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NPI 1285735332 · Raton, NM · Internal Medicine Physician
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Misbah Zmily is a internal medicine physician provider located in Raton, New Mexico. This profile covers 49 Medicare and 29 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.
Provider details (source: NPPES NPI Registry)
| Field | Value |
|---|---|
| Entity Type | Individual |
| Organization | Misbah Zmily |
| Address | 190 Hospital Dr |
| City | Raton |
| State | NM |
| ZIP | 87740 |
| Taxonomy | Internal Medicine Physician |
| NPI Enumerated | September 25, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $703K |
| Medicare | $609.4K |
This provider operates at a scale where Medicaid slightly exceeds Medicare: lifetime Medicare revenue is $609.4K while lifetime Medicaid revenue is $703K, indicating a dual-payer ambulatory practice with a modestly larger Medicaid footprint rather than a single-payer business. Both payers contribute meaningfully to overall volume, so network strategies should evaluate both Medicare and state Medicaid arrangements.
Medicare revenue is concentrated: the precomputed top three Medicare codes—99490 ($158.5K, 26.8%), 99214 ($95.7K, 16.2%), and 99457 ($69.7K, 11.8%)—account for 54.8% of this provider's total Medicare revenue, signaling reliance on chronic care management, mid-level office visits, and remote monitoring services for the majority of Medicare income. Payer negotiations or program changes that affect these codes would materially impact Medicare earnings.
The Medicaid side is even more concentrated: the precomputed top three Medicaid codes—99214 ($384.2K, 54.6%), 99204 ($103.6K, 14.7%), and 99402 ($61.6K, 8.8%)—together represent 78.1% of this provider's total Medicaid revenue, with 99214 alone generating a majority of Medicaid dollars. This profile points to a practice heavily dependent on established patient office visits for its Medicaid business and substantial revenue exposure to changes in evaluation-and-management reimbursement.
Clinical/service-line implications are clear from the CPT mix: high Medicare revenue from 99490, 99457, and 99454 plus substantial Medicaid use of 99214 and 99204 suggests a primary-care/internal-medicine operation that couples traditional office-based E/M work with a significant remote physiologic monitoring (RPM) program (device supply and monitoring time codes). The presence of lab panels and vaccination codes at smaller dollar levels supports a comprehensive ambulatory clinic model that manages chronic disease and preventive care.
On national Medicare competitiveness, the provider is a strong outlier on several monitoring and mid-level visit measures: 99214 on Medicare is an "extreme outlier, far above typical national volume for this code," while 99457 and 99454 are classified as "notably above typical national volume for this code." At the same time 99490 is noted as "typical, unremarkable volume for this code" despite a high percentile rank; overall this indicates national-level prominence in RPM and high-volume 99214 billing but not universal outlier status across every chronic-care code.
Within New Mexico Medicaid competition, 99214 ranks in the 79th percentile in-state and is labeled "typical, unremarkable volume for this code," and 99204 and 99402 also sit in roughly the 75–80th percentile band in-state. Those placements indicate the provider is a meaningful local participant for office-based E/M services—particularly established-patient visits—but not necessarily the dominant statewide leader in those services.
Operationally, the claims mix implies a staffed workflow: codes like 99490 (clinical staff care coordination time), 99457 (professional time for RPM management), and 99454 (device supply) require continuous clinical-staff involvement and technology or device logistics. Payers and partners assessing network value should consider the provider’s infrastructure for RPM and chronic care management when modeling utilization or contracting for population health programs.
