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

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

Sjmh Medical Practice-smhc (NPI 1346284684)

Sjmh Medical Practice-smhc is a internal medicine physician provider located in Pontiac, Michigan. This profile covers 0 Medicare and 173 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	Sjmh Medical Practice-smhc
Address	44405 Woodward Ave
City	Pontiac
State	MI
ZIP	48341
Taxonomy	Internal Medicine Physician
NPI Enumerated	June 16, 2006

Payer Source	Total Paid
Medicaid	$14.8M
Medicare	$0

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

173 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	48,950	$50	$2.3M
59409	In this procedure, the provider provides admission to the hospital for delivery, labor management, including induction of labor, fetal monitoring, use of low forceps, and episiotomy, vaginal delivery…	2,120	$760	$1.6M
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…	24,620	$60	$1.6M
59426	This service is considered a mini global code for the provider who provides seven or more antepartum visits. This can happen when the patient transfers out of the practice prior to delivery or the…	1,190	$690	$824K
59514	The provider admits the patient to the hospital for delivery, delivers the fetus and placenta via an abdominal incision, and provides care immediately after delivery on the same date of service. This…	590	$840	$496.9K
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…	7,980	$60	$439.1K
76818	The provider performs a biophysical profile test to measure the health of the baby during pregnancy. The test consists of a nonstress test and an ultrasound.	12,820	$30	$384.6K
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…	4,270	$90	$379.7K
99392	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	4,690	$80	$356.4K
99391	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	4,780	$70	$310.6K

Showing 1–10 of 173

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Michigan Distribution

Sjmh Medical Practice-smhc — 4 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Michigan

Full comparison — all codes billed, vs. Michigan median

173 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99469	The provider evaluates and manages the subsequent care of a newborn or infant less than 28 days of age in a neonatal critical care setting, after the first day.	12	20	2,940	$340	$1.8M
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.	325	480	1,350	$110	$1.7M
99283	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a low level of medical decision making.	227	450	1,540	$90	$1.3M
99479	The provider directs the care of a recovering low birth weight infant, whose current weight is between 1500 and 2500 grams.	16	20	3,450	$100	$916.9K
99468	The provider evaluates and manages the initial care of a newborn or infant less than 28 days of age in a neonatal critical care setting.	14	20	540	$770	$650.1K
99480	The provider directs the care of a recovering low birth weight infant, whose current weight is between 2501 and 5000 grams.	16	20	1,120	$100	$636.6K
59409	In this procedure, the provider provides admission to the hospital for delivery, labor management, including induction of labor, fetal monitoring, use of low forceps, and episiotomy, vaginal delivery…	18	130	200	$750	$636K
59514	The provider admits the patient to the hospital for delivery, delivers the fetus and placenta via an abdominal incision, and provides care immediately after delivery on the same date of service. This…	18	50	230	$760	$523.3K
59426	This service is considered a mini global code for the provider who provides seven or more antepartum visits. This can happen when the patient transfers out of the practice prior to delivery or the…	30	160	260	$820	$506.6K
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…	126	270	510	$140	$395.2K

Showing 1–10 of 173

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Abul Shamsuddoha	MI	Internal Medicine Physician	$24.5K	$761.3K
Stacy Loree	MI	Cardiovascular Disease Physician	$682.8K	$0
Arezo Amirikia	MI	Ophthalmology Physician	$563.9K	$0
Surindar Jolly	MI	Vascular Neurology Physician	$257.5K	$212.2K
Diego Hernandez	MI	Vascular Surgery Physician	$384.2K	$0
Kiritkumar Patel	MI	Cardiovascular Disease Physician	$368K	$0
Feras Aloka	PA	Internal Medicine Physician	$239.1K	$0
Sara Sarwar Riaz	MI	Hematology & Oncology Physician	$229K	$0
Zachary Leonard	MI	Orthopaedic Surgery Physician	$220.4K	$0
Anibal Drelichman	MI	Medical Oncology Physician	$218.4K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
St Joseph Mercy Hospital-smhc	MI	General Acute Care Hospital	$0	$51.8M
Common Ground	MI	Community/Behavioral Health Agency	$0	$44.5M
Oakland Family Services	MI	Clinic/Center	$0	$25.6M
John Antonucci	MI	Radiation Oncology Physician	$786.7K	$0
Michael Ghilezan	MI	Radiation Oncology Physician	$627.8K	$0
Frank Vicini	MI	Radiation Oncology Physician	$609.1K	$0
Dilraj Ghumman	MI	Diagnostic Radiology Physician	$592K	$0
Larry Kestin	MI	Radiation Oncology Physician	$562.3K	$0
Sameer Naik	MI	Student in an Organized Health Care Education/Training Program	$409.7K	$0
Fahd Al-saghir	MI	Nephrology Physician	$348.1K	$0

Sjmh Medical Practice-smhc — Billing Profile & Reimbursement Data

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Sjmh Medical Practice-smhc — 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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