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

Why is the Medicaid comparison limited to West 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. West 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.

West Virginia University Medical Corporation (NPI 1275504508)

Key Findings

Field	Value
Entity Type	Organization
Organization	West Virginia University Medical Corporation
Address	1 Medical Center Drive
City	Morgantown
State	WV
ZIP	26506
Taxonomy	Family Medicine Physician
NPI Enumerated	January 26, 2006

Payer Source	Total Paid
Medicaid	$162.1M
Medicare	$0

This provider is effectively a Medicaid-focused biller with no Medicare revenue on file and $162.1M in lifetime Medicaid revenue. The absence of any Medicare billing makes its current payer mix effectively single‑payer (Medicaid) in scale, which materially shapes revenue, utilization, and competitive comparisons that follow.

Revenue is highly concentrated in office/outpatient evaluation and management: the precomputed top‑3 Medicaid codes account for 49.5% of this provider's total Medicaid revenue, led by 99214 (22.7% of Medicaid revenue, $26.4M), 99213 (19.6%, $22.8M), and 99204 (7.3%, $8.5M). This concentration indicates that ambulatory visits for new and established patients are the primary revenue drivers.

The code mix demonstrates broad service lines beyond primary care ambulatory visits, including emergency, inpatient, imaging, lab, maternity, neonatal, and behavioral health services. High‑revenue codes include ED E/M 99284 ($6.1M, 5.2%) and 99285 ($6.1M, 5.2%), inpatient subsequent care 99232 ($5.6M, 4.8%) and 99233 ($4.1M, 3.5%), MRI 70553 ($2.1M, 1.8%), pathology 88305 ($1.5M, 1.3%), and psychotherapy 90837 ($2.8M, 2.4%), which together point to an integrated clinical operation handling outpatient visits, emergent and inpatient care, diagnostics, and behavioral health.

Statewide competitive standing is dominant across many codes: the provider ranks #1 in‑state for 99214, 99213, 99204, 99232, 99233, 99291 and numerous diagnostic and procedural codes, frequently at the 100th percentile and labeled an "extreme outlier." These rank positions indicate the provider is the leading Medicaid biller in West Virginia for a large set of high‑volume services and far exceeds typical state volumes for those codes.

Although ED visit ranks for 99284 and 99285 are #3 and #4 in‑state (99th and 98th percentiles), the presence of 99291 (critical care) at #1 with $3.5M in revenue (3.0%) signals substantial emergency and critical care capacity. The combination of high ED volume and top critical care volume suggests this provider operates significant acute care resources tied into its Medicaid population.

The provider also shows meaningful perinatal and neonatal service lines with 59409 (vaginal delivery) at $1.9M (1.6%) ranking #1 in‑state and neonatal critical care codes 99469 ($1.3M, 1.1%) and 99472 ($1.7M, 1.4%) ranking at the top in the state. These figures indicate active obstetrics and NICU-level care contributing nontrivial shares of Medicaid revenue.

Diagnostic and procedural throughput supports the clinical breadth: MRI brain 70553 ($2.1M, 1.8%) ranks #1 in‑state, cardiac echo 93306 ($1.6M, 1.4%) ranks #1, and lab testing 87637 ($1.8M, 1.5%) ranks #1, underscoring a high-volume imaging and lab footprint that generates substantial non‑E/M revenue streams within Medicaid billing.

The NPI has long tenure on file (enumerated 2006-01-26, ~20 years ago) and is listed under the Family Medicine Physician taxonomy; however, the scale and breadth of claims (hundreds of thousands of E/M claims and system‑level procedural volumes) are far larger than typical for a single ambulatory family physician, which is consistent with a multi‑site or hospital‑based billing footprint driving the Medicaid revenue profile.

Medicaid: Complete Services Breakdown

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

666 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…	382,570	$70	$26.4M
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…	414,440	$60	$22.8M
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…	91,950	$90	$8.5M
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.	70,840	$90	$6.1M
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.	50,050	$120	$6.1M
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…	112,440	$50	$5.6M
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…	56,780	$70	$4.1M
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…	61,660	$60	$3.8M
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…	26,210	$130	$3.5M
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…	31,880	$100	$3.1M

Showing 1–10 of 666

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. West Virginia Distribution

West Virginia University Medical Corporation — 25 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — West Virginia

Full comparison — all codes billed, vs. West Virginia median

666 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
H0036	Community psychiatric supportive treatment, face-to-face, per 15 minutes	24	20	2,650	$460	$2.9M
T1015	Clinic visit/encounter, all-inclusive	145	390	4,610	$130	$2.2M
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.	4	130	2,090	$210	$1.5M
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.	3	170	3,350	$120	$1.1M
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.	1	10	3,780	$250	$1.1M
96156	The provider assesses psychological, behavioral, emotional, cognitive, and social factors that affect a patient’s physical health, rather than assessing a specific mental health disorder. There are…	2	10	60	$170	$888.7K
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.	3	160	3,690	$80	$714.8K
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.	1	10	940	$260	$683.6K
99479	The provider directs the care of a recovering low birth weight infant, whose current weight is between 1500 and 2500 grams.	1	10	7,500	$100	$617.9K
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.	5	80	950	$140	$559.5K

Showing 1–10 of 666

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
West Virginia University Hospitals, Inc	WV	General Acute Care Hospital	$0	$124.1M
West Virginia University Hospitals, Inc.	WV	Substance Abuse Rehabilitation Facility	$0	$15.4M
West Virginia University Hospitals, Inc	WV	Emergency Medicine Physician	$0	$3M
Inderjit Mehmi	CA	Hematology & Oncology Physician	$2.3M	$0
City Hospital, Inc.	WV	Internal Medicine Physician	$0	$1.9M
Randall J. Hill, M.d., P.L.L.C.	WV	Specialist	$0	$1.9M
E. Ronald Salvitti, M.d., Inc.	PA	Ambulatory Surgical Clinic/Center	$986.7K	$20.9K
Edward Kiggundu	WV	Radiation Oncology Physician	$835.2K	$0
David Weber	PA	Specialist	$292.8K	$498.8K
Matthew Oliverio	PA	Otolaryngology Physician	$175.2K	$514.5K

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
West Virginia University Dental Corporation	WV	Dentist	$0	$5.9M
Heather Boo	WV	Neuroradiology Physician	$596.8K	$0
Arijit Chakravarty	WV	Nephrology Physician	$281K	$0
Adeem Akbar	WV	Nephrology Physician	$162.7K	$0
Robert Marsh	WV	Neurological Surgery Physician	$152.1K	$0
Mark Lisle	WV	Diagnostic Radiology Physician	$150.1K	$710
Brian Hamlin	WV	Adult Reconstructive Orthopaedic Surgery Physician	$148.2K	$0
David Tingler	WV	Cardiovascular Disease Physician	$145.7K	$0
Charles Moore	WV	Ophthalmology Physician	$145.3K	$0
Parvez Shaikh	WV	Radiation Oncology Physician	$137.8K	$0

West Virginia University Medical Corporation — 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