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

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

Southcoast Physicians Group, Inc. (NPI 1336137629)

Southcoast Physicians Group, Inc. is a family medicine physician provider located in Fairhaven, Massachusetts. This profile covers 0 Medicare and 304 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	Southcoast Physicians Group, Inc.
Address	200 Mill Road
City	Fairhaven
State	MA
ZIP	02719
Taxonomy	Family Medicine Physician
NPI Enumerated	October 11, 2005

Payer Source	Total Paid
Medicaid	$49.8M
Medicare	$0

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

304 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	371,290	$40	$16M
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…	273,190	$30	$9.3M
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…	120,610	$20	$2.9M
99204	The provider sees a new 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 provider…	25,190	$90	$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…	52,560	$40	$1.9M
99203	The provider sees a new 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 provider…	26,320	$60	$1.6M
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…	21,060	$70	$1.6M
99291	Critical care services include the treatment of vital organ failure or prevention of further life–threatening conditions. Delivering medical care in a moment of crisis and in time of emergency is…	14,830	$80	$1.2M
99239	The provider sees a patient for hospital inpatient or observation discharge day management, involving evaluation and management (E/M). The provider spends more than 30 minutes on the service on the…	30,700	$40	$1.2M
99222	The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	17,040	$50	$885.9K

Showing 1–10 of 304

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Massachusetts Distribution

Southcoast Physicians Group, Inc. — 19 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Massachusetts

Full comparison — all codes billed, vs. Massachusetts median

304 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
43239	The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum where he removes one or more tissue biopsy specimens for diagnostic analysis.	16	120	530	$450	$681.5K
99284	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making.	219	830	130	$120	$671K
J0585	Injection, onabotulinumtoxina, 1 unit	26	40	430	$490	$616K
90834	In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere…	912	1,620	580	$80	$599.6K
59400	In this global service, the provider and nonphysician healthcare providers in the practice provide all of the antepartum care, admission to the hospital for delivery, labor management, including…	13	20	70	$2,130	$586.8K
45380	The provider examines the rectum and colon using a flexible colonoscope, a tubular instrument with a light source and camera, to look for the cause of a patient's symptoms, which may include…	29	100	260	$550	$524.4K
45385	The provider examines the colon and rectum using a colonoscope, a long, thin flexible tubular instrument with a light source and camera. He removes one or more tumors, polyps, or other lesions with a…	45	100	230	$600	$511.3K
69436	This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia.	19	30	40	$1,170	$484.3K
99282	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a straightforward level of medical decision making.	91	160	270	$130	$469.1K
45378	The provider examines the colon and rectum using a colonoscope, a flexible tube with a camera at its inserted end. If he sees any areas of abnormal mucosa or tissue, he takes samples using a brush…	36	70	160	$620	$428.7K

Showing 1–10 of 304

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Regis Burlas	OH	Anesthesiology Physician	$9.5K	$1.3M
Daniel Collins	RI	Family Medicine Physician	$24.4K	$902.1K
Ocean State Urgent Care Center Of Warwick, LLC	RI	Urgent Care Clinic/Center	$0	$460.6K
Ocean State Urgent Care Center Of Cumberland, LLC	RI	Urgent Care Clinic/Center	$0	$447.7K
John Johnson	MA	Allergy & Immunology Physician	$424.5K	$0
Ocean State Urgent Care Center Of Smithfield LLC	RI	Urgent Care Clinic/Center	$0	$403.1K
Lindsey Monti	NH	Physician Assistant	$28.4K	$324.2K
Richard Pin	MA	Vascular Surgery Physician	$351.6K	$0
Michael Duque	RI	Internal Medicine Physician	$77.5K	$253.6K
Linda Young	RI	Nurse Practitioner	$33.9K	$282.5K

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Behavioral Connections	MA	Community/Behavioral Health Agency	$0	$11M
Southcoast Visiting Nurse Association. Inc	MA	Home Health Agency	$0	$9.9M
Active Ma, Inc.	MA	Adult Day Care Clinic/Center	$0	$6.1M
Southcoast Visiting Nurse Association, Inc	MA	Community Based Hospice Care Agency	$0	$5.9M
Town Of Fairhaven	MA	Ambulance	$514K	$883.6K
Michael Crowe	MA	Podiatrist	$116.3K	$440.1K
Tina Parker-howayeck	MA	Optometrist	$28.5K	$467.2K
Walgreen Co	MA	Pharmacy	$240.3K	$0
Patrick Gagnon	MA	Radiation Oncology Physician	$217.9K	$0
Michael Barretti	MA	Critical Care Medicine (Internal Medicine) Physician	$121.5K	$0

Southcoast Physicians 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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