Ambulance	$0	$46.7M
Mercy Clinic Joplin LLC	MO	Family Medicine Physician	$0	$20.4M
Mercy Hospital Carthage	MO	Critical Access Hospital	$0	$18.8M
Mercy Clinic Springfield Communities	MO	Family Medicine Physician	$0	$15.1M
Adam Carver	MO	Ophthalmology Physician	$2.2M	$0
Erica Ballard	MO	Ophthalmology Physician	$1.4M	$0
Robert Blair	HI	Oral and Maxillofacial Surgery (Dentist)	$0	$1.4M
Patrick Gomez	IL	Hematology & Oncology Physician	$990.5K	$94.3K

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Supported Living And Employment Services, Inc.	MO	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$276.6M
Easy Living Inc.	MO	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$183.2M
Lester E Cox Medical Centers	MO	General Acute Care Hospital	$0	$112.3M
Healthcare Services Of The Ozarks, Inc	MO	Home Health Agency	$0	$60.3M
Abilities First	MO	Case Management Agency	$0	$45.8M
Southwest Center For Independent Living	MO	In Home Supportive Care Agency	$0	$45.3M
Lester E Cox Medical Centers	MO	Land Ambulance	$0	$25.8M
Seniorage Area Agency On Aging	MO	Case Management Agency	$0	$19.2M
Maxim Healthcare Services, Inc.	MO	Home Health Agency	$0	$17.7M
Lester E Cox Medical Centers	MO	Family Medicine Physician	$0	$17M

Mercy Clinic Springfield Communities — 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