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.

Three Rivers Medical Clinics Inc (NPI 1568567345)

Three Rivers Medical Clinics Inc is a internal medicine physician provider located in Louisa, Kentucky. This profile covers 0 Medicare and 82 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	Three Rivers Medical Clinics Inc
Address	Hwy 644
City	Louisa
State	KY
ZIP	41230
Taxonomy	Internal Medicine Physician
NPI Enumerated	September 14, 2006

Payer Source	Total Paid
Medicaid	$7M
Medicare	$0

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

82 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…	104,940	$30	$2.8M
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…	35,530	$40	$1.4M
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…	17,380	$30	$451.8K
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…	5,450	$50	$278K
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.	3,410	$80	$275.8K
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…	5,190	$50	$269.7K
45380	The provider examines the rectum and colon using a flexible colonoscope, a tubular instrument with a light source and camera, to look for the cause of a patient's symptoms, which may include…	2,270	$110	$259K
99238	The provider sees a patient for hospital inpatient or observation discharge day management, involving evaluation and management (E/M). The provider spends 30 minutes or less on the service on the…	4,490	$30	$148.3K
96372	A therapeutic, prophylactic, or diagnostic substance (a fluid, a drug, etc.) is injected via intramuscular or subcutaneous route into the patient's body. The procedure is performed by the physician…	11,210	$10	$134.5K
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,…	7,160	$20	$128.9K

Showing 1–10 of 82

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

Three Rivers Medical Clinics Inc — 3 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

82 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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.	33	170	1,300	$230	$441K
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…	42	3,340	1,020	$30	$296K
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…	132	160	420	$140	$270.5K
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…	59	2,460	580	$40	$245K
45380	The provider examines the rectum and colon using a flexible colonoscope, a tubular instrument with a light source and camera, to look for the cause of a patient's symptoms, which may include…	12	120	300	$320	$215.2K
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…	48	470	770	$20	$188.2K
45385	The provider examines the colon and rectum using a colonoscope, a long, thin flexible tubular instrument with a light source and camera. He removes one or more tumors, polyps, or other lesions with a…	39	110	230	$340	$175.7K
71046	In this diagnostic procedure, the provider performs a minimum of two radiological views of the chest. He performs this study for the assessment of conditions affecting the chest, its contents, and…	189	330	1,400	$30	$156.7K
99233	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	278	290	520	$30	$156.6K
76830	The provider performs a transvaginal ultrasound to assess the reproductive organs, that is, the uterus, fallopian tubes, ovaries, cervix, and vagina in a female patient.	79	150	490	$90	$120.4K

Showing 1–10 of 82

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Kwadwo Gyarteng-dakwa	NC	Pain Medicine (Anesthesiology) Physician	$391K	$0
Timothy Hart	KY	Family Medicine Physician	$83.6K	$25K
Lindsay Montgomery	KY	Physician Assistant	$80.2K	$70
Mark Veronneau	KY	Otolaryngology Physician	$51.5K	$16.2K
Denise Roof	KY	Certified Registered Nurse Anesthetist	$63.5K	$0
Jon Brinkman	KY	Plastic Surgery within the Head & Neck (Otolaryngology) Physician	$44.2K	$0
Timothy Wheeler	KY	Surgery Physician	$36.4K	$0
Akshay Goel	CO	Orthopaedic Surgery Physician	$26.8K	$0
Bonnie Hill	KY	Family Nurse Practitioner	$24.1K	$0
Matthew Halliday	SC	Certified Registered Nurse Anesthetist	$18.6K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Addiction Recovery Care LLC	KY	Substance Abuse Rehabilitation Facility	$0	$308.9M
Hospital Of Louisa, Inc.	KY	General Acute Care Hospital	$0	$27.8M
Odyssey Inc	KY	Substance Abuse Rehabilitation Facility	$0	$25.4M
Pioneer Health Group LLC	KY	Addiction Medicine (Family Medicine) Physician	$0	$20.4M
Science Hill Family Care LLC Dba Pioneer Rural Health Clinic	KY	Rural Health Clinic/Center	$0	$8.4M
Joseph Skeens	KY	Diagnostic Radiology Physician	$40.2K	$222K
Brittany Tackett	KY	Family Nurse Practitioner	$99.2K	$0
James Carrico	KY	Diagnostic Radiology Physician	$97.7K	$0

Three Rivers Medical Clinics Inc — Billing Profile & Reimbursement Data

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Three Rivers Medical Clinics Inc — 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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