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

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

Ephraim Mcdowell Health Resource, Inc (NPI 1477879500)

Ephraim Mcdowell Health Resource, Inc is a gastroenterology physician provider located in Danville, Kentucky. This profile covers 0 Medicare and 53 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	Ephraim Mcdowell Health Resource, Inc
Address	216 W Walnut St
City	Danville
State	KY
ZIP	40422
Taxonomy	Gastroenterology Physician
NPI Enumerated	April 14, 2010

Payer Source	Total Paid
Medicaid	$3M
Medicare	$0

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

53 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…	26,720	$30	$908.6K
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…	28,190	$20	$563.8K
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…	4,830	$70	$328.4K
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…	7,990	$40	$279.7K
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…	2,790	$80	$228.8K
99223	The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	1,850	$50	$97.8K
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…	3,550	$30	$95.8K
95806	A technologist is not in attendance during this sleep study, which involves measuring several parameters while the patient sleeps in a clinic or sleep lab to help diagnose sleep disorders.	860	$90	$80.4K
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.	870	$80	$70.1K
93010	The provider interprets and reports on the results of a routine 12–lead (or more) electrocardiogram.	11,240	$10	$67.5K

Showing 1–10 of 53

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Kentucky Distribution

Ephraim Mcdowell Health Resource, Inc — 2 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Kentucky

Full comparison — all codes billed, vs. Kentucky median

53 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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…	25	210	1,340	$160	$568K
93005	The provider records the electrical conduction of the heart to examine any abnormality in its functioning, based on signals from at least 12 leads, wires that connect the recording device to…	110	130	6,080	$40	$449.7K
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.	105	170	1,300	$230	$441K
78452	In this procedure, the provider performs multiple SPECT studies of the heart to determine the areas of deficient blood flow. The goal of the procedure is to determine areas that have deficient blood…	73	130	420	$270	$375.3K
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…	232	3,340	1,020	$30	$296K
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…	26	160	420	$140	$270.5K
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…	82	2,460	580	$40	$245K
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,…	45	70	230	$420	$228.2K
45380	The provider examines the rectum and colon using a flexible colonoscope, a tubular instrument with a light source and camera, to look for the cause of a patient's symptoms, which may include…	91	120	300	$320	$215.2K
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…	277	470	770	$20	$188.2K

Showing 1–10 of 53

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Tariq Muhammad	KY	Nephrology Physician	$245.5K	$189K
Charles Grigsby	KY	Interventional Cardiology Physician	$173.3K	$0
Steve Lin	KY	Interventional Cardiology Physician	$171.3K	$0
Jared Hagaman	KY	Internal Medicine Physician	$128.5K	$0
Adam Bryant	KY	Diagnostic Radiology Physician	$120.5K	$0
Timothy Whitt	KY	Diagnostic Radiology Physician	$120.5K	$0
Roland Laswell	KY	Certified Registered Nurse Anesthetist	$98K	$0
Edgar Salas	KY	Gastroenterology Physician	$83.8K	$0
Aslam Ahmad	KY	Cardiovascular Disease Physician	$82.7K	$0
George Munday	KY	Surgery Physician	$73.6K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Spero Health Of Kentucky, LLC	KY	Addiction Medicine (Family Medicine) Physician	$0	$154.3M
Ephraim Mcdowell Regional Medical Center Incorporated	KY	General Acute Care Hospital	$0	$60M
Addixxion Recovery Of Kentucky, LLC	KY	Addiction Medicine (Family Medicine) Physician	$0	$16.6M
G & R Staed, Inc	KY	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$12M
D&s Residential Services, LP	KY	Developmental Disabilities Clinic/Center	$0	$9.8M
Family Ties, LLC	KY	Developmentally Disabled Services Day Training Agency	$0	$8.7M
Empact Midwest LLC	KY	Emergency Medicine Physician	$0	$7.3M
A1 Case Management	KY	Case Management Agency	$0	$7.1M
Danville Pediatrics And Primary Care, PLLC	KY	Pediatrics Physician	$0	$5.9M
Ekkco Inc.	KY	Adult Care Home Facility	$0	$5.5M

Ephraim Mcdowell Health Resource, Inc — Billing Profile & Reimbursement Data

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Ephraim Mcdowell Health Resource, 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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