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

Why is the Medicaid comparison limited to North Carolina 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. North Carolina (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.

Private Diagnostic Clinic, PLLC (NPI 1457389033)

Key Findings

Field	Value
Entity Type	Organization
Organization	Private Diagnostic Clinic, PLLC
Address	40 Duke Medicine Cir
City	Durham
State	NC
ZIP	27710
Taxonomy	General Practice Physician
NPI Enumerated	June 30, 2006

Payer Source	Total Paid
Medicaid	$46.5M
Medicare	$0

This entity has no Medicare billing on file and is effectively a single-payer Medicaid provider, reporting Total Medicaid revenue of $46.5M. The provider’s NPI was enumerated on 2006-06-30 (~20 years ago), indicating roughly two decades of enrollment in the national registry and a long operational tenure in the market.

Revenue is concentrated: the precomputed top three Medicaid codes account for 33.7% of this provider's total Medicaid revenue. Those top three codes are 99233 ($5.1M revenue, 13.4% of Medicaid revenue), 99215 ($4M revenue, 10.4%), and 99214 ($3.8M revenue, 10.0%), showing a heavy reliance on high-acuity evaluation and management services.

The service-line mix implied by the top revenue-driving codes points to a hybrid inpatient/ambulatory and emergency care model. High revenues and counts for 99233 (78.7K claims), 99215 (50.3K claims) and 99214 (72.2K claims) indicate sustained volume in subsequent inpatient hospital care and high- to moderate-complexity outpatient visits, consistent with a provider embedded in both hospital and clinic settings.

Neonatal and pediatric critical-care services are a visible part of the portfolio. Codes such as 99472 ($3M revenue, ranks #2 of 12, 91th percentile), 99469 ($1.7M revenue, ranks #5 of 16, 73th percentile), 99479 ($1.5M revenue, ranks #4 of 22, 86th percentile) and 99480 ($459.9K revenue, ranks #7 of 22, 71th percentile) show nontrivial revenue and suggest NICU or specialized infant follow-up care is an important operational line.

Imaging and cardiac diagnostics contribute meaningfully to Medicaid revenue and show unusually high statewide standing. Echocardiography codes 93306 ($1.3M revenue, ranks #5 of 224, 98th percentile) and 93303 ($1.3M revenue, ranks #1 of 36, 100th percentile; labeled an extreme outlier) alongside high-volume chest radiography 71045 (170.1K claims, $850.3K revenue, ranks #4 of 222, 99th percentile; extreme outlier) point to high throughput diagnostic services tied to inpatient and outpatient care.

Emergency and critical-care services are another major component of the mix, with both ED-level E/M and critical care codes represented. 99285 ($3M revenue, ranks #27 of 281, 91th percentile) and 99284 ($2M revenue, ranks #83 of 325, 75th percentile) show emergency department activity, while 99291 ($1.3M revenue, ranks #5 of 144, 97th percentile; extreme outlier) indicates substantial billed critical care minutes.

Several specialized procedural diagnostics rank at or near the top statewide, signaling dominant niche volume in targeted services. Codes like 95720 ($861.4K revenue, ranks #1 of 27, 100th percentile; extreme outlier), 95951 ($663.6K revenue, ranks #1 of 22, 100th percentile), and 93010 (124.5K claims, $622.4K revenue, ranks #4 of 243, 99th percentile; extreme outlier) reinforce that this provider is a major statewide source for EEG review, certain neurophysiology procedures, and ECG interpretation.

From a competitive and contracting perspective, the provider is a dominant Medicaid-volume participant in multiple high-revenue and specialty codes across North Carolina. Multiple 100th-percentile and top-ranked code positions (including several labeled extreme outlier) indicate the provider is a major statewide player for those services, which should be treated as material when evaluating network capacity, reimbursement negotiations, or service-line partnerships.

