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

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

District Medical Group, Inc (NPI 1295968162)

Key Findings

Field	Value
Entity Type	Organization
Organization	District Medical Group, Inc
Address	2601 E Roosevelt St
City	Phoenix
State	AZ
ZIP	85008
Taxonomy	Internal Medicine Physician
NPI Enumerated	August 26, 2009

Payer Source	Total Paid
Medicaid	$130.6M
Medicare	$0

This provider has no Medicare billing on file and is effectively single‑payer in our extract, reporting total Medicaid revenue of $130.6M. The absence of Medicare activity means payer exposure and revenue risk are concentrated in Medicaid flows rather than split across payers.

Revenue is highly concentrated: the top three Medicaid codes (T1015, 99284, 99232) account for 61.4% of the provider’s Medicaid revenue, and T1015 alone represents $50.8M (45.4% of Medicaid revenue). That level of concentration around one all‑inclusive clinic visit code indicates a business model dependent on very high volumes of bundled clinic/encounter billing.

The code mix shows a heavy operational emphasis on emergency and inpatient E/M alongside high‑volume clinic encounters: 99284 (116.2K claims, $10.7M), 99283 (99.4K claims, $5.6M), 99285 (39.3K claims, $5.1M) and a suite of inpatient codes 99232/33/31 and 99238. Supporting diagnostic and procedure volumes — e.g., 74177 ($3M), 70450 ($1.2M), 93306 ($860.7K), 88305 ($1.2M) and very large ECG volume 93010 (156.9K claims, $1.1M) — are consistent with an integrated acute care and high‑throughput outpatient visit operation.

On statewide competitive standing, several codes place this provider among the very highest volume peers: 99232 ranks #2 of 613 providers in‑state (100th percentile; extreme outlier), 99238 ranks #1 of 232 providers in‑state (100th percentile; extreme outlier), and 93010 ranks #1 of 141 providers in‑state (100th percentile; extreme outlier). Other ED and inpatient codes (e.g., 99284 at #8 of 259, 97th percentile) are described as notably above typical state volume, indicating the provider is a major statewide participant for inpatient and emergency services.

Multiple specific codes are flagged in the data as statistical outliers or far above typical state volume, which is meaningful for utilization analysis: 99232 is an extreme outlier (100th percentile), 99213 is an extreme outlier (99th percentile; far above typical), and 99222 and 99238 are also described as extreme outliers (99th–100th percentiles). These labels point to coding and volume patterns that stand out relative to state peers and merit focused review when assessing utilization trends.

Operationally, the mix includes very high counts of low‑paid diagnostics (93010: 156.9K claims at $7 avg paid/claim; 71045: 82.6K claims at $8 avg paid/claim) alongside high‑value all‑inclusive clinic visits (T1015 at $265 avg paid/claim) and higher‑paid ED/inpatient E/M services. For payers this combination suggests throughput‑driven revenue with many touchpoints for care delivery and potential opportunities for care‑pathway management, bundling, or utilization controls around high‑frequency services.

Tenure in the system is long: the NPI was enumerated 2009-08-26 (~17 years ago), indicating an established presence and likely mature operational workflows that have produced the sustained high volumes seen in the Medicaid data. This longevity supports interpreting the reported patterns as persistent rather than transient.

Given that T1015 accounts for 45.4% of Medicaid revenue and the top three codes account for 61.4%, payers and provider analysts should prioritize monitoring of all‑inclusive clinic visit billing and the suite of ED/inpatient E/M codes. Because multiple codes rank at or near the 100th and 99th percentiles statewide, targeted utilization management, contract design, and performance monitoring around those high‑volume code families would be the most data‑grounded next step.

Medicaid: Complete Services Breakdown

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

338 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T1015	Clinic visit/encounter, all-inclusive	191,730	$270	$50.8M
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.	116,170	$90	$10.7M
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…	135,770	$50	$7.2M
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.	99,360	$60	$5.6M
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.	39,330	$130	$5.1M
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…	68,930	$70	$4.7M
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…	59,240	$70	$4.1M
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…	79,810	$50	$3.6M
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.	38,360	$80	$3M
99238	The provider sees a patient for hospital inpatient or observation discharge day management, involving evaluation and management (E/M). The provider spends 30 minutes or less on the service on the…	32,950	$60	$2M

Showing 1–10 of 338

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Arizona Distribution

District Medical Group, Inc — 17 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Arizona

Full comparison — all codes billed, vs. Arizona median

338 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1015	Clinic visit/encounter, all-inclusive	9	360	3,640	$230	$7.7M
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.	33	260	1,330	$240	$3.5M
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.	8	260	3,030	$190	$3.4M
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.	8	260	2,600	$170	$2.6M
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.	6	180	1,490	$320	$2.2M
T1016	Case management, each 15 minutes	465	1,160	2,110	$30	$1.2M
99479	The provider directs the care of a recovering low birth weight infant, whose current weight is between 1500 and 2500 grams.	8	10	4,480	$110	$1.1M
99480	The provider directs the care of a recovering low birth weight infant, whose current weight is between 2501 and 5000 grams.	8	10	3,790	$100	$1.1M
47562	The provider removes the gallbladder through a laparoscope, a tubular instrument with a light source and camera inserted through the abdominal wall, to treat gallbladder disease.	19	30	70	$3,620	$999.9K
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.	7	10	1,510	$340	$994.4K

Showing 1–10 of 338

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Stephen Desouza	AZ	Retina Specialist (Ophthalmology) Physician	$2.5M	$0
Matthew Welch	AZ	Retina Specialist (Ophthalmology) Physician	$2.2M	$0
Benjamin Bakall	AZ	Retina Specialist (Ophthalmology) Physician	$2M	$0
Rima Patel	AZ	Retina Specialist (Ophthalmology) Physician	$1.8M	$0
Henry Kwong	AZ	Retina Specialist (Ophthalmology) Physician	$1.7M	$0
Alan Gordon	AZ	Retina Specialist (Ophthalmology) Physician	$1.6M	$0
Michael Switzer	AZ	Vascular & Interventional Radiology Physician	$1.5M	$0
Jaime Gaitan	AZ	Retina Specialist (Ophthalmology) Physician	$1.3M	$0
Apar Gupta	AZ	Radiation Oncology Physician	$1.3M	$0
Subhakar Mutyala	AZ	Radiation Oncology Physician	$1.1M	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Maricopa County Special Health Care District	AZ	General Acute Care Hospital	$0	$251.6M
Maricopa County Special Health Care District	AZ	Federally Qualified Health Center (FQHC)	$0	$56.5M
St. Luke's Pediatrics	AZ	Primary Care Clinic/Center	$0	$31.6M
Alliance Ambulance Of Arizona LLC	AZ	Ambulance	$444.7K	$31.1M
Elevate Youth And Family Services	AZ	Mental Health Counselor	$0	$24.6M
Maricopa County Special Health Care District	AZ	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$12.5M
Terros Inc	AZ	Federally Qualified Health Center (FQHC)	$0	$11.9M
Safe Wing LLC	AZ	Non-emergency Medical Transport (VAN)	$0	$11.7M
Mind 247 Practice LLC	AZ	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$11.5M
Abc Ambulance LLC	AZ	Ambulance	$0	$11.4M

District Medical Group, 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