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

Why is the Medicaid comparison limited to Vermont 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. Vermont (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 Health Partners - Vermont LLP (NPI 1285687616)

Key Findings

Field	Value
Entity Type	Organization
Organization	Primary Care Health Partners - Vermont LLP
Address	600 Blair Park Rd Ste 285
City	Williston
State	VT
ZIP	05495
Taxonomy	Family Medicine Physician
NPI Enumerated	May 18, 2006

Payer Source	Total Paid
Medicaid	$2.8M
Medicare	$0

This provider is effectively single‑payer in the dataset: there is no Medicare billing on file while total Medicaid revenue is $2.8M, so Medicaid entirely dominates its public payer footprint and financial scale. Analysts should treat Medicaid utilization and unit rates as the primary lens for assessing this entity’s revenue and network impact.

Revenue is highly concentrated: the precomputed top 3 Medicaid codes by revenue account for 74.1% of the provider’s total Medicaid revenue. Those top three are 99213 ($1M, 37.4%), 99214 ($786.4K, 28.2%), and 90460 ($235.2K, 8.4%), which together create a narrow set of services driving most dollars.

The code mix and high volumes indicate a primary care/family medicine operation with strong longitudinal outpatient care and preventive services: 99213 (80.2K claims) and 99214 (43.7K claims) are the two largest drivers by claim count and revenue, reflecting heavy ambulatory established‑patient visit activity. The presence of preventive medicine codes such as 99391 ($191.9K, 6.9%) and childhood well‑visit codes (99392, 99393) plus high immunization volume (90460 and 90461) further point to substantial pediatric and well‑visit throughput.

Unit payments are low relative to volume for the top evaluation & management codes: 99213 has an $13 avg paid/claim and 99214 has an $18 avg paid/claim, suggesting the practice generates revenue predominantly through high encounter volume rather than high per‑visit reimbursement. This combination of low unit price and very high claim counts implies operational scale is a key driver of revenue.

Competitive standing in Vermont is dominant for several Medicaid codes: the provider ranks #3 of 319 in‑state for 99213 (99th percentile, labeled an extreme outlier) and #6 of 323 for 99214 (98th percentile, notably above typical volume). It also ranks #1 of 44 for 90460 (100th percentile, extreme outlier) and #1 of 31 for 90461 (100th percentile), indicating market leadership in pediatric immunization encounters statewide.

Multiple additional codes show extreme or notable outlier status statewide, including T1023 (2.7K claims, $86.7K revenue; rank #1 of 35, 100th percentile), 96127 (15.6K claims, $15.6K revenue; rank #1 of 56, 100th percentile), and several well‑visit codes (e.g., 99393 rank #1 of 43, 100th percentile). These concentrated outlier rankings indicate the provider is a key deliverer of screening, behavioral/developmental assessment, and well‑child services in the Vermont Medicaid network.

Given the NPI tenure (enumerated 2006-05-18, ~20 years ago), this is an established practice with a long presence in the market; longevity combined with high statewide rankings suggests entrenched referral relationships and stable patient panel dynamics. Analysts should consider historical continuity when modeling utilization trends or negotiating network arrangements.

From a payer or network management perspective, the provider’s profile — heavy reliance on a small set of E/M and immunization codes, extreme state‑level volumes, and sole Medicaid exposure in the file — implies concentrated utilization risk and potential operational capacity implications for pediatric and primary care access. Any care‑management or contracting strategies should focus on high‑volume visit workflows, vaccine delivery, and preventive‑care throughput given where most dollars and encounters originate.

Medicaid: Complete Services Breakdown

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

82 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	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…	80,150	$10	$1M
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…	43,690	$20	$786.4K
90460	In this procedure, the provider administers a single live attenuated vaccine through a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age.	21,380	$10	$235.2K
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…	3,310	$60	$191.9K
90461	In this procedure, the provider administers an additional live attenuated vaccine either via a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age after the…	7,400	$10	$96.1K
T1023	Screening to determine the appropriateness of consideration of an individual for participation in a specified program, project or treatment protocol, per encounter	2,710	$30	$86.7K
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…	3,460	$20	$72.6K
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…	4,740	$10	$56.9K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	4,520	$10	$40.7K
99212	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,…	3,400	$10	$30.6K

Showing 1–10 of 82

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Vermont Distribution

Primary Care Health Partners - Vermont LLP — 17 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Vermont

Full comparison — all codes billed, vs. Vermont median

82 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average 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…	6	320	680	$30	$146.1K
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…	3	320	760	$20	$88.2K
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…	2	110	170	$70	$38.6K
90460	In this procedure, the provider administers a single live attenuated vaccine through a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age.	1	40	890	$10	$32.1K
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…	3	40	170	$40	$31.6K
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…	2	40	280	$20	$19.5K
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…	35	40	570	$20	$18.1K
87804	The analyst performs an immunoassay with direct optical, meaning visual, observation to detect influenza, also called flu, in a patient sample, typically a throat or nasal swab or nasal washings.	10	20	170	$10	$17.3K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	1	40	290	$20	$16K
87635	Using an amplified nucleic acid probe technique, the lab analyst performs the necessary steps to identify the nucleic acids from the severe acute respiratory syndrome coronavirus 2 (SARS–COV–2) virus…	6	20	180	$40	$15.6K

Showing 1–10 of 82

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Brian Ashley, Ma, Plc	VT	Psychologist	$0	$1M
Healthdirect Institutional Pharmacy Services, Inc.	VT	Long Term Care Pharmacy	$411.2K	$503.7K
Evergreen Family Health Partners	VT	Family Medicine Physician	$0	$626.1K
Town Of Williston	VT	Ambulance	$160.7K	$234.6K
Lisa Angstman	VT	Clinical Psychologist	$116.1K	$261.4K
Benjamin Physical Medicine, Plc	VT	Medical Specialty Clinic/Center	$0	$307.8K
Thomas Chittenden Health Center, Plc	VT	Family Medicine Physician	$0	$288.9K
Beth Morelli	VT	Mental Health Counselor	$0	$288.7K
Sawyer Lecompte	VT	Mental Health Counselor	$0	$284.7K
Kathleen Kelley	VT	Mental Health Counselor	$0	$242.3K

Primary Care Health Partners - Vermont LLP — Billing Profile & Reimbursement Data

Sign up for Primary Care Health Partners - Vermont LLP — Billing Profile & Reimbursement Data policy alerts

Primary Care Health Partners - Vermont LLP — Billing Profile & Reimbursement Data

Sign up for Primary Care Health Partners - Vermont LLP — Billing Profile & Reimbursement Data policy alerts

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
J. Gregory King	VT	Family Medicine Physician	$175K	$0
Lorne Babb	VT	Family Medicine Physician	$98.7K	$0
Stewart Manchester	VT	Family Medicine Physician	$86.4K	$0
Terri Nielsen	VT	Family Medicine Physician	$84.7K	$0
Tina D'amato	VT	Family Medicine Physician	$82.6K	$0
Toby Sadkin	VT	Family Medicine Physician	$61.5K	$0
Camille Zentkovich	VT	Family Nurse Practitioner	$34.1K	$0
Kathleen Burgess	VT	Family Medicine Physician	$30.4K	$0
Sarah Owen	VT	Family Nurse Practitioner	$13K	$0