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.

Baptist Health Medical Group Inc (NPI 1518360296)

Key Findings

Field	Value
Entity Type	Organization
Organization	Baptist Health Medical Group Inc
Address	4071 Tates Creek Centre Dr
City	Lexington
State	KY
ZIP	40517
Taxonomy	Nurse Practitioner
NPI Enumerated	October 8, 2014

Payer Source	Total Paid
Medicaid	$54.1M
Medicare	$0

BAPTIST HEALTH MEDICAL GROUP INC appears to be effectively a Medicaid-focused billing entity: it has no Medicare revenue on file and reports $54.1M in lifetime Medicaid revenue, indicating a single-payer operational footprint in the available claims data. This makes Medicaid the sole visible source of federal program revenue and suggests payer mix and contracting strategy should be assessed primarily through Medicaid lines.

Revenue concentration is high across a small set of services: the top three Medicaid codes by revenue account for 59.9% of the provider’s total Medicaid revenue. This concentration implies that a few core outpatient evaluation-and-management and inpatient E/M services dominate financial performance, and any changes in reimbursement or utilization for those codes would materially affect overall Medicaid revenue.

The provider’s Medicaid code mix is heavily weighted to office and inpatient evaluation-and-management services: 99214 ($15.6M, 35.7%), 99213 ($7.4M, 16.9%), and 99232 ($3.2M, 7.3%) are the largest contributors. Together these high-volume E/M codes indicate a service line profile focused on high-throughput ambulatory follow-up and substantial inpatient follow-up care, consistent with a broad primary care and hospitalist or hospital-affiliated outpatient practice model.

State-level competitive standing is exceptionally strong for multiple high-revenue codes. For 99214 the provider ranks #5 of 2462 in-state and is labeled an extreme outlier at the 100th percentile; 99213 ranks #16 of 3339 (100th percentile, extreme outlier); and 99232 ranks #5 of 474 (99th percentile, extreme outlier). These ranks indicate the provider is a dominant volume leader in Kentucky for core E/M services relative to peers.

Several non-E/M services also show unusually high state volumes, signaling breadth beyond primary care visits. High-ranking, extreme outlier volumes appear for imaging/diagnostic and procedural services such as 93306 (echocardiography, $1.7M; #2 of 209, 100th percentile) and 43239 (upper endoscopy with biopsy, $883.1K; #2 of 174, 99th percentile). This mix suggests the organization provides or networks for significant diagnostic and procedural capacity alongside its E/M workload.

The provider also posts elevated volumes in higher-acuity and specialty codes, including 99291 (critical care, $1.1M; #7 of 158, 96th percentile, notably above typical) and 99223 (initial inpatient care, $1.7M; #3 of 289, 99th percentile, extreme outlier). These placements imply a meaningful role in inpatient and acute-care settings rather than being limited to routine ambulatory care.

Several behavioral-health and newborn/neonatal service lines are present but at more typical to above-typical state volumes: 90837 ($1M, 92nd percentile, typical), 90834 ($490K, 95th percentile, typical), and 99469 ($432K, 89th percentile, typical). These entries show the provider’s scope includes mental-health and neonatal critical-care follow-up services, but these are not the primary revenue drivers relative to the dominant E/M codes.

Provider tenure is long enough to establish stable operations: the NPI was enumerated on 2014-10-08 (~12 years ago). This duration supports the likelihood that the observed high volumes and code concentration reflect an established practice footprint rather than a brief or emerging billing pattern.

Medicaid: Complete Services Breakdown

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

299 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…	380,930	$40	$15.6M
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…	254,450	$30	$7.4M
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…	128,070	$30	$3.2M
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…	30,580	$70	$2.2M
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…	21,830	$80	$1.7M
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…	40,550	$40	$1.7M
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…	10,830	$100	$1.1M
90837	In this service, the provider performs psychotherapy, a series of technique for treating the psychiatric disorders of the patient. The treatment session typically lasts for a minimum of 53 minutes or…	15,070	$70	$1M
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.	9,100	$100	$883.1K
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…	17,040	$50	$869.2K

Showing 1–10 of 299

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

Baptist Health Medical Group Inc — 19 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

299 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
74177	The provider performs computed tomography of the abdomen and pelvis with contrast material to diagnose the cause of abdominal or pelvic pain or other abnormalities of the internal organs.	28	180	1,870	$280	$1.5M
99469	The provider evaluates and manages the subsequent care of a newborn or infant less than 28 days of age in a neonatal critical care setting, after the first day.	2	10	600	$260	$1.1M
74176	The provider performs computed tomography of the abdomen and pelvis without contrast material to diagnose the cause of abdominal or pelvic pain or other abnormalities of the internal organs.	11	170	2,610	$250	$1M
J0585	Injection, onabotulinumtoxina, 1 unit	10	20	460	$540	$739.9K
70450	The provider performed computed tomography, or CT scanning, of the head or brain, without contrast. He performs the procedure to diagnose any brain or intracranial abnormalities.	21	180	2,960	$110	$672.4K
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…	2	210	1,340	$160	$568K
93458	In this procedure, the provider performs imaging supervision and interpretation for a coronary angiography with left heart catheterization and intraprocedural injections for left ventriculography. He…	12	60	170	$780	$500.2K
87636	The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, and influenza B using a multiplex amplified nucleic…	62	70	310	$100	$495.2K
47562	The provider removes the gallbladder through a laparoscope, a tubular instrument with a light source and camera inserted through the abdominal wall, to treat gallbladder disease.	14	40	120	$1,340	$494.5K
70553	In this procedure, the provider performs a magnetic resonance imaging, or MRI, study of the brain including the brain stem. He performs this procedure without using contrast material. He then follows…	75	100	440	$320	$477.2K

Showing 1–10 of 299

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Baptist Health Deaconess Madisonville Inc	KY	Rural Acute Care Hospital	$0	$80.8M
Baptist Healthcare System, Inc.	KY	General Acute Care Hospital	$0	$58.5M
Baptist Health Medical Group Inc	KY	Internal Medicine Physician	$0	$27.9M
Baptist Health Medical Group Inc	KY	Urgent Care Clinic/Center	$0	$26.7M
Baptist Health Medical Group Inc	KY	Family Medicine Physician	$0	$21.9M
Baptist Health Medical Group Inc	KY	Internal Medicine Physician	$0	$13.7M
Irfan Afaq	IN	Specialist	$84.2K	$6M
Peter Blackburn	KY	Retina Specialist (Ophthalmology) Physician	$1M	$251.2K
Artin Aharonian	MD	Diagnostic Radiology Physician	$1M	$0
Corey Hatfield	KY	Rheumatology Physician	$736.3K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Kentucky Medical Services Foundation, Inc	KY	Internal Medicine Physician	$0	$110.4M
Bluegrass Area Development District	KY	Case Management Agency	$0	$75.4M
Bluegrass Area Development District	KY	Supports Brokerage Agency	$0	$65.3M
Afton Communiy Day, Inc.	KY	Adult Day Care Clinic/Center	$0	$56M
Families Hope, LLC	KY	Adult Care Home Facility	$0	$19.4M
Central Kentucky Radiology PLLC	KY	Diagnostic Radiology Physician	$0	$17.6M
Lionheart Trauma Support Services, LLC	KY	Clinical Social Worker	$0	$3.5M
Johannes Evans	KY	Ophthalmology Physician	$291.9K	$588.5K
David Blandford	KY	Ophthalmology Physician	$260.1K	$58.1K
William Curtis	KY	Ophthalmology Physician	$216.2K	$84.2K

Baptist Health Medical Group 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