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NPI 1326011321 · Germantown, WI · Family Medicine Physician
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Douglas Marx is a family medicine physician provider located in Germantown, Wisconsin. This profile covers 13 Medicare and 16 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 | Douglas Marx |
| Address | W168n11237 Western Ave |
| City | Germantown |
| State | WI |
| ZIP | 53022 |
| Taxonomy | Family Medicine Physician |
| NPI Enumerated | February 9, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $789.6K |
| Medicaid | $15.9K |
This provider’s billing is overwhelmingly Medicare-driven: total Medicare revenue is $789.6K versus $15.9K in Medicaid, indicating Medicare dominates the payer mix and overall scale of operations. Medicaid activity exists but is a very small share of lifetime revenue.
Medicare revenue is highly concentrated in a small set of vaccine-related codes — the top three Medicare codes (90662, 91322, G0008) account for 81.0% of Medicare revenue, with 90662 generating $302.9K (38.2%), 91322 generating $257.4K (32.4%), and G0008 generating $82.5K (10.4%). This concentration points to an immunization-centric revenue stream rather than a general primary-care E/M mix.
The mix of codes billed supports an operational focus on vaccination services: 90662 and G0008 are influenza vaccine products/administration codes and 91322 is a SARS–CoV–2 vaccine product, while traditional office E/M codes such as 99214 and 99213 make up relatively small proportions of Medicare revenue ($15.8K / 2.0% and $2.7K / 0.3% respectively). That pattern is consistent with a practice that runs high-volume immunization programs (seasonal flu and COVID vaccination) alongside some office-based continuity care.
On national competitive standing, the provider is an outlier for key vaccine codes: 90662 ranks #13 of 70752 providers nationally (100th percentile; extreme outlier, far above typical national volume), 91322 ranks #25 of 29357 providers nationally (100th percentile; notably above typical national volume), and G0008 ranks #17 of 119096 providers nationally (100th percentile; extreme outlier). These rankings indicate this provider is a top-volume national outlier specifically for vaccination services rather than for general primary care.
Medicaid billing is also concentrated: the top three Medicaid codes (0002A, 0001A, 90686) account for 87.2% of Medicaid revenue, with 0002A at $6.7K (42.0%), 0001A at $5.8K (36.2%), and 90686 at $1.4K (9.0%). However, the absolute Medicaid dollar amounts are small, so the practice’s Medicaid footprint is modest and focused on a few procedures.
In-state competitive standing on Medicaid is unremarkable to modest for the listed top codes — 0002A ranks #161 of 427 in-state (62nd percentile) and 0001A ranks #172 of 458 in-state (63rd percentile), while 90686 ranks #239 of 909 in-state (74th percentile). These percentiles suggest typical volume relative to peers statewide rather than dominance, reinforcing that Medicare vaccination work is the primary differentiator.
There are reporting anomalies that merit attention: several vaccine-related product codes appear with substantial claim counts but $0 reported paid amounts (e.g., Medicare 91312: 724 claims, $0 revenue, ranks #2 of 806 nationally; Medicaid 91300: 317 claims, $0 revenue). Such patterns often reflect program- or manufacturer-supplied vaccine product reporting, bundled payments, or coverage/payment specifics rather than clinical volume alone and should be investigated before drawing conclusions about reimbursement.
The provider has an established presence (NPI enumerated 2006-02-09, ~20 years ago), indicating long tenure in the marketplace. Given that longevity plus the revenue concentration in vaccines, payers and partners should view this entity as an established, immunization-focused practice with potential seasonal and program-driven revenue volatility if vaccine demand or reimbursement rules change.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
13 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 90662 | This code represents a flu vaccine product that is a split virus type, contains no preservatives, and has enhanced effectiveness due to a higher antigen content. It is administered as an injection… | 5,310 | $60 | $302.9K |
| 91322 | This code represents a SARS–CoV–2 vaccine product administered by intramuscular injection to reduce the patient’s risk of contracting COVID–19. The dosage is 50 mcg/0.5 mL. | 1,810 | $140 | $257.4K |
| G0008 | Administration of influenza virus vaccine | 5,890 | $10 | $82.5K |
| 90480 | The provider administers the first or only component of a SARS–CoV–2 (COVID–19) vaccine by intramuscular injection to reduce the patient's risk of contracting COVID–19. | 1,810 | $40 | $70.6K |
| 0124A | N/A | 700 | $40 | $27.3K |
| 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… | 210 | $80 | $15.8K |
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 110 | $120 | $13.2K |
| 90686 | This code represents a vaccine product administered into the muscle to protect against four strains of influenza (flu). It is preservative free, uses split virus technology, and is given as a 0.5 mL… | 580 | $20 | $11.6K |
| 90677 | This code represents a vaccine product administered intramuscularly to protect against pneumococcal disease, a bacterial infection. This is a 20–valent vaccine, protecting against 20 strains of the… | 30 | $280 | $8.7K |
| 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… | 50 | $60 | $2.7K |
Showing 1–10 of 13
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 13 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
13 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| 91322 | 2 | 750 | 70 | $140 | $17.5K |
| 99214 | 1,715 | 9,800 | 80 | $70 | $9.2K |
| G0439 | 579 | 2,350 | 50 | $120 | $9.1K |
| 90677 | 169 | 1,080 | 20 | $280 | $6.5K |
| 90662 | 1 | 1,640 | 40 | $70 | $5.2K |
| 99213 | 5,249 | 9,380 | 60 | $50 | $4.7K |
| 90480 | 2 | 1,210 | 70 | $30 | $4.5K |
| G0008 | 1 | 2,540 | 40 | $30 | $2.4K |
| 0124A | 2 | 420 | 20 | $40 | $1.7K |
| 93000 | 463 | 860 | 20 | $10 | $650 |
Showing 1–10 of 13
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.
