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

Why is the Medicaid comparison limited to South Dakota 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. South Dakota (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.

Scott Pham (NPI 1558366500)

Field	Value
Entity Type	Individual
Organization	Scott Pham
Address	1305 W 18th St
City	Sioux Falls
State	SD
ZIP	57105
Taxonomy	Clinical Cardiac Electrophysiology Physician
NPI Enumerated	June 16, 2005

Payer Source	Total Paid
Medicare	$408.6K
Medicaid	$0

Key Findings

This provider is effectively single‑payer: total Medicare revenue is $408.6K and there is no Medicaid billing on file. The practice’s revenue concentration is significant — the precomputed top 3 Medicare codes by revenue account for 33.2% of this provider's total Medicare revenue — indicating a dependence on a small set of high-value procedural and monitoring services.

The code mix aligns with a clinical cardiac electrophysiology operation that combines device implantation/revision, remote device monitoring, electrophysiology studies/ablations, and both outpatient and inpatient E/M care. High‑revenue device and monitoring codes include 33208, 33249, 33228, 93295, 93294, and procedural EP codes such as 93653 and 93650, which together signal a practice structured around cardiac device management and interventional electrophysiology.

Top revenue drivers include office E/M and device/monitoring services: 99214 generated $51.5K (13.6% of Medicare revenue), 33208 generated $44.7K (11.8%), and 93295 generated $29.9K (7.9%). These individual code revenues are among the largest contributors to the $408.6K Medicare total and match the precomputed finding that the top 3 codes account for 33.2% of Medicare revenue.

Several individual CPTs position this provider as a national outlier in device work: 33208 is an extreme outlier (ranks #2 of 3026 nationally, 100th percentile), 33207 ranks #1 of 88 (100th percentile) and 93295 ranks #6 of 4938 (100th percentile). Multiple other device/monitoring codes are also in very high percentiles (for example, 93294 at 98th percentile and 33228 at 99th percentile), indicating a dominant role in pacemaker/ICD implantation and follow‑up relative to national peers.

Volume patterns emphasize remote monitoring as a core operational capability: 93295 shows 1.2K claims, 93294 shows 1.1K claims, and 93298 shows 741 claims, producing meaningful revenue despite modest avg paid/claim values ($25, $19, and $18 respectively). The combination of very high claim counts for monitoring codes with top percentile ranks suggests an organized, high‑throughput device surveillance program that materially contributes to Medicare revenue.

Clinical setting and visit mix show both ambulatory and inpatient activity: 99214 has 735 claims and ranks in the 95th percentile nationally (notably above typical national volume), 99204 has 247 claims and is a 99th percentile outlier, and inpatient initial/subsequent codes such as 99222 (228 claims) and 99232 (292 claims) are in high percentiles. This distribution indicates the provider operates across clinic and hospital settings, managing new and established patients in addition to procedural volume.

The provider’s NPI tenure (enumerated 2005‑06‑16, ~21 years ago) indicates a long‑standing presence in the market; sustained high ranks on specialized device and monitoring codes over many years is consistent with an experienced, focused electrophysiology practice. Long tenure combined with concentrated device work strengthens the provider’s positioning as an established source of pacemaker/ICD implant and monitoring services in the region.

From a payer and network perspective, the concentrated revenue mix and multiple extreme outlier ranks on device implantation and monitoring codes flag this provider as a high‑capacity partner for cardiac device management. The strong national rankings on procedural and remote monitoring CPTs suggest leverage in contracting discussions for device programs, while the absence of Medicaid billing on file confirms Medicare as the primary public payer exposure to consider when evaluating utilization and budgeting risks.

Medicare: Complete Services Breakdown

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

44 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…	740	$70	$51.5K
33208	The provider inserts or replaces a permanent pacemaker and implants electrodes into the right atrium and right ventricle.	120	$380	$44.7K
93295	In this service the provider evaluates from a remote location an implantable single, dual, or multiple lead defibrillator system. The service includes his interim analyses during a period of up to 90…	1,200	$30	$29.9K
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…	540	$50	$26.1K
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…	250	$100	$24.5K
33249	The provider either replaces or implants a new permanent defibrillator system with single or dual chamber transvenous leads or electrodes. Defibrillators sense and regulate the heart rate by…	40	$670	$23.4K
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…	230	$100	$22.6K
93294	The provider, a physician or other qualified health care professional, remotely analyzes, for a period up to 90 days, the function of a single, dual, multiple lead, or leadless pacemaker system,…	1,140	$20	$21.6K
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…	290	$60	$17.8K
93653	A comprehensive electrophysiologic (EP) study involves the provider placing wire electrodes in the heart to measure electrical activity. The provider induces, or attempts to induce, arrhythmia. The…	20	$610	$14.5K

Showing 1–10 of 44

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 44 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. South Dakota Distribution

Scott Pham — 13 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — South Dakota

Full comparison — all codes billed, vs. state median

44 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
93306	20	60	250	$50	$21.4K
33208	1	10	50	$380	$17.7K
93653	2	10	20	$580	$12.9K
33249	1	10	10	$660	$11.9K
99214	47	1,660	90	$70	$11.4K
99233	259	290	60	$90	$10.8K
99232	109	570	80	$60	$9.2K
33207	1	10	30	$350	$8.7K
93294	1	20	310	$20	$8.2K
33285	1	10	10	$320	$7.6K

Showing 1–10 of 44

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Allina Health System	MN	Ambulance	$9M	$118M
Sanford Medical Center	SD	Family Medicine Physician	$0	$68.8M
Columbus Radiology Corp	OH	Diagnostic Radiology Physician	$0	$49.9M
Allina Health System	MN	General Acute Care Hospital	$0	$48.8M
Allina Health System	MN	Internal Medicine Physician	$0	$32.9M
Allina Health System	MN	General Acute Care Hospital	$0	$27M
Allina Health System	MN	General Acute Care Hospital	$0	$25.7M
Somc Medical Care Foundation, Inc.	OH	Family Medicine Physician	$0	$25.3M
Sanford Medical Center	SD	General Acute Care Hospital	$0	$24.4M
Allina Health System	MN	Family Medicine Physician	$0	$22.2M

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
South Dakota Achieve	SD	Developmental Disabilities Clinic/Center	$0	$166.9M
Dakotabilities	SD	Voluntary or Charitable Agency	$0	$77.8M
Volunteers Of America, Dakotas	SD	Intellectual and/or Developmental Disabilities Residential Treatment Facility	$0	$60.9M
Southeastern Behavioral Healthcare	SD	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$59.1M
Resouces For Human Development, Inc.	SD	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$31.1M
Childrens Dental Center	SD	Pediatric Dentistry	$0	$24M
Sanford Medical Center	SD	Air Ambulance	$0	$11.9M
Avera Mckennan	SD	Family Medicine Physician	$0	$10.6M
Sanford Clinic	SD	Pediatrics Physician	$0	$5.5M
Avera Mckennan	SD	Air Ambulance	$0	$5.3M

Scott Pham — 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