This provider has a long-tenured NPI (enumerated 2006-09-25, ~20 years ago), which combined with the high RPM and chronic care volumes suggests an established practice that has incorporated newer remote monitoring services into its care model. Tenure supports an experienced panel management approach, but the practice’s revenue concentration around a few codes highlights sensitivity to policy or reimbursement changes affecting chronic care and RPM billing.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
49 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 99490 | The clinical staff provides services directed by the provider to support and coordinate a patient’s care across multiple disciplines. The patient has two or more chronic conditions that place the… | 3,520 | $50 | $158.5K |
| 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… | 1,090 | $90 | $95.7K |
| 99457 | The provider manages treatment using data from remote physiologic monitoring. The service requires at least one real–time interactive communication with the patient or caregiver during the month and… | 1,940 | $40 | $69.7K |
| 99454 | The provider supplies one or more devices for remote physiologic monitoring that occurs for 16 to 30 days in a 30–day period. | 1,950 | $40 | $68.2K |
| 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… | 590 | $60 | $34.4K |
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 220 | $120 | $26.7K |
| 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… | 120 | $170 | $20.2K |
| 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… | 120 | $140 | $16.6K |
| 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… | 250 | $60 | $15K |
| 90694 | This code represents a vaccine product administered into the muscle to protect against four strains of influenza (flu). It is an inactivated, adjuvanted, preservative–free vaccine given as a 0.5 mL… | 190 | $80 | $14.2K |
Showing 1–10 of 49
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 49 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
49 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| 99309 | 125 | 130 | 180 | $70 | $24.7K |
| 82306 | 14 | 30 | 110 | $30 | $17K |
| 93306 | 77 | 90 | 190 | $60 | $15.9K |
| 84443 | 13 | 60 | 110 | $20 | $13.3K |
| 99214 | 31 | 2,700 | 90 | $70 | $12.9K |
| 80053 | 20 | 90 | 100 | $10 | $11.5K |
| 80061 | 13 | 60 | 80 | $10 | $10.8K |
| G0439 | 33 | 490 | 50 | $120 | $9.7K |
| 99291 | 36 | 340 | 40 | $160 | $9.5K |
| 99490 | 1 | 140 | 100 | $40 | $8.9K |
Showing 1–10 of 49
Medicaid revenue breakdown by year and by CPT/HCPCS procedure code, including monthly billing trends and the top codes driving revenue.
View: By Year1 / 3
Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.
29 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… | 4,570 | $80 | $384.2K |
| 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… | 790 | $130 | $103.6K |
| 99402 | 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… | 1,140 | $50 | $61.6K |
| 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… | 780 | $60 | $47.3K |
| 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… | 1,430 | $30 | $44.3K |
| 99407 | The provider counsels the patient on how to stop tobacco use. The counseling lasts more than 10 minutes. | 540 | $20 | $13K |
| 99211 | An established patient presents for an office or other outpatient visit that may not require the presence of a physician or other qualified healthcare professional. | 450 | $20 | $7.6K |
| 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… | 40 | $170 | $6.4K |
| 36415 | In this procedure, the provider inserts a needle into a vein to collect a blood sample. | 1,740 | $1 | $5.2K |
| 90471 | In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route. | 260 | $20 | $4.5K |
Showing 1–10 of 29
How this provider's Medicaid billing volume and revenue compare to other New Mexico providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. New Mexico median
29 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 99211 | An established patient presents for an office or other outpatient visit that may not require the presence of a physician or other qualified healthcare professional. | 43 | 140 | 130 | $220 | $568.5K |
| 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… | 500 | 930 | 910 | $80 | $521.6K |
| 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… | 203 | 960 | 1,010 | $90 | $490K |
| 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… | 64 | 70 | 970 | $140 | $356.3K |
| 99393 | The provider performs an established well–patient visit for a child who is between the ages of 5 and 11. | 122 | 120 | 430 | $110 | $205.4K |
| 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… | 75 | 380 | 150 | $130 | $132.8K |
| 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. | 116 | 150 | 660 | $30 | $123.7K |
| 99490 | The clinical staff provides services directed by the provider to support and coordinate a patient’s care across multiple disciplines. The patient has two or more chronic conditions that place the… | 35 | 40 | 390 | $30 | $89K |
| 76700 | An abdominal ultrasound is a noninvasive procedure used to assess the body parts within the abdomen (i.e. liver, gallbladder, pancreas, bile ducts, spleen, and abdominal aorta). This particular code… | 52 | 50 | 180 | $70 | $85.5K |
| 99173 | The provider checks the eyesight in both eyes of a pediatric patient by asking him to read letters of varying sizes on a standard chart, such as a Snellen’s chart, which he keeps 20 feet away from… | 63 | 80 | 160 | $30 | $57.6K |
Showing 1–10 of 29
Other providers in the same ZIP code as Misbah Zmily, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Citizens For The Developmentally Disabled, Inc. | NM | Community/Behavioral Health Agency | $0 | $4M |
| Lancer Health Group, LLC | NM | Multi-Specialty Clinic/Center | $0 | $3.8M |
| Rocky Mountain Physical Therapy, Inc | NM | Physical Therapist | $0 | $1.6M |
| City Of Raton | NM | Land Ambulance | $81.2K | $535.7K |
| Ted Kamp | NM | Physical Therapist | $251K | $0 |
| Bruce Washburn | NM | Chiropractor | $41.3K | $0 |
| Crystal Washburn | NM | Chiropractor | $21.7K | $0 |
| Louisa Chavez | NM | Obstetrics & Gynecology Physician | $7K | $0 |
| Linde Schuster | NM | Speech-Language Pathologist | $5.9K | $0 |
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