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

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

Northwestern Medical Center, Inc. (NPI 1417274663)

Northwestern Medical Center, Inc. is a family medicine physician provider located in Saint Albans, Vermont. This profile covers 0 Medicare and 10 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	Northwestern Medical Center, Inc.
Address	260 Crest Rd
City	Saint Albans
State	VT
ZIP	05478
Taxonomy	Family Medicine Physician
NPI Enumerated	April 28, 2010

Payer Source	Total Paid
Medicaid	$176.8K
Medicare	$0

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

10 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…	2,450	$40	$88.1K
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…	3,570	$20	$74.9K
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,…	2,200	$10	$11K
G2012	Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an…	850	$1	$850
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	100	$10	$800
90686	This code represents a vaccine product administered into the muscle to protect against four strains of influenza (flu). It is preservative free, uses split virus technology, and is given as a 0.5 mL…	90	$10	$740
99201	Deleted code, effective Jan. 1, 2021	20	$10	$210
99211	An established patient presents for an office or other outpatient visit that may not require the presence of a physician or other qualified healthcare professional.	30	$1	$120
96127	The provider performs a brief emotional/behavioral assessment of the patient using a standardized instrument (such as a recognized form). The provider scores and documents the assessment.	30	$1	$50
3725F	The provider screens a patient with dementia for the presence of depression, which is a mental disorder characterized by sadness, guilt feelings, hopelessness, or irritability.	40	$0	$0

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Vermont Distribution

Northwestern Medical Center, Inc. — 0 of 9 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Vermont

Full comparison — all codes billed, vs. Vermont median

10 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average 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…	98	320	680	$30	$146.1K
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…	78	320	760	$20	$88.2K
99211	An established patient presents for an office or other outpatient visit that may not require the presence of a physician or other qualified healthcare professional.	23	30	140	$10	$15.6K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	65	90	330	$10	$10K
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,…	10	110	150	$10	$4.6K
G2012	Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an…	3	10	200	$1	$2K
96127	The provider performs a brief emotional/behavioral assessment of the patient using a standardized instrument (such as a recognized form). The provider scores and documents the assessment.	44	60	420	$1	$1.8K
99201	Deleted code, effective Jan. 1, 2021	2	10	20	$20	$790
90686	This code represents a vaccine product administered into the muscle to protect against four strains of influenza (flu). It is preservative free, uses split virus technology, and is given as a 0.5 mL…	63	90	320	$1	$690
3725F	The provider screens a patient with dementia for the presence of depression, which is a mental disorder characterized by sadness, guilt feelings, hopelessness, or irritability.	4	10	110	$0	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Northwestern Medical Center, Inc.	VT	Pediatrics Physician	$0	$1.4M
Northwestern Medical Center, Inc.	VT	General Acute Care Hospital	$0	$1.1M
Northwestern Medical Center, Inc.	VT	Urgent Care Clinic/Center	$0	$757.2K
Northwestern Medical Center, Inc.	VT	Pediatrics Physician	$0	$596.5K
Michael Hooker	VA	Orthopaedic Surgery Physician	$382.5K	$0
Northwestern Medical Center Inc	VT	General Acute Care Hospital	$0	$349.6K
Gregory Brophey	VT	Ophthalmology Physician	$234.2K	$0
Michael Barnum	FL	Orthopaedic Surgery of the Spine Physician	$200.3K	$0
Stephanie Neider	VT	Dermatology Physician	$145.1K	$0
Joseph Winget	VT	Cardiovascular Disease Physician	$140.2K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Northwestern Counseling & Support Services	VT	Community/Behavioral Health Agency	$0	$129.9M
Northwestern Counseling & Support Services Inc	VT	Community/Behavioral Health Agency	$0	$70.4M
Amcare Medical Systems, Inc.	VT	Land Ambulance	$576.2K	$2.2M
Baart Behavioral Health Services, Inc.	VT	Substance Use Disorder Rehabilitation Clinic/Center	$180.2K	$2.5M
Remy Vallee Dmd Inc	VT	Dentist	$0	$1.1M
Calm Reflections Psychotherapy, LLC	VT	Clinical Social Worker	$0	$840.8K
Northern Valley Eyecare, Inc.	VT	Optometrist	$0	$703.1K
Michelle Pelkey	VT	Clinical Social Worker	$0	$550.9K
Gillian Ireland	VT	Mental Health Counselor	$0	$388.4K
Avalon Natural Medicine Of Vermont, PLLC	VT	Naturopath	$0	$373K

Northwestern Medical Center, Inc. — Billing Profile & Reimbursement Data

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Northwestern Medical Center, Inc. — 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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