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

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

Tidalhealth Physician Network, Inc. (NPI 1467534636)

Key Findings

Field	Value
Entity Type	Organization
Organization	Tidalhealth Physician Network, Inc.
Address	801 Middleford Rd
City	Seaford
State	DE
ZIP	19973
Taxonomy	Family Medicine Physician
NPI Enumerated	October 19, 2006

Payer Source	Total Paid
Medicaid	$8.7M
Medicare	$0

This provider is effectively single-payer in the federal program mix: there is no Medicare billing on file while total Medicaid revenue is $8.7M, indicating Medicaid is the operational and financial focus for this entity. Analysts evaluating payer strategy should treat Medicaid as the primary revenue source rather than Medicare.

Revenue is highly concentrated in a small set of evaluation-and-management codes: the top 3 Medicaid codes account for 65.8% of this provider's total Medicaid revenue, with 99214 generating $2.7M (33.4%), 99213 generating $2.1M (26.4%), and 99204 generating $480K (5.9%). This concentration signals that routine office visits and E/M services drive the majority of billed Medicaid dollars.

The code mix points to a family medicine practice delivering high-volume primary care with bundled maternity and procedure services. Dominant E/M codes (99214, 99213) alongside obstetric delivery codes such as 59409 and 59400 and procedure codes like 43239 and 45380 show the practice spans outpatient primary care, prenatal/maternity services, and some endoscopy/diagnostic procedures.

On statewide competitive standing, this provider is a major outlier for core outpatient visit volume: 99214 ranks #4 of 504 providers in-state (99th percentile; extreme outlier) and 99213 ranks #5 of 543 providers in-state (99th percentile; extreme outlier). Those ranks indicate this entity is a dominant deliverer of established outpatient visits in Delaware compared with peers.

Several other codes also show above-typical statewide presence that complements the primary care base: 99212 has 13.4K claims and $268.4K revenue (3.3%) and ranks #2 of 177 providers in-state (99th percentile; extreme outlier), while preventive visit codes 99395 ($199.5K, 2.5%) and 99396 ($169.1K, 2.1%) rank in the mid–high percentiles (94th and 96th respectively). These patterns reinforce an emphasis on routine ambulatory and preventive care at scale.

The practice also provides inpatient and hospital outpatient services, but at more moderate levels compared with office visits: hospital E/M codes such as 99232 ($157.1K, 1.9%) and 99223 ($115.2K, 1.4%) rank in the 70–80th statewide percentiles, indicating regular inpatient involvement without being a dominant inpatient provider. This mix suggests a primary care anchor with supplementary inpatient care capability rather than a hospital-centric operation.

Provider tenure and specialty support the family-medicine profile: NPI enumerated 2006-10-19 (~20 years ago) and the listed taxonomy is Family Medicine Physician, located in SEAFORD, DE. The long enumeration date combined with high Medicaid volumes suggests an established regional practice with durable patient panels and referral relationships.

For payers and network planners, the combination of $8.7M in Medicaid revenue, extreme outlier rankings on core E/M codes, and 65.8% revenue concentration in the top three codes flags this entity as a high-volume Medicaid primary care anchor in-state. Contracting, access planning, and utilization management strategies should account for large ambulatory visit volumes and integrated maternity and procedure services when engaging this provider.

Medicaid: Complete Services Breakdown

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

134 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…	60,080	$50	$2.7M
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…	68,860	$30	$2.1M
99204	The provider sees a new 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 provider…	6,580	$70	$480K
59409	In this procedure, the provider provides admission to the hospital for delivery, labor management, including induction of labor, fetal monitoring, use of low forceps, and episiotomy, vaginal delivery…	1,010	$390	$393.5K
99203	The provider sees a new 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 provider…	6,070	$50	$273.1K
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,…	13,420	$20	$268.4K
99395	The provider performs an established well–patient visit for a patient who is between the ages of 18 and 39.	3,380	$60	$199.5K
99396	The provider performs an established well–patient visit for a patient who is between the ages of 40 and 64.	2,730	$60	$169.1K
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…	6,830	$20	$157.1K
43239	The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum where he removes one or more tissue biopsy specimens for diagnostic analysis.	1,600	$90	$139.3K

Showing 1–10 of 134

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Delaware Distribution

Tidalhealth Physician Network, Inc. — 6 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Delaware

Full comparison — all codes billed, vs. Delaware median

134 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
0241U	N/A	8	10	2,480	$120	$788.1K
43775	Using laparoscopic technique, the provider reduces the size of the stomach by removing the bulk of the stomach in a vertical fashion. This procedure leaves a long, cylindrical stomach without the…	3	10	170	$2,970	$600.2K
S9083	Global fee urgent care centers	23	20	1,320	$80	$576.2K
59409	In this procedure, the provider provides admission to the hospital for delivery, labor management, including induction of labor, fetal monitoring, use of low forceps, and episiotomy, vaginal delivery…	3	10	420	$420	$392.6K
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…	16	20	1,350	$120	$348.4K
59514	The provider admits the patient to the hospital for delivery, delivers the fetus and placenta via an abdominal incision, and provides care immediately after delivery on the same date of service. This…	4	10	220	$410	$340.8K
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…	26	50	1,030	$60	$292.3K
90960	The provider manages all the services associated with the monthly care of a patient who is 20 years old or older and has a condition known as end stage renal disease or ESRD. For this service, the…	5	10	970	$50	$284.2K
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…	18	80	940	$30	$277.8K
95810	Polysomnography refers to the continuous and simultaneous monitoring and recording of various physiological and pathophysiological parameters of sleep for six or more hours with physician review,…	7	10	410	$480	$250.4K

Showing 1–10 of 134

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Tidalhealth Nanticoke, Inc	DE	General Acute Care Hospital	$0	$19.2M
Justin Kucinski	MD	Internal Medicine Physician	$6.9M	$0
Tanya Clifford	MD	Nurse Practitioner	$2.9M	$0
Tidalhealth Physician Network, Inc.	DE	Family Medicine Physician	$0	$2.9M
Muhammad Siddique	MD	Medical Oncology Physician	$1.6M	$0
David Chung	MD	Diagnostic Ultrasound Physician	$1.1M	$0
Kunal Agarwal	FL	Sleep Medicine (Family Medicine) Physician	$700.7K	$0
Gerard Hogan	MD	Body Imaging Physician	$631.9K	$0
Daniel Cason	MD	Diagnostic Radiology Physician	$614.6K	$0
Assen Todorov	MD	Diagnostic Radiology Physician	$607.9K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Dynamic Therapy Services LLC	DE	Physical Therapist	$0	$12.8M
Addiction Medical Facility, LLC	DE	Substance Abuse Rehabilitation Facility	$98.8K	$9M
Resouces For Human Development, Inc.	DE	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$5.4M
Ambient Medical Care, LLC	DE	Urgent Care Clinic/Center	$0	$3.3M
Lynch, Rodriguez And Keller, PA	DE	Dentist	$0	$3.3M
Ivonne Herrera	DE	Rheumatology Physician	$2.7M	$0
Seaford Internal Medicine LLC	DE	Internal Medicine Physician	$0	$2.7M
Alpha Care Medical, LLC	DE	Family Medicine Physician	$0	$2.6M
La Red Health Center, Inc.	DE	Federally Qualified Health Center (FQHC)	$0	$2.5M
Nanticoke River Physicians, LLC	DE	Emergency Medicine Physician	$0	$2.3M

Tidalhealth Physician Network, Inc. — Billing Profile & Reimbursement Data

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Tidalhealth Physician Network, Inc. — 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