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 Armed Forces Europe for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to Armed Forces Europe 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. Armed Forces Europe (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.

Sarah Niles (NPI 1487835831)

Field	Value
Entity Type	Individual
Organization	Sarah Niles
Address	Cmr 411 Box 4564
City	Apo
State	AE (Armed Forces Europe)
ZIP	09112
Taxonomy	Public Health & General Preventive Medicine Physician
NPI Enumerated	November 14, 2007

Payer Source	Total Paid
Medicare	$7.6K
Medicaid	$0

Key Findings

This provider bills almost exclusively to Medicare: total Medicare revenue is $7.6K and there is no Medicaid billing on file, so the practice is effectively single-payer from the available claims. The absence of Medicaid activity suggests limited exposure to state programs and a Medicare-dominant payer mix for analytic and contracting purposes.

Revenue is heavily concentrated in a very small set of inpatient evaluation-and-management codes: the precomputed top 3 Medicare codes (99232, 99239, 99222) account for 89.9% of this provider's total Medicare revenue. That concentration means a few encounter types drive nearly all measurable Medicare receipts and creates sensitivity to utilization changes or coding/coverage edits on those specific codes.

The top two revenue-driving codes are 99232 (49 claims, $58 avg paid/claim, $2.8K revenue; 37.3% of this provider's total Medicare revenue, ranks #116892 of 177383 providers nationally — 33th percentile; typical, unremarkable volume for this code) and 99239 (33 claims, $86 avg paid/claim, $2.8K revenue; 37.3% of this provider's total Medicare revenue, ranks #41216 of 62398 providers nationally — 33th percentile; typical, unremarkable volume for this code). Both codes contribute the same dollar revenue despite different claim counts and average payments, indicating a mix of shorter/longer or lower/higher-paying inpatient E/M encounters that together dominate receipts.

Clinical/service-line implications are clear from the code mix: 99222 (initial hospital inpatient visit, moderate MDM or ≥55 minutes), 99232 (subsequent inpatient visit, moderate MDM or ≥35 minutes), and 99239 (discharge day management, >30 minutes) point to an inpatient/observation-focused practice pattern with admission, subsequent inpatient management, and discharge responsibilities. This profile aligns with roles that provide longitudinal hospital-based care rather than outpatient procedure or ambulatory preventive services.

Competitive standing across these codes is modest: 99232 and 99239 both sit at the 33th percentile nationally with “typical, unremarkable volume for this code,” while 99222 ranks #107011 of 117621 (4th percentile; typical, unremarkable volume for this code) and 99231 ranks at the 24th percentile. These ranks indicate the provider is not a dominant national player on these inpatient E/M codes and instead represents a low-to-moderate volume contributor compared with peers.

Operational detail: individual code-level volumes are small in absolute terms (for example, 99222 shows 12 claims, $97 avg paid/claim, $1.2K revenue; 99231 shows 22 claims, $35 avg paid/claim, $770 revenue). Given the overall Medicare revenue of $7.6K, these per-code counts suggest intermittent inpatient activity rather than a high-throughput hospitalist operation, which has implications for utilization review and network impact analyses.

The provider has long tenure in the NPI directory (enumerated 2007-11-14, ~19 years ago) but the low lifetime Medicare revenue and concentrated code mix imply either limited Medicare-facing clinical activity, a role that bills infrequently to Medicare, or primary revenue sources outside of Medicare/Medicaid billing on file. For payer/provider analysts this combination of long enumeration and low Medicare billing is a flag to check for non-claim revenue streams, affiliation with larger groups, or non-billable clinical roles.

From a risk and contracting perspective, the small absolute Medicare revenue ($7.6K) and its reliance on a narrow set of inpatient E/M codes mean the provider likely has limited leverage in network negotiations and minimal financial impact to a payer’s overall network. Analysts focused on utilization management or rate-setting should prioritize review of 99232, 99239, and 99222 coding practices because they collectively represent 89.9% of the provider’s Medicare revenue.

Medicare: Complete Services Breakdown

The CPT/HCPCS codes generating the most Medicare revenue for this provider.

4 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	50	$60	$2.8K
99239	The provider sees a patient for hospital inpatient or observation discharge day management, involving evaluation and management (E/M). The provider spends more than 30 minutes on the service on the…	30	$90	$2.8K
99222	The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	10	$100	$1.2K
99231	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a straightforward or low level of medical…	20	$40	$770

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 4 CPT/HCPCS codes. Note: this provider's state, "AE," is a US military postal designation for Armed Forces stationed in Europe, the Middle East, Africa, or Canada — not a traditional US state; the State panel below benchmarks against other providers coded under the same designation.

View: State1 / 2

Claims Volume vs. Armed Forces Europe Distribution

Sarah Niles — 0 of 3 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Armed Forces Europe

Full comparison — all codes billed, vs. state median

4 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99232	7	10	140	$70	$9.3K
99222	8	10	10	$100	$3.6K
99231	7	10	40	$40	$1.4K
99239	2	0	N/A	$N/A	$N/A

Related Providers

Other providers that share a Tax Identification Number (TIN) with Sarah Niles, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Sauk Prairie Healthcare Inc	WI	General Acute Care Hospital	$0	$2.8M
Eric Phillippi	WI	Family Medicine Physician	$271.5K	$0
Michael Lamson	WI	Orthopaedic Surgery Physician	$184.5K	$0
Chad Schneider	WI	Internal Medicine Physician	$183.9K	$0
David Marcu	WI	Orthopaedic Surgery Physician	$141.5K	$0
Matthew Hebert	WI	Orthopaedic Surgery Physician	$130.8K	$0
Andrew Ertl	WI	Orthopaedic Surgery Physician	$113.7K	$0
John Mcauliffe	WI	Family Medicine Physician	$105.5K	$0
Kristen Hoskins	WI	Family Nurse Practitioner	$91.1K	$0
Leah Ederer	WI	Family Medicine Physician	$79.4K	$0

Nearby Providers

Other providers in the same ZIP code as Sarah Niles, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Bruce Burns	AE (Armed Forces Europe)	Psychiatry Physician	$1.7K	$0

Sarah Niles — Billing Profile & Reimbursement Data

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Sarah Niles — Billing Profile & Reimbursement Data

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Key Findings

Medicare: Total Revenue Breakdown by CPT/HCPCS Code

Medicare: Complete Services Breakdown

Medicare: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References