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.

Prakash Patel (NPI 1306832928)

Prakash Patel is a pediatrics physician provider located in Vienna, West Virginia. This profile covers 0 Medicare and 31 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.

(source: NPPES NPI Registry)

Medicaid: Complete Services Breakdown

Field	Value
Entity Type	Individual
Organization	Prakash Patel
Address	800 Grand Central Mall Ste 6
City	Vienna
State	WV
ZIP	26105
Taxonomy	Pediatrics Physician
NPI Enumerated	September 20, 2005

Payer Source	Total Paid
Medicaid	$1.1M
Medicare	$0

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

31 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…	5,300	$60	$302.1K
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…	2,650	$70	$180.4K
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…	2,330	$70	$170.2K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	1,600	$80	$122.8K
90472	This code represents each injection of a vaccine after the first; list this code in addition to the code for the first injection.	2,890	$30	$98.2K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	5,740	$20	$86.1K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	820	$90	$69.9K
90658	This code represents a trivalent influenza vaccine product containing split virus components. It is administered into the muscle in a 0.5 mL dosage.	1,800	$10	$10.8K
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.	380	$20	$8.3K
90700	This code represents a DTaP vaccine product administered into the muscle to protect against diphtheria, tetanus, and pertussis (whooping cough). It is used for children younger than 7 years of age.	1,890	$1	$7.5K

Showing 1–10 of 31

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

Prakash Patel — 3 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

31 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average 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…	327	1,270	1,240	$30	$245K
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…	28	150	520	$50	$76.2K
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…	24	140	550	$50	$67.2K
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…	83	90	250	$50	$55.5K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	31	190	220	$50	$42.7K
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…	45	60	210	$30	$37.5K
96110	The provider screens the patient for a developmental disorder using a standardized instrument (such as a recognized form) focused on areas such as developmental milestones and age–appropriate…	46	120	440	$10	$28.2K
90472	This code represents each injection of a vaccine after the first; list this code in addition to the code for the first injection.	27	200	360	$20	$26K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	29	180	140	$50	$24.8K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	25	430	200	$10	$18.3K

Showing 1–10 of 31

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Wv Asthma And Allergy Centers, Inc.	WV	Allergy & Immunology Physician	$0	$1.8M
Mid-ohio Valley Nephrology Association	WV	Nephrology Physician	$0	$919.4K
Parkersburg Infectious Disease PLLC	WV	Infectious Disease Physician	$0	$802.2K
Zane Lazer	WV	Ophthalmology Physician	$506.4K	$0
David George	WV	Ophthalmology Physician	$451K	$0
John Conner	WV	Family Medicine Physician	$380.9K	$0
Seyoum Bage	WV	Infectious Disease Physician	$101.1K	$269.8K
Barrett Louden	WV	Dermatology Physician	$259.2K	$0
Mirza Hamirani	WV	Nephrology Physician	$245.5K	$0
Karyn Plotz	WV	Physical Therapist	$172.8K	$0

Prakash Patel — Billing Profile & Reimbursement Data

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Prakash Patel — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

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