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

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

Balboa Nephrology Medical Group, Inc. (NPI 1316997505)

Balboa Nephrology Medical Group, Inc. is a nephrology physician provider located in San Diego, California. This profile covers 0 Medicare and 54 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.

Medicaid: Complete Services Breakdown

Field	Value
Entity Type	Organization
Organization	Balboa Nephrology Medical Group, Inc.
Address	9373 Hazard Way Ste 200
City	San Diego
State	CA
ZIP	92123
Taxonomy	Nephrology Physician
NPI Enumerated	May 11, 2006

Payer Source	Total Paid
Medicaid	$25.9M
Medicare	$0

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

54 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
90960	The provider manages all the services associated with the monthly care of a patient who is 20 years old or older and has a condition known as end stage renal disease or ESRD. For this service, the…	112,090	$110	$12.7M
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…	111,090	$30	$2.8M
36902	The provider introduces a needle and/or catheter under fluoroscopic guidance (live X–rays that can be viewed on a monitor) and injects contrast material into the dialysis access point to visualize…	5,220	$510	$2.6M
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…	68,320	$30	$2.2M
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…	38,600	$30	$1.1M
36905	Under fluoroscopic guidance (live X–rays that can be viewed on a monitor), the provider introduces a catheter into a vessel in the dialysis circuit and extracts a blood clot (hematoma) with special…	890	$1,090	$970.3K
90961	The provider manages all the services associated with the monthly care of a patient who is 20 years old or older and has a condition known as end stage renal disease, or ESRD. For this service, the…	9,240	$100	$905.2K
90966	The provider manages all the physician related services for one full month for the home dialysis care of a patient who is 20 years old or older and has a condition known as end stage renal disease,…	6,290	$120	$729.8K
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…	8,990	$50	$485.2K
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…	9,520	$20	$209.4K

Showing 1–10 of 54

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. California Distribution

Balboa Nephrology Medical Group, Inc. — 14 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — California

Full comparison — all codes billed, vs. California median

54 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
90960	The provider manages all the services associated with the monthly care of a patient who is 20 years old or older and has a condition known as end stage renal disease or ESRD. For this service, the…	1	360	880	$130	$408.5K
37225	N/A	11	10	130	$1,960	$347.7K
36902	The provider introduces a needle and/or catheter under fluoroscopic guidance (live X–rays that can be viewed on a monitor) and injects contrast material into the dialysis access point to visualize…	1	60	130	$420	$263.5K
36905	Under fluoroscopic guidance (live X–rays that can be viewed on a monitor), the provider introduces a catheter into a vessel in the dialysis circuit and extracts a blood clot (hematoma) with special…	1	10	90	$990	$191.2K
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…	60	2,670	540	$40	$183.4K
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…	122	13,300	640	$40	$169.6K
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…	6	2,840	490	$40	$139.6K
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…	1,288	4,230	210	$110	$135K
90935	Hemodialysis is a procedure that involves drawing blood via an intra–arterial or intravenous catheter, then sieving it through a semi permeable membrane to remove the impurities and finally…	7	110	260	$110	$125.5K
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…	2,078	14,520	760	$10	$122.8K

Showing 1–10 of 54

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Private Diagnostic Clinic, PLLC	NC	General Practice Physician	$0	$46.5M
Duke Health Integrated Practice, Inc.	NC	General Practice Physician	$0	$36.3M
Alexander Salloum	CA	Vascular Surgery Physician	$2.8M	$0
Majda Hadziahmetovic	NC	Ophthalmology Physician	$2.3M	$0
Michael Allingham	NC	Retina Specialist (Ophthalmology) Physician	$1.7M	$0
Jonathan Cook	NC	Dermatology Physician	$1.6M	$0
Tywana Donaldson	NC	Nurse Practitioner	$1.4M	$0
Eleonora Lad	NC	Retina Specialist (Ophthalmology) Physician	$1.4M	$0
David Namazy	CA	Nephrology Physician	$1.2M	$0
Dimitri Sherev	CA	Interventional Cardiology Physician	$1.1M	$4.3K

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Sharp Memorial Hospital	CA	General Acute Care Hospital	$0	$133.7M
Kaiser Foundation Hospitals	CA	General Acute Care Hospital	$0	$93.1M
Rady Children's Hospital San Diego	CA	Pediatrics Physician	$0	$77.3M
American Medical Response Ambulance Service Inc	CA	Ambulance	$9.6M	$65.4M
Rady Children's Hospital San Diego	CA	Children's Hospital	$0	$69.1M
Serene Health	CA	Mental Health Counselor	$0	$60.5M
Rac & Associates, Inc.	CA	Durable Medical Equipment & Medical Supplies	$0	$58.2M
Anesthesia Service Medical Group	CA	Anesthesiology Physician	$0	$31M
Centro De Salud De La Comunidad De San Ysidro, Inc.	CA	Dental Clinic/Center	$0	$22.3M
Atul Jain	CA	Ophthalmology Physician	$3.5M	$0

Balboa Nephrology Medical Group, Inc. — Billing Profile & Reimbursement Data

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Balboa Nephrology Medical Group, Inc. — 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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