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

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

Emergency Coverage, LLC (NPI 1427005008)

Key Findings

Field	Value
Entity Type	Organization
Organization	Emergency Coverage, LLC
Address	435 2nd St
City	Newport
State	TN
ZIP	37821
Taxonomy	Family Medicine Physician
NPI Enumerated	May 28, 2006

Payer Source	Total Paid
Medicaid	$121.9M
Medicare	$0

This entity is effectively a Medicaid-only billing operation: there is no Medicare revenue on file and the provider reports $121.9M in lifetime Medicaid revenue. The absence of Medicare activity means payer exposure and contracting negotiation will be concentrated almost entirely on Medicaid programs and managed-Medicaid plans.

Revenue is extremely concentrated in three emergency department E/M codes: the precomputed top-3 codes account for 98.0% of the provider's Medicaid revenue. Specifically, 99285 accounts for $54.3M (44.6% of Medicaid revenue), 99284 accounts for $47M (38.6%), and 99283 accounts for $18.1M (14.9%), indicating a narrow revenue base dominated by a small set of ED evaluation-and-management services.

The code mix and descriptions point to a high-volume emergency-department service line: 99285 (high MDM), 99284 (moderate MDM), and 99283 (low MDM) together drive nearly all revenue, and the presence of critical-care codes such as 99291 (10.9K claims, $1.1M) indicates the provider also performs higher-acuity interventions. This pattern is consistent with an organization operating continuous, acute-care ED coverage rather than an outpatient clinic-focused practice.

On statewide competitive standing the provider is a dominant outlier for core ED codes: 99285, 99284, and 99283 each rank #1 in-state and are labeled "extreme outlier" or 100th percentile for volume, placing this provider far above typical state peers for ED visits. The provider also ranks highly for 99291 (rank #3 of 162, 99th percentile), reinforcing its role as a leading source of emergency and critical-care billings in Tennessee.

High claim volumes and average payments indicate both throughput and acuity: 99285 has 662.4K claims at $82 avg paid/claim, 99284 has 770.1K claims at $61 avg paid/claim, and 99283 has 489.4K claims at $37 avg paid/claim. Those counts coupled with the large revenue shares for a small set of codes suggest operational capacity to process very large ED patient volumes and reliance on per-visit reimbursement rather than procedure-driven revenue.

Ancillary and facility-level codes further support a 24/7 ED operating model: 93010 (117.2K claims, $468.8K revenue) ranks #4 in-state (99th percentile; extreme outlier) and 99053 (309.2K claims, $309.2K revenue) ranks #1 in-state (100th percentile; extreme outlier). The high volume of overnight-service and routine EKG billing is consistent with continuous emergency coverage and high encounter frequency.

Although the top codes dominate, there is limited evidence of other procedure lines: wound repairs (12001, 12011), incision and drainage (10060/10061), airway management (31500), and splinting codes appear at much lower revenue levels and in some cases are unique-state entries. These ancillary procedural billings are consistent with on-site acute care management in an ED context but do not materially diversify the provider's revenue base away from E/M visits.

The provider has long tenure on file, with NPI enumerated 2006-05-28 (~20 years ago), indicating an established presence in the market. Combined with the extreme state-level rankings and concentrated Medicaid revenue, this suggests an entrenched emergency-coverage operator that is strategically important to Medicaid access in its region, while simultaneously presenting concentrated payer risk if Medicaid contracting or utilization patterns change.