16 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 0002A | N/A | 180 | $40 | $6.7K |
| 0001A | N/A | 190 | $30 | $5.8K |
| 90686 | This code represents a vaccine product administered into the muscle to protect against four strains of influenza (flu). It is preservative free, uses split virus technology, and is given as a 0.5 mL… | 210 | $10 | $1.4K |
| 0012A | N/A | 30 | $30 | $920 |
| 0011A | N/A | 20 | $30 | $600 |
| 0124A | N/A | 40 | $10 | $300 |
| 0054A | N/A | 10 | $20 | $230 |
| 90471 | In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route. | 100 | $0 | $0 |
| 90480 | The provider administers the first or only component of a SARS–CoV–2 (COVID–19) vaccine by intramuscular injection to reduce the patient's risk of contracting COVID–19. | 40 | $0 | $0 |
| 90662 | This code represents a flu vaccine product that is a split virus type, contains no preservatives, and has enhanced effectiveness due to a higher antigen content. It is administered as an injection… | 80 | $0 | $0 |
Showing 1–10 of 16
How this provider's Medicaid billing volume and revenue compare to other Wisconsin providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Wisconsin median
16 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 91322 | This code represents a SARS–CoV–2 vaccine product administered by intramuscular injection to reduce the patient’s risk of contracting COVID–19. The dosage is 50 mcg/0.5 mL. | 49 | 130 | 30 | $80 | $8K |
| 0002A | N/A | 161 | 430 | 120 | $30 | $7.2K |
| 0001A | N/A | 172 | 460 | 120 | $30 | $7K |
| 90686 | This code represents a vaccine product administered into the muscle to protect against four strains of influenza (flu). It is preservative free, uses split virus technology, and is given as a 0.5 mL… | 239 | 910 | 80 | $10 | $6.4K |
| 90480 | The provider administers the first or only component of a SARS–CoV–2 (COVID–19) vaccine by intramuscular injection to reduce the patient's risk of contracting COVID–19. | 47 | 80 | 40 | $20 | $4K |
| 0012A | N/A | 237 | 310 | 60 | $30 | $3.5K |
| 0011A | N/A | 284 | 340 | 70 | $30 | $3K |
| 90471 | In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route. | 128 | 270 | 80 | $1 | $3K |
| 0124A | N/A | 102 | 200 | 40 | $30 | $2.5K |
| 0054A | N/A | 87 | 100 | 30 | $30 | $2.3K |
Showing 1–10 of 16
Other providers in the same ZIP code as Douglas Marx, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Wisconsin Lutheran Child And Family Service Inc | WI | Mental Health Clinic/Center (Including Community Mental Health Center) | $0 | $4.8M |
| Aurora Surgery Centers, LLC | WI | Ambulatory Surgical Clinic/Center | $352.3K | $44.1K |
| Amy Miller | WI | Family Medicine Physician | $248.5K | $0 |
| Mark Kaeppler | WI | Cardiovascular Disease Physician | $155.8K | $0 |
| Timothy Goggins | WI | Hematology & Oncology Physician | $136.3K | $0 |
| Joseph Hylander | WI | Hospitalist Physician | $77.3K | $0 |
| Michael Brody | WI | Orthopaedic Surgery Physician | $47.4K | $0 |
| Paul Miller | WI | Orthopaedic Surgery Physician | $45.7K | $0 |
| Miranda Davis | WI | Physical Therapist | $34.2K | $0 |
| Christopher Weber | WI | Internal Medicine Physician | $9K | $0 |
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