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NPI 1376521773 · Stratford, CT · Internal Medicine Physician
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David Chess is a internal medicine physician provider located in Stratford, Connecticut. This profile covers 10 Medicare and 8 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.
Provider details (source: NPPES NPI Registry)
| Field | Value |
|---|---|
| Entity Type | Individual |
| Organization | David Chess |
| Address | 99 Hawley Ln Ste 1102 |
| City | Stratford |
| State | CT |
| ZIP | 06614 |
| Taxonomy | Internal Medicine Physician |
| NPI Enumerated | January 5, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $41.7M |
| Medicaid | $150.5K |
Service-line profile: The provider’s Medicare and Medicaid billing is overwhelmingly concentrated in chronic care management and remote monitoring services, led by 99490 (care management), 99439 (add-on care management), and 99457 (remote physiologic monitoring with interactive communication). High volumes for related device/setup codes (99454, 99453) and RTM device codes appearing in Medicaid (98976, 98977) further indicate an operational model centered on remote patient management and continuous chronic-condition follow-up rather than traditional in-person E/M office visits. This code mix is consistent with a business that runs a large, staff-driven CCM/RPM program delivering recurring per-patient monthly services.
Medicare revenue concentration: The top three Medicare codes account for 98.4% of this provider’s total Medicare revenue, with 99490 generating $24.1M (57.9%) and 99439 generating $15.7M (37.8%), and 99457 contributing $1.1M (2.7%). That extreme concentration means the provider’s Medicare financial performance is highly dependent on continued high-volume billing of CCM and RPM services. Payers and network partners should treat reimbursement or utilization changes for these codes as having outsized impact on the provider’s Medicare revenue stream.
Medicare competitive standing and outlier status: For each of the primary Medicare codes the provider ranks at the top nationally—99490 ranks #1 of 16216 providers (100th percentile; extreme outlier), 99439 ranks #1 of 8395 providers (100th percentile; extreme outlier), and 99457 ranks #1 of 6044 providers (100th percentile; extreme outlier). These rankings characterize the provider as a national-scale outlier and dominant biller for CCM/RPM codes relative to peers, indicating unusually large program scale or breadth of enrolled patients for these services. Such standing suggests the provider is a major national participant in virtual chronic care delivery.
Medicaid footprint and competitive standing: The provider’s Medicaid billing is small in absolute dollars ($150.5K total Medicaid revenue) but concentrated in the same service lines: 99490 ($76.3K, 53.7%) and 99439 ($42.1K, 29.6%) are the top Medicaid codes and 99454 adds $8.1K (5.7%), with the top three Medicaid codes accounting for 89.0% of Medicaid revenue. In-state rank for 99490 is #1 of 60 providers (100th percentile; extreme outlier) and 99439 is #1 of 14 providers (100th percentile; extreme outlier), indicating dominant state-level billing for CCM/RPM despite the overall small Medicaid dollar magnitude.
Payer mix and scale: The provider’s Medicare revenue ($41.7M) dwarfs Medicaid revenue ($150.5K), making this effectively a Medicare-driven practice in scale and financial importance. Analysts should treat this entity as a Medicare-centric CCM/RPM operator where Medicaid participation is present but financially peripheral to overall operations. Contracting, risk-sharing, or utilization review efforts will therefore have much greater impact if focused on Medicare activity.
Per-claim reimbursement patterns: Medicare per-claim averages for leading codes (e.g., 99490 at $56/claim and 99439 at $42/claim) are substantially higher than Medicaid per-claim averages for the same codes in-state (99490 at $2/claim and 99439 at $2/claim), as shown in the provided tables. The combination of high Medicare per-claim rates and extremely high Medicare claim volumes drives the large Medicare revenue totals, while Medicaid contributes many claims at low per-claim payment and thus limited revenue. This disparity has implications for patient mix economics and for payers evaluating cost per-member-month across payers.
Operational concentration and risk note: With 98.4% of Medicare revenue tied to three codes and 89.0% of Medicaid revenue tied to three codes, the provider has a narrowly focused revenue base in recurring monthly CCM/RPM services. Any regulatory, coding, or reimbursement policy changes that affect CCM or RPM billing rules, documentation expectations, or allowable telehealth/RPM payments would therefore present concentrated operational and financial risk to the provider. Payers and partners should monitor utilization trends for 99490, 99439, and 99457 closely as leading indicators of shifts in the provider’s revenue trajectory.
