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 U.S. Virgin Islands for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to U.S. Virgin Islands 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. U.S. Virgin Islands (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.

Primary Care Gyn, PLLC (NPI 1477991495)

Field	Value
Entity Type	Organization
Organization	Primary Care Gyn, PLLC
Address	4040 Estate La Grande Princess
City	Christiansted
State	VI
ZIP	00820
Taxonomy	Advanced Practice Midwife
NPI Enumerated	June 12, 2013

Payer Source	Total Paid
Medicaid	$36.1K
Medicare	$0

Key Findings

PRIMARY CARE GYN, PLLC shows effectively single-payer activity: there is no Medicare billing on file and all recorded federal claims come through Medicaid, with total Medicaid revenue of $36.1K. This concentration means analyses of this provider’s Medicare footprint are not possible from claims data, and any payer-mix conclusions should treat the provider as Medicaid-focused based on available records.

Revenue concentration is very high: the precomputed top three Medicaid codes account for 100.0% of the provider’s Medicaid revenue, indicating that a very small set of services drives virtually all billed Medicaid dollars. This suggests a narrow service profile or consistent emphasis on a limited set of outpatient visits and preventive services within the Medicaid population.

The dominant code is 99213, which accounts for $33.4K or 92.5% of the provider’s total Medicaid revenue with 388 claims at an $86 average paid per claim. This pattern indicates the practice primarily provides established patient office/outpatient evaluation and management visits at a routine, lower-complexity level rather than higher-acuity procedures or hospital-based services.

G0439 (annual wellness visit with personalized prevention plan) contributes $2.7K or 7.5% of Medicaid revenue across 25 claims at an average paid of $109 per claim. The presence of G0439 alongside heavy 99213 volume suggests the practice offers standard preventive care and wellness services in addition to routine follow-up visits for established patients.

Competitive standing for the top codes is modest within the state: for 99213 the provider ranks #22 of 41 in-state (48th percentile), which the dataset characterizes as typical, unremarkable volume for this code. For G0439 the provider ranks #3 of 4 in-state (33th percentile), again described as typical; these ranks portray the provider as a modest, not dominant, participant in statewide Medicaid markets for these services.

The provider has a long registration history, with NPI enumeration on 2013-06-12 (~13 years ago). This tenure implies established presence in the market; coupled with the limited code mix and Medicaid-only billing, it suggests steady outpatient primary care/gynecologic service delivery focused on routine follow-up and prevention rather than rapid expansion into new service lines.

Given the code mix (99213 and G0439) and their relative shares, the business/service-line implication is a clinic-oriented practice model centered on ambulatory evaluation & management and preventive annual visits. The absence of procedure-heavy or higher-level E/M codes in the reported top codes points to low acuity, longitudinal ambulatory care as the core offering.

Because the top three Medicaid codes account for 100.0% of Medicaid revenue and there is no Medicare revenue, the provider’s financial vulnerability is higher to changes in Medicaid reimbursement or patient volume for these few codes. Any payer policy or rate change affecting 99213 or G0439 would disproportionately affect the provider’s revenue stream.

Medicaid: Complete Services Breakdown

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

2 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	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…	390	$90	$33.4K
G0439	Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	30	$110	$2.7K

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. U.S. Virgin Islands Distribution

Primary Care Gyn, PLLC — 0 of 2 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — U.S. Virgin Islands

Full comparison — all codes billed, vs. U.S. Virgin Islands median

2 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…	22	40	430	$110	$260.9K
G0439	Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	3	10	30	$20	$820

Nearby Providers

Other providers in the same ZIP code as Primary Care Gyn, PLLC, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
St Croix Vision Center Inc	VI	Optometrist	$0	$3.6M
One Dental Practice LLC	VI	Dentist	$0	$3.2M
Governor Juan F. Luis Hospital & Medical Center	VI	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$3M
Js Therapies, LLC	VI	Occupational Therapist	$0	$2.9M
Healthquest, LLC.	VI	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$2.4M
Department Of Health, Ems Stx	VI	Land Ambulance	$0	$2.2M
Lindsy Wagner LLC	VI	Clinical Social Worker	$0	$2.2M
Ophthalmology Consultants, PC	VI	Ophthalmology Physician	$0	$2.1M
Acute Alternative Medical Group	VI	Emergency Medical Services (Emergency Medicine) Physician	$0	$1.9M
Pediatric Care Center LLC	VI	Pediatrics Physician	$0	$1.7M

Primary Care Gyn, PLLC — Billing Profile & Reimbursement Data

Sign up for Primary Care Gyn, PLLC — Billing Profile & Reimbursement Data policy alerts

Primary Care Gyn, PLLC — Billing Profile & Reimbursement Data

Sign up for Primary Care Gyn, PLLC — Billing Profile & Reimbursement Data policy alerts

Key Findings

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Nearby Providers

Frequently Asked Questions

References