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

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

Emergency Medicine Specialists, S.c. (NPI 1568413524)

Key Findings

Field	Value
Entity Type	Organization
Organization	Emergency Medicine Specialists, S.c.
Address	10625 W North Ave
City	Milwaukee
State	WI
ZIP	53226
Taxonomy	Emergency Medicine Physician
NPI Enumerated	May 15, 2006

Payer Source	Total Paid
Medicaid	$35.3M
Medicare	$0

EMERGENCY MEDICINE SPECIALISTS, S.C. bills almost exclusively to Medicaid, reporting $35.3M in lifetime Medicaid revenue and no Medicare billing on file. The Medicaid book of business is highly concentrated: the top 3 Medicaid codes by revenue account for 83.9% of this provider's total Medicaid revenue, driven primarily by emergency department evaluation-and-management services.

The single largest revenue driver is 99284, producing $18.2M (51.5% of total Medicaid revenue) from 378.8K claims and ranking #1 of 432 providers in-state (100th percentile, extreme outlier). 99285 is the second major driver with $8.1M (22.9%) from 188K claims and also ranks #1 in-state (100th percentile, extreme outlier), while 99283 contributes $3.4M (9.5%) and ranks #4 (99th percentile, extreme outlier). These three codes together constitute the overwhelming majority of billed Medicaid dollars for this entity.

Competitive standing within Wisconsin is dominant for core ED services: the provider is a statewide outlier on high-acuity ED codes (99284 and 99285, both rank #1, 100th percentile) and shows exceptional volume on critical care code 99291 ($1M, 2.9% of Medicaid revenue; rank #2 of 116, 99th percentile). This pattern identifies the group as a major Medicaid emergency-care provider in the state, billing far above typical peers for high-acuity ED and critical care services.

Operational profile implied by the code mix is a high-volume emergency department with a substantial high-acuity caseload: large volumes of ED E/M codes (99284, 99285, 99283) plus 99291 for critical care and 93010 (111.5K claims, $668.9K) for routine 12-lead ECG interpretation support continuous, acute-care ED workflows rather than sporadic outpatient practice. The presence of 99053 (164.1K claims, $0 revenue; rank #1) further suggests frequent overnight or 24-hour facility coverage.

Although the billing is heavily concentrated in ED services, the provider also bills notable outpatient/clinic levels of care, with 99214 accounting for $2.7M (7.6% of Medicaid revenue; 50.9K claims) and 99204 contributing $795.9K (2.3%); 99214 ranks #30 of 1628 providers in-state (98th percentile), indicating a meaningful secondary stream of moderate-complexity outpatient/observation E/M encounters. These non-ED E/M codes suggest the group may also provide follow-up, observation, or clinic-based visits alongside core ED operations.

Several non–revenue-bearing billing items show very high counts and top-state ranks, including G8427 (71.1K claims, $0 revenue; rank #1 of 86, 100th percentile), G8950 (29.3K claims, $0 revenue; rank #1 of 4, 100th percentile), and G9744 (17.3K claims, $0 revenue; rank #1 of 9, 100th percentile). The high counts of these documentation/quality codes and other $0-revenue codes reflect extensive use of quality and administrative reporting fields in the provider's Medicaid submissions, consistent with systematic ED documentation practices.

This provider has long tenure in the NPI registry, enumerated 2006-05-15 (~20 years ago), which combined with the concentrated, high-volume Medicaid ED billing suggests an established presence in the Milwaukee-area emergency-care market. The combination of long standing enrollment and extreme statewide volume on core ED codes signals stable, high-capacity Medicaid emergency services rather than a new or marginal entrant.

Medicaid: Complete Services Breakdown

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

34 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
99284	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making.	378,850	$50	$18.2M
99285	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a high level of medical decision making.	188,040	$40	$8.1M
99283	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a low level of medical decision making.	111,960	$30	$3.4M
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…	50,910	$50	$2.7M
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…	18,230	$60	$1M
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…	8,750	$90	$795.9K
93010	The provider interprets and reports on the results of a routine 12–lead (or more) electrocardiogram.	111,480	$10	$668.9K
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…	5,980	$40	$221.3K
H0049	Alcohol and/or drug screening	8,890	$20	$177.7K
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…	900	$70	$60.6K

Showing 1–10 of 34

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Wisconsin Distribution

Emergency Medicine Specialists, S.c. — 9 of 21 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Wisconsin

Full comparison — all codes billed, vs. Wisconsin median

34 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99283	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a low level of medical decision making.	4	360	1,550	$70	$614.4K
99284	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making.	1	430	760	$60	$484.6K
99282	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a straightforward level of medical decision making.	167	190	1,790	$90	$390.9K
99285	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a high level of medical decision making.	1	330	1,350	$60	$338K
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	1,630	270	$40	$205.3K
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…	210	1,760	250	$40	$173.2K
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…	176	350	210	$60	$95.8K
93308	The provider performs a limited or follow–up transthoracic echocardiography to obtain a two dimensional (2D) image of the heart through the chest wall. It is a limited examination of a focused…	10	30	70	$90	$80K
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…	2	120	120	$60	$56.6K
11042	The provider uses surgical instruments to remove the dead tissue in skin down to the subcutaneous layer and including the epidermis and dermis, up to the first 20 cm2.	41	60	200	$50	$50.2K

Showing 1–10 of 34

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Matthew Valente	MT	Emergency Medicine Physician	$34.8K	$289.5K
David Lieberman	WI	Emergency Medicine Physician	$29K	$223.2K
Manish Acharya	WI	Emergency Medicine Physician	$59.4K	$86.4K
Rosie Goodhue	WI	Emergency Medicine Physician	$72.7K	$0
Alexandra Mandel	CO	Medical Physician Assistant	$69.1K	$0
Kristi Maso	WI	Critical Care Medicine (Internal Medicine) Physician	$52.8K	$0
Aleksandr Pevtsov	NC	Emergency Medicine Physician	$32.8K	$0
Rebecca Ioder	WI	Nurse Practitioner	$10.6K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Children's Hospital Of Wisconsin, Inc.	WI	Children's Hospital	$0	$262.3M
Froedtert Memorial Lutheran Hospital, Inc.	WI	General Acute Care Hospital	$0	$157.8M
The Medical College Of Wisconsin, Inc.	WI	Internal Medicine Physician	$17.8K	$74.8M
Wisconsin Diagnostic Laboratories LLC	WI	Clinical Medical Laboratory	$2.3M	$22.7M
Childrens Hospital Of Wisconsin, Inc.	WI	Pediatrics Physician	$0	$19M
Children's Hospital And Health System, Inc.	WI	Urgent Care Clinic/Center	$0	$17.7M
Option Care Home Care Inc	WI	Pharmacy	$0	$12.5M
Curative Care Network, Inc.	WI	Rehabilitation Clinic/Center	$0	$12.2M
Children's Specialty Group, Inc.	WI	Pediatrics Physician	$0	$10.4M
Brian Blocher	WI	Oral & Maxillofacial Surgery (D.M.D.)	$0	$5.5M

Emergency Medicine Specialists, S.c. — Billing Profile & Reimbursement Data

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Emergency Medicine Specialists, S.c. — 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