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

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

Primary Care Associates, LLC (NPI 1245616416)

Primary Care Associates, LLC is a medical specialty clinic/center provider located in Hilo, Hawaii. This profile covers 0 Medicare and 16 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	Primary Care Associates, LLC
Address	346 Waianuenue Ave
City	Hilo
State	HI
ZIP	96720
Taxonomy	Medical Specialty Clinic/Center
NPI Enumerated	August 10, 2015

Payer Source	Total Paid
Medicaid	$246.9K
Medicare	$0

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

16 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…	2,220	$60	$137.6K
99401	At an encounter separate from a preventive medicine visit, the provider offers counseling related to subjects appropriate for the patient’s age, family history, and areas of concern. The subjects…	1,690	$30	$49K
99396	The provider performs an established well–patient visit for a patient who is between the ages of 40 and 64.	370	$80	$29.7K
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…	450	$40	$18.5K
99395	The provider performs an established well–patient visit for a patient who is between the ages of 18 and 39.	100	$80	$7.7K
83036	Sugar in the bloodstream can get attached to the hemoglobin in red blood cells. Once the sugar is attached, it stays there for the lifetime of the red blood cell (around 120 days or over 3 months).…	230	$10	$1.6K
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…	10	$110	$1.4K
90756	This code represents a flu vaccine product that protects against four strains of influenza. It is derived from cell cultures, contains no antibiotics, and is administered as a 0.5 mL injection into…	50	$10	$670
99497	The provider discusses and shares planning with a patient, his family, or an individual representing the patient, regarding the future health care needs of the patient. Use this code for the first 30…	40	$10	$350
G0439	Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	70	$1	$200

Showing 1–10 of 16

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Hawaii Distribution

Primary Care Associates, LLC — 2 of 13 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Hawaii

Full comparison — all codes billed, vs. Hawaii median

16 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…	395	710	650	$90	$274.1K
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…	164	690	650	$90	$235.4K
83036	Sugar in the bloodstream can get attached to the hemoglobin in red blood cells. Once the sugar is attached, it stays there for the lifetime of the red blood cell (around 120 days or over 3 months).…	37	70	230	$10	$66.5K
99396	The provider performs an established well–patient visit for a patient who is between the ages of 40 and 64.	5	20	30	$140	$40.2K
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…	156	170	70	$90	$23.3K
99395	The provider performs an established well–patient visit for a patient who is between the ages of 18 and 39.	9	30	30	$110	$11.1K
99401	At an encounter separate from a preventive medicine visit, the provider offers counseling related to subjects appropriate for the patient’s age, family history, and areas of concern. The subjects…	1	20	310	$20	$6.8K
99397	The provider performs an established well–patient visit for a patient who is 65 years or older.	29	30	90	$30	$5.6K
99497	The provider discusses and shares planning with a patient, his family, or an individual representing the patient, regarding the future health care needs of the patient. Use this code for the first 30…	23	30	120	$10	$3.6K
G0439	Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	32	50	160	$10	$2.5K

Showing 1–10 of 16

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Hilo Benioff Medical Center	HI	General Acute Care Hospital	$0	$51.2M
Liberty Dialysis - Hawaii LLC	HI	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$19.3M
Metropacific Group, Corp	HI	Developmentally Disabled Services Day Training Agency	$0	$13.3M
Triple Ace Venture Capital, Corp.	HI	In Home Supportive Care Agency	$0	$10.5M
Whchc - Hawaii Island Community Health Center	HI	Federally Qualified Health Center (FQHC)	$0	$8.1M
West Hawaii Community Health Center, Inc.	HI	Federally Qualified Health Center (FQHC)	$0	$7.1M
Hilo Urgent Care Center, LLC	HI	Urgent Care Clinic/Center	$0	$6.5M
Alpha Care Hawaii LLC	HI	In Home Supportive Care Agency	$0	$5.9M
Mastercare Inc	HI	In Home Supportive Care Agency	$0	$5.4M
Americare Hawaii Incorporated	HI	In Home Supportive Care Agency	$0	$3.7M

Primary Care Associates, LLC — Billing Profile & Reimbursement Data

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Primary Care Associates, LLC — 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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Frequently Asked Questions

References