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

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

Sentara Medical Group (NPI 1265485270)

Key Findings

Field	Value
Entity Type	Organization
Organization	Sentara Medical Group
Address	824 N Military Hwy Ste 100
City	Norfolk
State	VA
ZIP	23502
Taxonomy	Family Medicine Physician
NPI Enumerated	May 19, 2006

Payer Source	Total Paid
Medicaid	$48.7M
Medicare	$0

This entity effectively operates as a Medicaid-focused provider: there is no Medicare billing on file and the lifetime Medicaid revenue on record is $48.7M, indicating a near single-payer (Medicaid) footprint in available claims data. Analysts should treat Medicare-related comparisons as inapplicable for this NPI because no Medicare revenue is reported.

Revenue is highly concentrated in a small set of evaluation-and-management codes: the precomputed top three Medicaid codes account for 63.0% of this provider’s total Medicaid revenue, with 99214 alone generating $19.2M (41.7% of Medicaid revenue). This concentration signals that a majority of Medicaid dollars flow through established-patient office visits.

The code mix points to a blended ambulatory and inpatient footprint: high-volume outpatient E/M services (99214, 99213) are the primary revenue drivers, while substantial use of subsequent and initial inpatient visit codes (99232, 99233, 99223) and critical care (99291) indicates the provider also bills hospital-based encounters. Together these patterns are consistent with an organization that delivers both clinic-based primary care and significant hospital-associated care rather than only low-acuity office visits.

On statewide competitiveness, SENTARA MEDICAL GROUP is a dominant performer for multiple high-revenue codes: 99214 ranks #5 of 3523 providers in-state (100th percentile; extreme outlier), 99213 ranks #12 of 4012 (100th percentile; extreme outlier), and 99232 ranks #2 of 398 (100th percentile; extreme outlier). Those ranks and percentiles indicate volumes far above typical state peers and suggest market leadership in Medicaid-covered primary and inpatient E/M services.

Beyond E/M codes, the provider shows extreme outlier volume in several procedural and imaging services that diversify its Medicaid revenue: 93306 ($1.8M, rank #1 of 211, 100th percentile; extreme outlier), 93970 ($347.8K, rank #1 of 105, 100th percentile; extreme outlier), and 93971 ($308.7K, rank #1 of 136, 100th percentile; extreme outlier). These ranks indicate the organization is not only high-volume for visits but also for cardiac imaging and vascular duplex studies.

Claim-volume metrics underscore very high throughput: 99214 appears on 319.4K claims, 99213 on 131.7K claims, and 99232 on 129.3K claims, showing the provider processes large absolute claim counts for several core codes. Such volumes are consistent with system-scale operations or multi-site delivery under a single tax ID rather than a low-volume independent practice.

Payment profile shows a mix of low-unit-value, high-volume services and some higher-priced items: average paid/claim is $60 for 99214, $45 for 99213, and $30 for 99232, while select items like J0585 have an average paid/claim of $439. This mix means total Medicaid revenue is driven both by very large claim counts on routine E/M and by occasional higher-priced procedures or injections.

The provider’s NPI has been enumerated since 2006-05-19 (~20 years ago), indicating long tenure in the market; combined with the large Medicaid revenue ($48.7M) and persistent extreme-percentile rankings across multiple codes, the data suggest an established organization with sustained, high-volume Medicaid activity rather than a recent or transient billing pattern.

Medicaid: Complete Services Breakdown

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

208 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…	319,360	$60	$19.2M
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…	131,690	$50	$5.9M
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…	129,320	$30	$3.9M
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…	69,430	$50	$3.4M
99223	The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	24,900	$80	$2M
93306	The provider uses transducers to obtain two–dimensional (2D) images of the heart structures through the chest wall. He evaluates the anatomy and function of all four heart chambers, valves, adjacent…	43,210	$40	$1.8M
90833	In this add–on service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient, in addition to an evaluation and management service in the…	31,020	$50	$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…	10,210	$90	$898.2K
99239	The provider sees a patient for hospital inpatient or observation discharge day management, involving evaluation and management (E/M). The provider spends more than 30 minutes on the service on the…	16,940	$50	$864K
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…	10,650	$80	$809K

Showing 1–10 of 208

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Virginia Distribution

Sentara Medical Group — 23 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Virginia

Full comparison — all codes billed, vs. Virginia median

208 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0585	Injection, onabotulinumtoxina, 1 unit	9	20	750	$540	$871.7K
93306	The provider uses transducers to obtain two–dimensional (2D) images of the heart structures through the chest wall. He evaluates the anatomy and function of all four heart chambers, valves, adjacent…	1	210	920	$140	$367.6K
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…	5	3,520	370	$70	$280.7K
90837	In this service, the provider performs psychotherapy, a series of technique for treating the psychiatric disorders of the patient. The treatment session typically lasts for a minimum of 53 minutes or…	777	1,340	710	$90	$245K
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,…	28	60	110	$530	$242.3K
64615	The provider bilaterally administers a chemical compound to the muscles innervated by the trigeminal, facial, cervical spinal, and accessory nerves. The goal of this procedure is to paralyze the…	7	10	550	$270	$224.5K
78452	In this procedure, the provider performs multiple SPECT studies of the heart to determine the areas of deficient blood flow. The goal of the procedure is to determine areas that have deficient blood…	15	100	160	$470	$207K
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…	12	4,010	290	$50	$199.8K
45378	The provider examines the colon and rectum using a colonoscope, a flexible tube with a camera at its inserted end. If he sees any areas of abnormal mucosa or tissue, he takes samples using a brush…	52	60	120	$680	$199.6K
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…	6	130	440	$120	$197K

Showing 1–10 of 208

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Columbus Radiology Corp	OH	Diagnostic Radiology Physician	$0	$49.9M
Sentara Reference Lab Solutions, LLC	VA	Clinical Medical Laboratory	$12.9M	$4.7M
Rmh Medical Group LLC	VA	General Practice Physician	$0	$9.8M
Jonathan Wiesen	VA	Internal Medicine Physician	$2.4M	$0
Deepak Deshmukh	VA	Vascular Surgery Physician	$1.4M	$0
Kambiz Shamlou	FL	Diagnostic Radiology Physician	$1.4M	$0
Thomas Yuschok	FL	Diagnostic Radiology Physician	$1.2M	$0
Naren Gupta	MA	Vascular Surgery Physician	$1.1M	$0
Kyle Harner	NC	Rheumatology Physician	$1.1M	$0
Christopher Stout	AR	Vascular Surgery Physician	$908.2K	$260

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Sentara Hospitals	VA	General Acute Care Hospital	$0	$79.7M
Tremont Road Dental Super, P.C.	VA	General Practice Dentistry	$0	$63.5M
Emergency Physicians Of Tidewater	VA	Emergency Medicine Physician	$0	$47.9M
Community Alternative Inc	VA	Community/Behavioral Health Agency	$0	$44.3M
Life's Journey	VA	Adult Mental Health Clinic/Center	$0	$24.4M
Keys To Success Family & Developmental Services	VA	Community/Behavioral Health Agency	$0	$16.1M
Advantage Home Care, LLC	VA	Home Health Agency	$0	$15.7M
National Counseling Group, Inc	VA	Mental Health Counselor	$0	$14.5M
Childrens Medical Group Inc	VA	Pediatrics Physician	$0	$9.1M
Pediatric Services Of America, LLC	VA	Nursing Care Agency	$0	$9.1M

Sentara Medical Group — 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