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.

Mclaren Macomb (NPI 1396014601)

Mclaren Macomb is a internal medicine physician provider located in Mount Clemens, 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	Mclaren Macomb
Address	1000 Harrington Blvd.
City	Mount Clemens
State	MI
ZIP	48043
Taxonomy	Internal Medicine Physician
NPI Enumerated	December 16, 2011

Payer Source	Total Paid
Medicaid	$19.2M
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
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…	69,680	$70	$4.7M
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…	73,580	$50	$3.4M
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…	1,180	$760	$894.8K
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…	1,230	$670	$829K
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…	9,130	$80	$693.7K
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…	7,230	$90	$614.5K
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…	14,180	$40	$567.4K
99395	The provider performs an established well–patient visit for a patient who is between the ages of 18 and 39.	7,740	$70	$565.1K
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…	5,400	$100	$555.8K
99396	The provider performs an established well–patient visit for a patient who is between the ages of 40 and 64.	6,090	$80	$505.5K

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

Mclaren Macomb — 12 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
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.	298	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.	320	450	1,540	$90	$1.3M
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…	31	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…	32	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…	28	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…	89	270	510	$140	$395.2K
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…	30	4,380	1,000	$70	$289.9K
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…	35	4,770	1,060	$50	$247.8K
95951	N/A	19	20	930	$190	$229.8K
93306	The provider uses transducers to obtain two–dimensional (2D) images of the heart structures through the chest wall. He evaluates the anatomy and function of all four heart chambers, valves, adjacent…	36	310	850	$90	$215.4K

Showing 1–10 of 173

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Mclaren Macomb	MI	General Acute Care Hospital	$0	$56.7M
Thomas Giancarlo	MI	Neurology Physician	$458.1K	$0
Ryan Nelson	MI	Urology Physician	$353.7K	$0
Scott Wilkinson	MI	Urology Physician	$349.2K	$0
Fadi Alkhankan	WV	Pulmonary Disease Physician	$277.5K	$0
Andrew Ajluni	MI	Orthopaedic Surgery Physician	$250.7K	$0
Michael Hoff	MI	Urology Physician	$240.9K	$0
Katie Rosen	MI	Urology Physician	$222.4K	$0
Scott Sircus	MI	Urology Physician	$204.6K	$0
Victor Hunyadi	MI	Cardiovascular Disease Physician	$172.3K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Macomb Residential Opportunities, Inc.	MI	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$39.8M
Svs Vision Inc	MI	Optometrist	$0	$30.9M
Life Skills Centers, Inc.	MI	Developmentally Disabled Services Day Training Agency	$0	$28M
Macomb Emergency Physicians PLLC	MI	Emergency Medicine Physician	$0	$8.5M
Allergy And Asthma Physicians Of Commerce Township	MI	Allergy & Immunology Physician	$0	$5.4M
County Of Macomb	MI	Public Health or Welfare Agency	$207.7K	$1.8M
Henry Ford Macomb Ancillary Services	MI	Clinical Medical Laboratory	$147.1K	$66K
Pulin Patel	MI	Allergy & Immunology Physician	$198.6K	$2.4K
Arthur Frazier	MI	Radiation Oncology Physician	$168.6K	$0
Amy Wright	MI	Surgery Physician	$156.2K	$9.5K

Mclaren Macomb — 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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