NPI 1538280748 — Billing Profile & Reimbursement Data
NPI 1538280748 · XX · healthcare
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NPI 1538280748 is a healthcare provider located in Unspecified Location. This profile covers 4 Medicare and 0 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services. Note: "XX" is a placeholder CMS uses when a provider's practice-location state wasn't reported — not a traditional US state; claims coded under it are grouped and benchmarked here the same way a traditional state would be.
Provider details (source: NPPES NPI Registry)
| Field | Value |
|---|---|
| Entity Type | Individual |
| Organization | NPI 1538280748 |
| Address | |
| City | |
| State | XX (Unspecified Location) |
| ZIP | |
| Taxonomy | N/A |
| NPI Enumerated | |
| NPI Deactivated | October 9, 2025 |
(source: CMS Medicare & Medicaid claims data)
Key Findings
This provider’s billing is effectively single‑payer: total Medicare revenue is $31.2K and there is no Medicaid billing on file. In absolute terms this is a small Medicare revenue footprint, so the provider operates at a modest scale within the Medicare program rather than as a large-volume institutional biller.
Revenue is highly concentrated into a very narrow set of office E/M codes: the precomputed top three Medicare codes account for 99.2% of the provider’s Medicare revenue, and a single code, 99213, accounts for $27.3K or 87.1% of Medicare revenue. That level of concentration indicates that most clinical activity and billing value is driven by routine established‑patient office visits.
The code mix (99213, 99214, 99211) points to an office‑based outpatient practice pattern focused on evaluation and management of established patients, with encounters described as low to moderate medical decision making and short to moderate visit times. A small amount of diagnostic cardiac testing appears (: $242, 0.8% of Medicare revenue), but procedural or specialty codes are not present among the top billers, suggesting limited ancillary service lines.
Medicare: Total Revenue Breakdown by CPT/HCPCS Code
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
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 |
|---|---|---|---|---|
| 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… | 490 | $60 | $27.3K |
| 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… | 30 | $100 | $2.8K |
| 99211 | An established patient presents for an office or other outpatient visit that may not require the presence of a physician or other qualified healthcare professional. | 70 | $20 | $1.1K |
| 93000 | 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… | 20 | $10 | $240 |
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, "XX," is a placeholder CMS uses when a provider's practice-location state wasn't reported — not a traditional US state; the State panel below benchmarks against other providers coded under the same designation.
View: State1 / 2
Full comparison — all codes billed, vs. state median
Frequently Asked Questions
References
- 1.Medicare Physician & Other Practitioner by Provider and Service. CMS.gov.Provider-level Medicare Part B utilization and payment data.
- 2.NPPES NPI Registry. CMS.gov.National Provider Identifier registry used for provider enumeration and taxonomy metadata.
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