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.

Mountaineer Family Medicine, Inc. (NPI 1295874436)

Key Findings

Field	Value
Entity Type	Organization
Organization	Mountaineer Family Medicine, Inc.
Address	500 Poplar St
City	Charleston
State	WV
ZIP	25309
Taxonomy	Family Medicine Physician
NPI Enumerated	February 5, 2007

Payer Source	Total Paid
Medicaid	$19.5M
Medicare	$0

This provider is effectively a single‑payer Medicaid operation: there is no Medicare billing on file while total Medicaid revenue is $19.5M, indicating the practice’s scale and payer concentration is squarely within Medicaid. The absence of Medicare activity suggests its patient mix, contracting, or service model is focused on state Medicaid beneficiaries rather than Medicare populations.

Revenue is heavily concentrated: the top three Medicaid codes (99213, 80307, G0482) together account for 57.0% of this provider’s total Medicaid revenue. Individually, 99213 represents $5.2M (27.2%), 80307 $3M (15.7%), and G0482 $2.7M (14.1%), which shows a small set of services drives the majority of cashflow.

The code mix indicates a hybrid primary‑care plus behavioral‑health and substance‑use services model. High volume for 99213 (established office visits, $5.2M) aligns with the Family Medicine taxonomy and routine outpatient care, while psychotherapy codes (90832 $1.2M and 90837 $678.3K) and group therapy (90853 $187.7K) show substantive behavioral‑health throughput integrated into the practice.

Drug testing is a clear operational focus: 80307 ($3M), G0482 ($2.7M), G0480 ($1.2M), G0483 ($435.4K), and 80305 ($293.6K) together compose a large testing volume and revenue stream, implying on‑site or tightly coordinated lab services. Several of these codes are ranked highly in‑state; 80305 is listed as rank #1 of 170 providers in‑state (100th percentile; extreme outlier, far above typical state volume for this code) and 80307 is rank #3 of 106 (98th percentile; typical, unremarkable volume for this code).

The practice is a leading statewide provider for several counseling and prevention services: 99407 ($212.6K) and 99408 ($99.6K) are each ranked #1 in‑state with 99407 described as rank #1 of 23 providers (100th percentile; extreme outlier, far above typical state volume for this code) and 99408 as rank #1 of 18 providers (100th percentile; extreme outlier, far above typical state volume for this code). This pattern points to a sustained emphasis on tobacco‑cessation and substance‑use screening/intervention in the care mix.

Competitive standing versus in‑state peers shows dominance on high‑volume E/M and behavioral codes: 99213 is rank #9 of 1273 providers in‑state (99th percentile; extreme outlier, far above typical state volume for this code), and 90832 is rank #2 of 204 providers (100th percentile; extreme outlier, far above typical state volume for this code). Those ranks indicate the provider is a major Medicaid participant in the state for routine office visits and short psychotherapy sessions.

The revenue model appears to be high‑volume, lower‑unit‑price services: many high‑count codes pay modestly per claim (for example 99213 at $47 avg paid/claim, 80307 at $57 avg paid/claim, 82075 at $23 avg paid/claim), which implies operational scale and throughput are key to revenue generation rather than high‑unit procedures. This profile aligns with a clinic handling large patient panels, frequent drug testing, and many brief counseling/visit encounters.

The NPI tenure is long‑standing: enumerated 2007-02-05 (~19 years ago), which suggests an established presence in the market and likely stable payer relationships with West Virginia Medicaid. That longevity, combined with the concentrated code mix and multiple extreme‑outlier ranks, helps explain the provider’s current Medicaid market position.

Medicaid: Complete Services Breakdown

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

67 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…	110,900	$50	$5.2M
80307	The lab analyst performs presumptive drug test(s) via instrumented chemistry analyzers to screen for any number of drug classes on a single date.	52,590	$60	$3M
G0482	Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but…	30,950	$90	$2.7M
90832	In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere…	31,030	$40	$1.2M
G0480	Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but…	26,270	$50	$1.2M
82075	The lab analyst performs the technical lab test to analyze the quantitative amount of alcohol in a patient’s breath and correlates the measurement to blood alcohol content.	50,870	$20	$1.2M
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…	11,950	$70	$872.4K
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…	7,540	$90	$678.3K
G0483	Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but…	1,770	$250	$435.4K
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,…	14,450	$30	$433.6K

Showing 1–10 of 67

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

Mountaineer Family Medicine, Inc. — 10 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

67 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
G0482	Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but…	3	20	1,050	$80	$1.3M
80307	The lab analyst performs presumptive drug test(s) via instrumented chemistry analyzers to screen for any number of drug classes on a single date.	3	110	2,080	$50	$537.1K
G0480	Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but…	6	50	800	$70	$504.4K
87633	The lab analyst performs a test to identify a respiratory virus using amplified nucleic acid probe technique. He may also use a multiplex reverse transcription technique. The provider does this for…	16	30	300	$240	$420K
G0481	Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but…	6	20	690	$80	$346.6K
H0031	Mental health assessment, by non-physician	77	120	620	$160	$312.6K
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…	9	1,270	1,240	$30	$245K
G0483	Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but…	6	10	1,210	$120	$231.8K
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…	75	1,030	890	$50	$221K
82075	The lab analyst performs the technical lab test to analyze the quantitative amount of alcohol in a patient’s breath and correlates the measurement to blood alcohol content.	2	40	900	$20	$214.7K

Showing 1–10 of 67

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Mohamad Kalou	WV	Addiction Medicine (Family Medicine) Physician	$32.4K	$0
Melissa Kirk	WV	Family Nurse Practitioner	$31.7K	$0
Michael Pauley	WV	Clinical Social Worker	$21K	$0
Crystal Watkins	WV	Nurse Practitioner	$680	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Urgent Care, Inc.- West Virginia	WV	Urgent Care Clinic/Center	$0	$66.9M
Herbert J. Thomas Memorial Hospital Association	WV	General Acute Care Hospital	$0	$26.1M
Ths Physician Partners Inc	WV	Internal Medicine Physician	$0	$9.2M
Appalachian Medical LLC	WV	Durable Medical Equipment & Medical Supplies	$0	$8M
Pulmonary Associates Of Char LLC	WV	Pulmonary Disease Physician	$0	$5.5M
Maccorkle Emergency Physicians PLLC	WV	Emergency Medicine Physician	$0	$4.4M
Patel & Patel Md Inc	WV	Obstetrics & Gynecology Physician	$0	$4M
Wecare Medical LLC	WV	Oxygen Equipment & Supplies (DME)	$0	$3.7M
Woman Care Clinic Inc	WV	Obstetrics & Gynecology Physician	$0	$3.5M
Lincoln County Primary Care Center, Inc.	WV	Federally Qualified Health Center (FQHC)	$0	$2.7M

Mountaineer Family Medicine, Inc. — Billing Profile & Reimbursement Data

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Mountaineer Family Medicine, Inc. — 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