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

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

The Doctors Clinic (NPI 1467503433)

Field	Value
Entity Type	Organization
Organization	The Doctors Clinic
Address	851 Governor Carlos Camacho Road
City	Tamuning
State	GU
ZIP	96913
Taxonomy	Family Medicine Physician
NPI Enumerated	January 16, 2007

Payer Source	Total Paid
Medicaid	$256.5K
Medicare	$0

Key Findings

This provider reports no Medicare billing on file and $256.5K in lifetime Medicaid revenue, making its public billing footprint effectively single‑payer Medicaid rather than a mixed Medicare/Medicaid operation. Analysts should treat Medicaid performance as the primary lens for assessing current revenue exposure and payer risk.

Revenue is highly concentrated: the precomputed top-3 Medicaid codes by revenue account for 99.9% of this provider’s total Medicaid revenue, driven almost entirely by two office visit E/M codes. Specifically, 99214 generated $154.4K (60.2% of Medicaid revenue) and 99213 generated $98.3K (38.3% of Medicaid revenue), while 90471 contributed $3.4K (1.3%).

The code mix (dominance of 99214 and 99213) aligns with an outpatient family medicine practice focused on established‑patient office visits and routine management of chronic conditions and follow‑ups; these codes represent moderate‑ and low‑level evaluation and management visits, respectively. Immunization activity is present but peripheral to revenue, consistent with a clinic that primarily bills for face‑to‑face primary care visits.

Competitive standing within the state looks modest: 99214 ranks #15 of 35 providers in-state (59th percentile) and 99213 ranks #19 of 48 providers in-state (62th percentile), both labeled as 'typical, unremarkable volume for this code.' These rankings suggest the provider is a routine, mid‑tier participant statewide for primary care office visits rather than a dominant volume leader.

Several quality/documentation codes show non‑zero claim counts but no paid dollars: G8427 appears 427 times with $0 avg paid/claim and ranks #1 of 2 in-state (100th percentile), and G8417 appears 75 times with $0 avg paid/claim and ranks #1 of 1 in-state. This pattern indicates active documentation/reporting of medication lists and BMI follow‑up plans that do not generate direct Medicaid payments but may reflect engagement with quality reporting processes.

Vaccine administration codes are present but contribute negligible revenue: 90471 (181 claims, $3.4K revenue), 90472 (13 claims, $221 revenue), 90688 (92 claims, $92 revenue) and 90750 (12 claims, $0 revenue). Notably, 90688 ranks #3 of 10 in-state (78th percentile) despite producing very little paid revenue, so the clinic shows some relative activity in influenza vaccine administration but it is not a material revenue driver.

With an NPI enumeration date of 2007-01-16 (~19 years ago), the provider appears to be an established practice in the market; tenure supports expectations of a stable outpatient workflow and sustained Medicaid relationships. Longevity combined with a concentrated E/M code mix suggests operational continuity rather than a newly formed or rapidly shifting billing profile.

Given the extreme revenue concentration into 99214 and 99213, near‑term revenue growth under current payer mix would require higher visit volumes, a shift toward higher‑acuity E/M coding, or changes to payer composition; the absence of Medicare billing means the practice has little cushion from alternative federal reimbursement streams. Analysts should flag exposure to Medicaid rate changes and consider whether service‑line expansion (e.g., more vaccine billing or paid preventive services) is plausible based on current small vaccine revenue contributions.

Medicaid: Complete Services Breakdown

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

9 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…	1,700	$90	$154.4K
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…	1,590	$60	$98.3K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	180	$20	$3.4K
90472	This code represents each injection of a vaccine after the first; list this code in addition to the code for the first injection.	10	$20	$220
90688	This code represents a vaccine product administered into the muscle to protect against four strains of influenza (flu). It uses split virus technology and is given as a 0.5 mL dose.	90	$1	$90
90750	The provider injects an adjuvanted vaccine into a muscle to protect the patient against varicella zoster infection.	10	$0	$0
G0008	Administration of influenza virus vaccine	10	$0	$0
G8417	Bmi is documented above normal parameters and a follow-up plan is documented	80	$0	$0
G8427	Eligible clinician attests to documenting in the medical record they obtained, updated, or reviewed the patient's current medications	430	$0	$0

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Guam Distribution

The Doctors Clinic — 0 of 5 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Guam

Full comparison — all codes billed, vs. Guam median

9 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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…	19	50	900	$80	$201.7K
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…	15	40	630	$90	$172.1K
90472	This code represents each injection of a vaccine after the first; list this code in addition to the code for the first injection.	7	10	180	$30	$16.7K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	8	20	180	$20	$10.1K
90688	This code represents a vaccine product administered into the muscle to protect against four strains of influenza (flu). It uses split virus technology and is given as a 0.5 mL dose.	3	10	70	$10	$1.2K
G0008	Administration of influenza virus vaccine	9	10	100	$10	$830
90750	The provider injects an adjuvanted vaccine into a muscle to protect the patient against varicella zoster infection.	1	10	10	$0	$0
G8417	Bmi is documented above normal parameters and a follow-up plan is documented	1	10	80	$0	$0
G8427	Eligible clinician attests to documenting in the medical record they obtained, updated, or reviewed the patient's current medications	1	10	270	$0	$0

Nearby Providers

Other providers in the same ZIP code as The Doctors Clinic, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Thomas Lee	GU	Dentist	$0	$10.9M
Guam Memorial Hospital	GU	General Acute Care Hospital	$0	$3.5M
Rsa - Tumon, LLC	GU	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$2.9M
Robert Yang	GU	Dentist	$0	$2.4M
Antonio Garcia	GU	Pediatrics Physician	$0	$2.2M
Ma Gladys Linsangan	GU	Pediatrics Physician	$0	$2.2M
Ari Katerelos	GU	Radiation Oncology Physician	$2.1M	$0
Guam X-ray	GU	Vascular & Interventional Radiology Physician	$0	$2.1M
Sarah Clegg	GU	General Practice Dentistry	$0	$1.7M
Peter Kh Go	GU	Surgery Physician	$152.8K	$1.5M

The Doctors Clinic — Billing Profile & Reimbursement Data

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The Doctors Clinic — 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

Nearby Providers

Frequently Asked Questions

References