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

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

S P Gill Md PC (NPI 1366621930)

S P Gill Md PC is a medical specialty clinic/center provider located in Sun City, Arizona. This profile covers 0 Medicare and 12 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	S P Gill Md PC
Address	14815 N Del Webb Blvd
City	Sun City
State	AZ
ZIP	85351
Taxonomy	Medical Specialty Clinic/Center
NPI Enumerated	October 30, 2007

Payer Source	Total Paid
Medicaid	$9.5M
Medicare	$0

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

12 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
99254	The provider sees a patient for an inpatient or observation consultation involving evaluation and management (E/M). The E/M involves a moderate level of medical decision making or the provider spends…	42,250	$130	$5.5M
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…	64,400	$60	$3.7M
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…	1,080	$80	$89.9K
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…	1,970	$40	$86.6K
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…	1,880	$40	$65.7K
99253	The provider sees a patient for an inpatient or observation consultation involving evaluation and management (E/M). The E/M involves a low level of medical decision making or the provider spends at…	580	$90	$52.9K
99255	The provider sees a patient for an inpatient or observation consultation involving evaluation and management (E/M). The E/M involves a high level of medical decision making or the provider spends at…	290	$160	$45.8K
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…	100	$60	$5.6K
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…	50	$80	$3.6K
99348	The provider sees an established patient for a home or residence visit involving evaluation and management (E/M). The visit involves low medical decision making or the provider spends at least 30…	60	$50	$2.9K

Showing 1–10 of 12

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Arizona Distribution

S P Gill Md PC — 2 of 12 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Arizona

Full comparison — all codes billed, vs. Arizona median

12 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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…	255	540	900	$60	$475.8K
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…	2,380	3,040	750	$50	$343.9K
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…	10	610	610	$50	$258.3K
99254	The provider sees a patient for an inpatient or observation consultation involving evaluation and management (E/M). The E/M involves a moderate level of medical decision making or the provider spends…	1	120	120	$130	$163.6K
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…	874	1,030	130	$70	$134.1K
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…	832	1,160	150	$90	$96.5K
99255	The provider sees a patient for an inpatient or observation consultation involving evaluation and management (E/M). The E/M involves a high level of medical decision making or the provider spends at…	26	60	180	$160	$73.3K
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…	35	190	180	$20	$56.2K
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…	19	290	140	$90	$55.4K
99253	The provider sees a patient for an inpatient or observation consultation involving evaluation and management (E/M). The E/M involves a low level of medical decision making or the provider spends at…	8	50	70	$90	$33K

Showing 1–10 of 12

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Banner Boswell Medical Center	AZ	General Acute Care Hospital	$0	$27M
Succeeding At Recovery LLC	AZ	Substance Use Disorder Rehabilitation Clinic/Center	$0	$18.8M
Banner Imaging Services LLC	AZ	Diagnostic Radiology Physician	$0	$12.9M
Maxfar, LLC	AZ	Home Health Agency	$0	$8.9M
Leading Healthcare, LLC	AZ	Hospitalist Physician	$0	$7M
Express Urgent Care, PC	AZ	Urgent Care Clinic/Center	$0	$6.6M
Barnet Dulaney Perkins Eye Center, PC	AZ	Ambulatory Surgical Clinic/Center	$2.8M	$1.1M
Bcc West Valley LLC	AZ	Ambulatory Surgical Clinic/Center	$3.5M	$0
Sun City Ophthalmology Asc LLC	AZ	Ambulatory Surgical Clinic/Center	$2M	$1.2M
Baljeet Uppal	AZ	Vascular Surgery Physician	$2.9M	$0

S P Gill Md PC — Billing Profile & Reimbursement Data

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S P Gill Md PC — 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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