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

Why is the Medicaid comparison limited to Unspecified Location 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. Unspecified Location (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.

Giselle Vermilyea (NPI 1326651233)

Field	Value
Entity Type	Individual
Organization	Giselle Vermilyea
Address	1 Chome Misumimachi
City	Iwakuni
State	XX (Unspecified Location)
ZIP	74000
Taxonomy	Physical Therapist
NPI Enumerated	August 28, 2020

Payer Source	Total Paid
Medicare	$31K
Medicaid	$0

Key Findings

This provider’s Medicare activity is small but focused: lifetime Medicare revenue is $31K and there is no Medicaid billing on file, so the practice is effectively single-payer (Medicare) in the available data. The absence of any Medicaid claims suggests the provider either does not serve Medicaid populations or bills under a different entity for that payer.

Revenue concentration is extreme within Medicare: the precomputed top 3 codes account for 100.0% of total Medicare revenue, with a single code, 97530, representing $26.8K or 88.0% of the provider’s Medicare dollars. The remaining Medicare revenue is split between 97140 ($2.9K, 9.6%) and 97016 ($728, 2.4%), indicating very limited diversification of billed services.

The code mix indicates a practice centered on hands-on and functional therapeutic interventions. The dominant code, 97530 (1.2K claims), describes therapeutic activities to improve functional performance, supported by secondary use of manual therapy 97140 (183 claims) and edema management 97016 (104 claims), which together present a coherent outpatient physical therapy service-line focused on functional rehabilitation.

Competitive standing is mixed: the provider ranks relatively high nationally on the top code 97530 at #7053 of 62717 providers nationally (89th percentile; typical, unremarkable volume for this code), which suggests above-average placement for that specific service. By contrast, the provider’s activity in 97140 ranks #41115 of 65133 (37th percentile; typical, unremarkable volume for this code) and 97016 ranks #2476 of 4370 (43th percentile; typical, unremarkable volume for this code), indicating more modest participation on those service lines.

Tenure is moderate: the NPI was enumerated on 2020-08-28 (~6 years ago), indicating the provider has been in the Medicare billing system for several years but is not a long-established provider with decades of claims history. This tenure is consistent with the concentrated, functional caseload observed in Medicare billing.

Volume metrics reinforce an outpatient, procedure-driven practice: 97530 generated 1.2K claims at an average paid amount of $22 per claim, while 97140 and 97016 generated 183 and 104 claims at average paid amounts of $16 and $7 per claim respectively. Those per-claim payment levels and high claim count for 97530 explain why therapeutic activities dominate revenue despite modest overall dollars.

From a payer-mix and operational risk perspective, dependence on Medicare for all recorded revenue (no Medicaid billing) concentrates reimbursement exposure to a single federal payer and to a narrow set of CPT/HCPCS codes. Any changes in Medicare coverage, reimbursement rates, or utilization for 97530 would therefore have an outsized impact on the provider’s reported revenue.

All three top codes are characterized in the source as "typical, unremarkable volume for this code," which suggests the provider’s patterns do not trigger statistical outlier flags for unusual billing intensity among peers. In sum, the profile reflects a small, Medicare-focused physical therapy practitioner with concentrated service lines centered on functional therapeutic activity and modest competitive positioning outside its lead code.

Medicare: Complete Services Breakdown

The CPT/HCPCS codes generating the most Medicare revenue for this provider.

3 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
97530	The provider uses various activities during direct contact with the patient to improve the patient’s functional performance. Use this code for each 15 minutes of activity.	1,220	$20	$26.8K
97140	Manual therapy is a form of physical therapy which uses the controlled movement and pressure of hands to treat various disorders of soft tissues and joints, eg, chronic back pain. Manual therapy…	180	$20	$2.9K
97016	In this procedure, the provider applies the vasopneumatic device to an extremity for the purpose of reducing edema, or swelling.	100	$10	$730

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 3 CPT/HCPCS codes. Note: this provider's state, "XX," is a placeholder CMS uses when a provider's practice-location state wasn't reported — not a traditional US state; the State panel below benchmarks against other providers coded under the same designation.

View: State1 / 2

Claims Volume vs. Unspecified Location Distribution

Giselle Vermilyea — 0 of 2 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Unspecified Location

Full comparison — all codes billed, vs. state median

3 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
97530	1	10	1,770	$20	$36.6K
97140	1	10	730	$20	$12.2K
97016	1	0	N/A	$N/A	$N/A

Giselle Vermilyea — Billing Profile & Reimbursement Data

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Key Findings

Medicare: Total Revenue Breakdown by CPT/HCPCS Code

Medicare: Complete Services Breakdown

Medicare: Competitive Analysis & Benchmarks

Frequently Asked Questions

References