Medicaid: Complete Services Breakdown

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

278 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
99233	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	78,730	$70	$5.1M
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…	50,280	$80	$4M
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…	72,210	$50	$3.8M
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.	31,950	$90	$3M
99472	The provider performs follow up care of a critically ill infant or young child, 29 days through 24 months of age, in an inpatient setting.	12,210	$240	$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.	23,970	$90	$2M
99469	The provider evaluates and manages the subsequent care of a newborn or infant less than 28 days of age in a neonatal critical care setting, after the first day.	6,730	$250	$1.7M
99479	The provider directs the care of a recovering low birth weight infant, whose current weight is between 1500 and 2500 grams.	17,230	$90	$1.5M
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…	26,430	$50	$1.3M
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…	34,180	$40	$1.3M

Showing 1–10 of 278

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. North Carolina Distribution

Private Diagnostic Clinic, PLLC — 13 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — North Carolina

Full comparison — all codes billed, vs. North Carolina median

278 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.	83	330	6,130	$130	$2.7M
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.	156	320	6,160	$120	$2.1M
81229	The lab analyst performs the technical lab test using comparative genomic hybridization (CGH) microarray, also referred to as chromosomal microarray (CMA) or molecular karyotype performed by…	5	10	680	$480	$1.9M
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.	27	280	2,690	$130	$1.6M
99469	The provider evaluates and manages the subsequent care of a newborn or infant less than 28 days of age in a neonatal critical care setting, after the first day.	5	20	2,430	$300	$1.5M
99472	The provider performs follow up care of a critically ill infant or young child, 29 days through 24 months of age, in an inpatient setting.	2	10	1,880	$290	$1.4M
92507	The provider treats a patient with communication and hearing difficulties by directly interacting with the patient. He assesses the patient with impairment in his ability to make sounds, along with…	472	640	4,280	$60	$983.2K
D8670	N/A	174	190	2,510	$90	$774.4K
99479	The provider directs the care of a recovering low birth weight infant, whose current weight is between 1500 and 2500 grams.	4	20	3,950	$100	$740.3K
94799	Use 94799 to report a pulmonary service or procedure that does not have a specific code.	4	10	570	$80	$618.5K

Showing 1–10 of 278

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Duke University Health System, Inc.	NC	General Acute Care Hospital	$0	$44.4M
Duke Health Integrated Practice, Inc.	NC	General Practice Physician	$0	$36.3M
Balboa Nephrology Medical Group, Inc.	CA	Nephrology Physician	$0	$25.9M
Duke University Health System, Inc.	NC	General Acute Care Hospital	$0	$11.6M
Duke University Affiliated Physicians, Inc.	NC	Emergency Medicine Physician	$0	$11.6M
Duke University Health System, Inc.	NC	Parenteral & Enteral Nutrition Supplies (DME)	$0	$8.3M
Duke University Health System Inc	NC	General Acute Care Hospital	$0	$7.9M
Duke University Health System, Inc.	NC	Internal Medicine Physician	$0	$7.6M
Tamer Mahmoud	MI	Retina Specialist (Ophthalmology) Physician	$2.8M	$0
Francisco Folgar	SC	Ophthalmology Physician	$2.3M	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Michael Allingham	NC	Retina Specialist (Ophthalmology) Physician	$1.7M	$0
Jonathan Cook	NC	Dermatology Physician	$1.6M	$0
Tywana Donaldson	NC	Nurse Practitioner	$1.4M	$0
Pretesh Patel	NC	Radiation Oncology Physician	$668.8K	$0
Pedro Vargas	NC	Diagnostic Radiology Physician	$439.5K	$0
Michael Rehorn	NC	Student in an Organized Health Care Education/Training Program	$369.4K	$0
Christopher Brown	NC	Orthopaedic Surgery Physician	$360.8K	$0
Sunit Vekaria	NC	Diagnostic Radiology Physician	$358.3K	$0
Priyatham Mettu	NC	Ophthalmology Physician	$332.6K	$0
Christopher Boehlke	NC	Ophthalmology Physician	$314.3K	$0

Private Diagnostic Clinic, PLLC — 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