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

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

Pines Health Services (NPI 1518283126)

Pines Health Services is a federally qualified health center (fqhc) provider located in Presque Isle, Maine. This profile covers 0 Medicare and 38 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	Pines Health Services
Address	66 Spruce St Ste B
City	Presque Isle
State	ME
ZIP	04769
Taxonomy	Federally Qualified Health Center (FQHC)
NPI Enumerated	April 8, 2010

Payer Source	Total Paid
Medicaid	$3.7M
Medicare	$0

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

38 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T1015	Clinic visit/encounter, all-inclusive	19,650	$150	$3M
G0467	Federally qualified health center (fqhc) visit, established patient; a medically-necessary, face-to-face encounter (one-on-one) between an established patient and a fqhc practitioner during which…	6,650	$50	$312.6K
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…	11,390	$20	$193.7K
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…	9,500	$10	$85.5K
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,…	2,160	$20	$45.4K
90832	In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere…	90	$90	$8.4K
99395	The provider performs an established well–patient visit for a patient who is between the ages of 18 and 39.	100	$30	$2.8K
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…	120	$20	$2.4K
G2025	Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only	120	$20	$2.1K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	640	$1	$1.3K

Showing 1–10 of 38

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Maine Distribution

Pines Health Services — 0 of 20 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Maine

Full comparison — all codes billed, vs. Maine median

38 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1015	Clinic visit/encounter, all-inclusive	44	180	8,540	$180	$3M
G0467	Federally qualified health center (fqhc) visit, established patient; a medically-necessary, face-to-face encounter (one-on-one) between an established patient and a fqhc practitioner during which…	14	80	3,000	$50	$269.8K
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…	70	460	1,240	$30	$190K
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	480	1,030	$20	$128.9K
90792	In this procedure, the provider performs a psychiatric evaluation of the patient with the aim of making a diagnosis. In addition to the diagnostic evaluation, he also renders some additional medical…	47	50	110	$60	$72.1K
99215	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the…	120	170	380	$50	$63.7K
G2025	Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only	48	70	220	$70	$54K
90832	In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere…	115	140	670	$20	$48.8K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	71	190	390	$20	$42.6K
99309	The provider sees a patient for a subsequent nursing facility care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or the provider…	36	50	450	$20	$41.8K

Showing 1–10 of 38

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Pines Health Services	ME	Internal Medicine Physician	$0	$7.6M
Pines Health Services	ME	Obstetrics & Gynecology Physician	$0	$7.1M
Pines Health Services	ME	Family Medicine Physician	$0	$3M
Allan Espinosa Morazan	AZ	Medical Oncology Physician	$2.2M	$0
Pines Health Services	ME	Federally Qualified Health Center (FQHC)	$0	$480.1K
Ninu Sharma	ME	Anatomic Pathology & Clinical Pathology Physician	$109.9K	$1.9K
Albert Whiting	ME	Ophthalmology Physician	$98.3K	$0
Irene Djuanda	ME	Internal Medicine Physician	$65.7K	$0
Jean Michaud	ME	Sports Medicine (Orthopaedic Surgery) Physician	$59.3K	$0
Jeffrey Hoeksma	ME	Hospitalist Physician	$58K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Aroostook Mental Health Services, Inc.	ME	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$53.2M
The Aroostook Medical Center	ME	General Acute Care Hospital	$0	$38.5M
Central Aroostook Association	ME	Local Education Agency (LEA)	$0	$36.5M
Personal Services Of Aroostook	ME	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$10.7M
Life By Design, PA	ME	Clinical Social Worker	$0	$9.9M
Aroostook Agency On Aging	ME	In Home Supportive Care Agency	$0	$7.9M
Discovery House Wc, Inc.	ME	Methadone Clinic	$0	$4M
Northern Maine Oral & Facial Surgery PA	ME	Oral and Maxillofacial Surgery (Dentist)	$0	$3.5M
Dunrovin Enterprises, Inc.	ME	In Home Supportive Care Agency	$0	$3.1M
Aroostook Dental Clinic, Inc.	ME	Dental Clinic/Center	$0	$2.7M

Pines Health Services — Billing Profile & Reimbursement Data

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Pines Health Services — 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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