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.

Shobha Sem (NPI 1336124452)

Field	Value
Entity Type	Individual
Organization	Shobha Sem
Address	Psc80,box13453
City	Kadena Ab
State	XX (Unspecified Location)
ZIP	96367
Taxonomy	Family Medicine Physician
NPI Enumerated	December 12, 2005

Payer Source	Total Paid
Medicare	$5.6K
Medicaid	$0

Key Findings

The provider’s Medicare billing is concentrated in subsequent hospital inpatient/observation evaluation-and-management visits, with all top revenue codes being inpatient follow-up codes 99231, 99232, and 99233. Code descriptions indicate the practice is generating revenue from hospital-based follow-up care that ranges from straightforward/low complexity follow-ups (99231) to high medical decision making or prolonged time encounters (99233), suggesting the provider is operating primarily in an inpatient/observation care role rather than an outpatient office panel.

Revenue concentration is extreme within Medicare: the precomputed top-3 codes (99232, 99233, 99231) account for 100.0% of this provider's total Medicare revenue, with 99232 accounting for $2.8K (49.6% of Medicare revenue), 99233 accounting for $2K (35.1%), and 99231 accounting for $861 (15.3%). This pattern indicates virtually all reported Medicare receipts derive from a tightly focused set of inpatient follow-up services.

Payer mix is effectively single-payer: the provider’s Total Medicare revenue is $5.6K while there is no Medicaid billing on file, so Medicaid activity does not contribute to the provider’s billed volumes or revenue in the available data. For analysts, this means assessment of reimbursement risk or utilization should focus on Medicare inpatient pathways rather than dual-payer comparisons.

Competitive standing on these codes is modest at the national level. For 99232 the provider ranks #124028 of 177383 providers nationally (29th percentile; typical, unremarkable volume for this code), for 99233 the rank is #116467 of 128818 (8th percentile; typical, unremarkable volume for this code), and for 99231 the rank is #38879 of 50953 (21th percentile; typical, unremarkable volume for this code), all indicating the provider does not occupy a dominant position for these services.

Activity and payment profile are low in absolute scale: claim counts are 43 for 99232 with an average paid/claim of $65, 20 claims for 99233 with $99 avg paid/claim, and 21 claims for 99231 with $41 avg paid/claim. Combined these line items produce the reported Total Medicare revenue of $5.6K, signaling limited Medicare throughput despite use of higher-complexity inpatient codes like 99233.

The provider has long-standing enrollment history—NPI enumerated (registered) on 2005-12-12 (~21 years ago)—which indicates a stable registration tenure but does not correspond to high current Medicare revenue or Medicaid engagement. Analysts should treat the long tenure and low current Medicare billing as separate signals: administrative longevity with limited recent Medicare volume.

Statistical standing of the individual codes shows no notable outliers; each code is labeled in the source data as "typical, unremarkable volume for this code," reinforcing that claim volumes and ranks fall within expected ranges rather than reflecting anomalous intensity or extreme specialization. Given the percentiles (29th, 8th, and 21th), the provider’s code mix is within the lower-to-middle national distribution for these hospital follow-up services.

From a service-line and contracting perspective, the concentration on inpatient follow-up E/M codes suggests the provider’s value to payers or networks will be tied to hospital-based utilization patterns rather than broad ambulatory primary-care panels. Given the lack of Medicaid billing on file and the small absolute Medicare revenue ($5.6K), this provider represents a narrow, low-volume inpatient follow-up contributor rather than a sizable revenue source in either payer pool.

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
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…	40	$70	$2.8K
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…	20	$100	$2K
99231	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a straightforward or low level of medical…	20	$40	$860

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

Shobha Sem — 0 of 1 code 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
99232	9	10	110	$60	$6.9K
99231	8	0	N/A	$N/A	$N/A
99233	5	0	N/A	$N/A	$N/A

Related Providers

Other providers that share a Tax Identification Number (TIN) with Shobha Sem, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Brigid Bautista	PA	Psychiatry Physician	$178.1K	$0
Abayomi Ige	PA	Psychiatry Physician	$145.7K	$0
Anil Rai	PA	Psychiatry Physician	$107K	$0
Mahrukh Khan	PA	Psychiatry Physician	$95.2K	$0
David Gaines	DE	Nurse Practitioner	$0	$69.5K
Salman Salaria	DE	Psychiatry Physician	$60.7K	$0

Nearby Providers

Other providers in the same ZIP code as Shobha Sem, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Douglas Olson	AP (Armed Forces Pacific)	Orthodontics and Dentofacial Orthopedics Dentistry	$0	$52K
Kimberly Caldwell	AP (Armed Forces Pacific)	Family Medicine Physician	$22.4K	$0

Shobha Sem — 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

Related Providers

Nearby Providers

Frequently Asked Questions

References