Medicaid: Complete Services Breakdown

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

25 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
99285	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a high level of medical decision making.	662,370	$80	$54.3M
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.	770,100	$60	$47M
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.	489,430	$40	$18.1M
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…	10,940	$100	$1.1M
93010	The provider interprets and reports on the results of a routine 12–lead (or more) electrocardiogram.	117,200	$1	$468.8K
99053	The provider renders overnight services at a 24 hour facility.	309,220	$1	$309.2K
99282	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a straightforward level of medical decision making.	6,050	$20	$139K
10061	The provider incises the area of abscess and drains the collection of pus, such as those related to a carbuncle, hidradenitis, cyst, furuncle, or paronychia, with the help of surgical instruments. A…	1,180	$110	$126K
12001	This CPT code is used for the simple repair of superficial wounds to the scalp, neck, axillae, external genitalia, trunk, and/or extremities (including the hands and feet) that are 2.5 cm or less in…	2,290	$30	$70.9K
10060	The provider incises the area of abscess and drains the collection of pus from a lesion, such as a carbuncle, hidradenitis, cyst, furuncle, or paronychia, with the help of surgical instruments. A…	1,050	$70	$69.2K

Showing 1–10 of 25

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Tennessee Distribution

Emergency Coverage, LLC — 7 of 24 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Tennessee

Full comparison — all codes billed, vs. Tennessee median

25 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.	1	630	510	$120	$1.1M
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.	1	610	570	$110	$884.4K
99285	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a high level of medical decision making.	1	570	640	$100	$637.8K
99282	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a straightforward level of medical decision making.	24	180	480	$90	$245.5K
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…	3	160	110	$90	$96K
12011	This CPT code is used for the simple repair of superficial wounds to the face, ears, eyelids, nose, lips, and/or mucous membranes, that are 2.5 cm or less in size.	1	10	1,690	$40	$66.6K
99281	The provider sees a patient for the lowest level emergency department visit.	15	80	190	$70	$54K
71045	In this diagnostic procedure, the provider performs a single radiological view of the chest. He performs this study for the assessment of conditions affecting the chest, its contents, and nearby…	252	310	1,590	$1	$53.4K
31500	The provider inserts a flexible tube into the trachea (windpipe) typically via the mouth in an emergency situation to maintain an open airway in a patient with a compromised airway.	1	10	650	$70	$45K
10061	The provider incises the area of abscess and drains the collection of pus, such as those related to a carbuncle, hidradenitis, cyst, furuncle, or paronychia, with the help of surgical instruments. A…	2	10	290	$50	$44.6K

Showing 1–10 of 25

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Ayana Seibles	MD	Internal Medicine Physician	$630.6K	$0
Thomas Evans	TN	Internal Medicine Physician	$295.1K	$0
Mohammed Bah	TN	Family Medicine Physician	$149.6K	$63.5K
Jamee Martin	TN	Physician Assistant	$208.4K	$0
Justin Marlar	TN	Emergency Medicine Physician	$142.9K	$4.1K
Stacey Carlton	TN	Family Medicine Physician	$128.1K	$10.1K
Preston Gallaher	AL	Emergency Medicine Physician	$137.6K	$0
Ryan Hubbard	VA	Family Medicine Physician	$119.5K	$0
Luis Pagoaga	TN	Family Medicine Physician	$118.1K	$0
Erik Petersen	TN	Internal Medicine Physician	$107K	$4.3K

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Cocke County Hma, LLC	TN	General Acute Care Hospital	$0	$18.4M
Newport Pediatrics, P.C.	TN	Pediatrics Physician	$0	$11.7M
Rural Medical Services, Inc.	TN	Federally Qualified Health Center (FQHC)	$0	$2.9M
New Hope Treatment Center Of Tennessee LLC	TN	Substance Use Disorder Rehabilitation Clinic/Center	$146.6K	$2.4M
Robert Ampudia	TN	Surgery Physician	$246.9K	$49.9K
Candi Overholt	TN	Internal Medicine Physician	$202.5K	$0
Rajkamal Harricharan Singh	TN	Family Medicine Physician	$179.1K	$0
Blane Tarr	TN	Optometrist	$74.5K	$102.2K
Anton Daniel	TN	Internal Medicine Physician	$145.3K	$1.2K
James Williams	TN	Family Medicine Physician	$127.7K	$0

Emergency Coverage, LLC — Billing Profile & Reimbursement Data

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Emergency Coverage, LLC — Billing Profile & Reimbursement Data

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Key Findings

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References