Tenure and stability: The provider’s NPI was enumerated on 2006-01-05 (~20 years ago), indicating long-term presence in the market. That tenure, combined with extremely high ranks on CCM/RPM billing, suggests an established program and operational experience in delivering chronic care management and remote monitoring at scale rather than a recent short-lived billing pattern.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
10 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 99490 | The clinical staff provides services directed by the provider to support and coordinate a patient’s care across multiple disciplines. The patient has two or more chronic conditions that place the… | 429,560 | $60 | $24.1M |
| 99439 | The clinical staff provides services directed by the provider to support and coordinate a patient’s care across multiple disciplines. The patient has two or more chronic conditions that place the… | 373,820 | $40 | $15.7M |
| 99457 | The provider manages treatment using data from remote physiologic monitoring. The service requires at least one real–time interactive communication with the patient or caregiver during the month and… | 25,630 | $40 | $1.1M |
| 99454 | The provider supplies one or more devices for remote physiologic monitoring that occurs for 16 to 30 days in a 30–day period. | 11,100 | $50 | $510.7K |
| 99453 | The provider sets up equipment for remote physiologic monitoring and educates the patient on how to use it. | 7,130 | $20 | $128.3K |
| 99309 | The provider sees a patient for a subsequent nursing facility care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or the provider… | 70 | $90 | $6.1K |
| 99305 | The provider sees a patient for an initial nursing facility care visit involving evaluation and management (E/M). The visit involves moderate medical decision making or the provider spends at least… | 30 | $110 | $3.6K |
| 99306 | The provider sees a patient for an initial nursing facility care visit involving evaluation and management (E/M). The visit involves high medical decision making, and/or the provider spends at least… | 20 | $150 | $3.3K |
| 99310 | The provider sees a patient for a subsequent nursing facility care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the provider spends… | 20 | $130 | $2.9K |
| 99497 | The provider discusses and shares planning with a patient, his family, or an individual representing the patient, regarding the future health care needs of the patient. Use this code for the first 30… | 20 | $60 | $960 |
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 10 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
Medicaid revenue breakdown by year and by CPT/HCPCS procedure code, including monthly billing trends and the top codes driving revenue.
View: By Year1 / 3
Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.
8 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 99490 | The clinical staff provides services directed by the provider to support and coordinate a patient’s care across multiple disciplines. The patient has two or more chronic conditions that place the… | 38,170 | $1 | $76.3K |
| 99439 | The clinical staff provides services directed by the provider to support and coordinate a patient’s care across multiple disciplines. The patient has two or more chronic conditions that place the… | 21,030 | $1 | $42.1K |
| 99454 | The provider supplies one or more devices for remote physiologic monitoring that occurs for 16 to 30 days in a 30–day period. | 1,160 | $10 | $8.1K |
| 98976 | The provider supplies one or more devices for remote therapeutic monitoring (RTM) of the respiratory system for monitoring that occurs for 16 to 30 days in a 30–day period. | 540 | $10 | $7K |
| 99457 | The provider manages treatment using data from remote physiologic monitoring. The service requires at least one real–time interactive communication with the patient or caregiver during the month and… | 1,570 | $1 | $4.7K |
| 98977 | The provider supplies one or more devices for remote therapeutic monitoring (RTM) of the musculoskeletal system for monitoring that occurs for 16 to 30 days in a 30–day period. | 290 | $10 | $3.2K |
| 99309 | The provider sees a patient for a subsequent nursing facility care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or the provider… | 20 | $30 | $400 |
| 99453 | The provider sets up equipment for remote physiologic monitoring and educates the patient on how to use it. | 200 | $1 | $200 |
How this provider's Medicaid billing volume and revenue compare to other Connecticut providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Connecticut median
8 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 99309 | The provider sees a patient for a subsequent nursing facility care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or the provider… | 133 | 140 | 330 | $20 | $194.5K |
| 99457 | The provider manages treatment using data from remote physiologic monitoring. The service requires at least one real–time interactive communication with the patient or caregiver during the month and… | 5 | 20 | 680 | $20 | $33.1K |
| 99454 | The provider supplies one or more devices for remote physiologic monitoring that occurs for 16 to 30 days in a 30–day period. | 6 | 20 | 610 | $10 | $31.7K |
| 99490 | The clinical staff provides services directed by the provider to support and coordinate a patient’s care across multiple disciplines. The patient has two or more chronic conditions that place the… | 1 | 60 | 400 | $10 | $22.8K |
| 98976 | The provider supplies one or more devices for remote therapeutic monitoring (RTM) of the respiratory system for monitoring that occurs for 16 to 30 days in a 30–day period. | 3 | 10 | 590 | $10 | $19.9K |
| 99439 | The clinical staff provides services directed by the provider to support and coordinate a patient’s care across multiple disciplines. The patient has two or more chronic conditions that place the… | 1 | 10 | 100 | $1 | $5.3K |
| 98977 | The provider supplies one or more devices for remote therapeutic monitoring (RTM) of the musculoskeletal system for monitoring that occurs for 16 to 30 days in a 30–day period. | 2 | 10 | 440 | $1 | $1.6K |
| 99453 | The provider sets up equipment for remote physiologic monitoring and educates the patient on how to use it. | 6 | 10 | 200 | $1 | $1.1K |
Other providers in the same ZIP code as David Chess, ranked by combined Medicare and Medicaid revenue.
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