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NPI 1396121240 · Portsmouth, NH · General Practice Physician
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Pmc Medical Group, LLC is a general practice physician provider located in Portsmouth, New Hampshire. This profile covers 2 Medicare and 37 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 | Organization |
| Organization | Pmc Medical Group, LLC |
| Address | 100 Griffin Rd Unit B |
| City | Portsmouth |
| State | NH |
| ZIP | 03801 |
| Taxonomy | General Practice Physician |
| NPI Enumerated | August 3, 2015 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $11.2M |
| Medicare | $392K |
Payer mix is heavily weighted toward Medicaid: the provider reports $392K in total Medicare revenue versus $11.2M in total Medicaid revenue, indicating Medicaid is the primary source of billed services and revenue for this entity. This scale differential suggests the practice operates primarily within Medicaid patient flows rather than Medicare-centered care.
Revenue is highly concentrated in a small number of codes on both payers. Precomputed figures show the top 3 Medicare codes account for 100.0% of Medicare revenue and the top 3 Medicaid codes account for 87.5% of Medicaid revenue, signaling dependence on a narrow set of services for the bulk of payments.
The code mix points to a high-volume outpatient practice with integrated laboratory drug-testing and office-based evaluation-and-management services. Large contributions from 80307 and G0480 (definitive and presumptive drug testing) alongside substantial Medicaid revenue from 99214 and 99213 indicate an operational model oriented around frequent E/M visits plus routine specimen-based drug testing.
Medicare billing is driven almost entirely by drug-testing services: 80307 accounts for $242.6K (61.8% of Medicare revenue) and G0480 accounts for $150.2K (38.2% of Medicare revenue), which together match the precomputed 100.0% concentration. Nationally, the provider ranks #49 of 4760 for 80307 (99th percentile; notably above typical national volume) and #72 of 1590 for G0480 (96th percentile; typical, unremarkable volume for this code), indicating outsized national activity specifically on instrumented presumptive testing.
Medicaid revenue is dominated by high-level office visits and drug testing: 99214 generates $4.5M (40.2% of Medicaid revenue), 80307 generates $3.7M (33.5%), and 99213 generates $1.5M (13.8%); these three are the precomputed top contributors comprising 87.5% of Medicaid revenue. Competitive rankings underline in-state dominance for these lines—99214 ranks #2 of 416 (100th percentile; extreme outlier), 80307 ranks #1 of 47 (100th percentile; extreme outlier), and 99213 ranks #8 of 395 (98th percentile; extreme outlier).
Across payers the practice is a major state-level player for drug testing and higher-complexity E/M encounters. Multiple codes show extreme outlier status in-state (e.g., 80307 and 99214 at the 100th percentile) and Medicare rankings indicate strong national volume for 80307, so the provider is both a local market leader and a notable national outlier for specific laboratory services.
Although most revenue stems from E/M and drug-testing services, the presence of behavioral-health and ancillary codes suggests some service diversification: Medicaid paid claims include psychotherapy codes 90837 ($142.6K) and 90832 ($100.6K) and a high relative in-state rank for brief behavioral assessment 96127 ($6.9K, rank #3 of 38; 95th percentile; notably above typical state volume). Smaller H0015 and procedural vaccination codes are present but represent marginal revenue compared with core E/M and testing lines.
The provider has an established billing history with NPI enumeration on 2015-08-03 (~11 years ago), consistent with the scale and concentrated volumes reported; this tenure is sufficient to build the observed market position and referral/testing workflows reflected in the payer data.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
2 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 80307 | The lab analyst performs presumptive drug test(s) via instrumented chemistry analyzers to screen for any number of drug classes on a single date. | 4,110 | $60 | $242.6K |
| G0480 | Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but… | 1,390 | $110 | $150.2K |
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 2 CPT/HCPCS codes.
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.
37 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… | 111,530 | $40 | $4.5M |
| 80307 | The lab analyst performs presumptive drug test(s) via instrumented chemistry analyzers to screen for any number of drug classes on a single date. | 80,820 | $50 | $3.7M |
| 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… | 46,220 | $30 | $1.5M |
| G0480 | Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but… | 20,710 | $50 | $973.3K |
| 90837 | In this service, the provider performs psychotherapy, a series of technique for treating the psychiatric disorders of the patient. The treatment session typically lasts for a minimum of 53 minutes or… | 2,460 | $60 | $142.6K |
| 90832 | 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… | 4,790 | $20 | $100.6K |
| 99212 | The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,… | 2,570 | $30 | $66.8K |
| 99215 | The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the… | 520 | $50 | $23.7K |
| 96372 | A therapeutic, prophylactic, or diagnostic substance (a fluid, a drug, etc.) is injected via intramuscular or subcutaneous route into the patient's body. The procedure is performed by the physician… | 1,260 | $10 | $15.1K |
| 99393 | The provider performs an established well–patient visit for a child who is between the ages of 5 and 11. | 130 | $60 | $8K |
Showing 1–10 of 37
How this provider's Medicaid billing volume and revenue compare to other New Hampshire providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. New Hampshire median
37 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| H0015 | Alcohol and/or drug services; intensive outpatient (treatment program that operates at least 3 hours/day and at least 3 days/week and is based on an individualized treatment plan), including… | 24 | 30 | 500 | $110 | $455.7K |
| 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… | 86 | 130 | 520 | $50 | $338.8K |
| 90837 | In this service, the provider performs psychotherapy, a series of technique for treating the psychiatric disorders of the patient. The treatment session typically lasts for a minimum of 53 minutes or… | 49 | 190 | 500 | $70 | $286.7K |
| 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 | 420 | 480 | $50 | $223.9K |
| 80307 | The lab analyst performs presumptive drug test(s) via instrumented chemistry analyzers to screen for any number of drug classes on a single date. | 1 | 50 | 1,240 | $40 | $195.1K |
| 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… | 8 | 400 | 350 | $30 | $140.6K |
| 90853 | Group psychotherapy is provided to a group of people who are normally not acquainted with each other but might be sharing similar kinds of psychological issues. The psychotherapist selects a group of… | 19 | 30 | 1,020 | $30 | $113.7K |
| G0480 | Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but… | 1 | 30 | 1,240 | $40 | $102.4K |
| 90791 | In this service, the provider performs a psychiatric evaluation of the patient with the aim of making a diagnosis. | 49 | 70 | 140 | $90 | $100.8K |
| 90832 | 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… | 15 | 100 | 610 | $30 | $93.8K |
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Other providers in the same ZIP code as Pmc Medical Group, LLC, ranked by combined Medicare and Medicaid revenue.
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