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NPI 1568787448 · Menomonee Falls, WI · Internal Medicine Physician
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Froedtert &the Medical College Of Wisconsin Community Physicians, Inc. is a internal medicine physician provider located in Menomonee Falls, Wisconsin. This profile covers 65 Medicare and 211 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.
Provider details (source: NPPES NPI Registry)
| Field | Value |
|---|---|
| Entity Type | Organization |
| Organization | Froedtert &the Medical College Of Wisconsin Community Physicians, Inc. |
| Address | W180n8000 Town Hall Rd |
| City | Menomonee Falls |
| State | WI |
| ZIP | 53051 |
| Taxonomy | Internal Medicine Physician |
| NPI Enumerated | April 2, 2010 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $13.9M |
| Medicare | $1.2M |
This entity is effectively Medicaid‑focused by scale: reported lifetime Medicaid revenue is $13.9M compared with $1.2M in Medicare, indicating Medicaid is the dominant payer relationship in absolute dollars for this provider group.
Medicare billing is concentrated in routine laboratory testing: the top Medicare codes are 80061 (14K claims, $181.7K revenue, 16.3% of Medicare revenue), 80053 (15.4K claims, $154.1K revenue, 13.8%), and 80048 (12.3K claims, $98.7K revenue, 8.8%), which together reflect a lab-driven Medicare profile consistent with a primary care/internal medicine taxonomy ordering high volumes of panels.
Medicaid revenue is driven by high-volume E/M visits and therapy services: 99214 accounts for 153.2K claims and $5.5M revenue (45.2% of Medicaid revenue), 99213 has 88K claims and $2.4M (19.5%), and 97110 contributes 23.8K claims and $523.8K (4.3%). These counts and shares show outpatient evaluation/management and therapeutic exercise are core service lines for the Medicaid population.
Revenue concentration differs sharply by payer: the top 3 Medicare codes account for 38.9% of Medicare revenue, showing substantial reliance on a small set of lab panels for Medicare; by contrast the top 3 Medicaid codes account for 68.9% of Medicaid revenue, indicating an even higher concentration of Medicaid dollars in office E/M and related therapy codes.
Competitive standing is mixed: on Medicare the provider ranks at very high percentiles for many lab codes (for example 80061 ranks #116 of 21671, 99th percentile, described as typical for that code; 80048 ranks #74 of 14725, 100th percentile, an extreme outlier), suggesting unusually large lab volumes for some tests but otherwise typical national positioning on others. On Medicaid the provider is a major in‑state participant for core visit codes — 99214 ranks #10 of 1628 (99th percentile; extreme outlier) and 99213 ranks #20 of 1755 (99th percentile; extreme outlier) — indicating dominant state-level volume in those E/M categories.
There are multiple statistical outliers that merit operational attention: extremely high claim counts such as 153.2K claims for 99214 and 37.2K claims for 85025 on Medicaid, plus 15.4K claims for 80053 on Medicare, align with labelings like "extreme outlier" or very high percentile ranks (including 100th percentile entries such as 0002A at #2 in-state). These outlier designations point to exceptional throughput in specific services rather than a broad, evenly distributed case mix.
The provider’s NPI has been enumerated since 2010-04-02 (~16 years ago), indicating an established operation with a sustained pattern of billing that has produced the current lifetime revenue mix across Medicaid and Medicare.
Implications for payers and network managers: Medicaid contracting and utilization management should prioritize oversight of high-volume office E/M codes (99214, 99213) and related therapy codes where the provider generates the majority of its Medicaid revenue, while Medicare strategies should focus on lab utilization patterns given the substantial share of Medicare revenue coming from panels such as 80061, 80053, and 80048.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
65 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 80061 | The lab analyst performs a lipid panel test in which he measures the blood level of cholesterol and fats called triglycerides in the blood. | 13,980 | $10 | $181.7K |
| 80053 | The lab analyst performs a comprehensive metabolic panel, or CMP test in which he measures the blood level of 14 chemicals the code descriptor lists for the panel. | 15,410 | $10 | $154.1K |
| 80048 | The lab analyst performs a basic metabolic pane (BMP) test in which he measures the blood level of eight chemicals including total calcium, sodium, potassium, chloride, carbon dioxide, glucose, blood… | 12,340 | $10 | $98.7K |
| 83036 | Sugar in the bloodstream can get attached to the hemoglobin in red blood cells. Once the sugar is attached, it stays there for the lifetime of the red blood cell (around 120 days or over 3 months).… | 10,870 | $10 | $97.8K |
| 85025 | A complete blood count (better known as a CBC) is a blood test request by a doctor that provides detailed information about various types of cells in a patient's blood. Usually a pathologist or a… | 12,100 | $10 | $96.8K |
| 84443 | The lab analyst performs a test to measure the amount of thyroid–stimulating hormone (TSH), a hormone produced in the pituitary gland that helps regulate thyroid function. The typical specimen is the… | 5,990 | $20 | $95.8K |
| 82306 | The lab analyst measures the vitamin D level, typically on a serum specimen. This analyte, commonly known as vitamin D, is not really a vitamin, but is an important steroid hormone that is produced… | 3,080 | $30 | $89.4K |
| 85027 | The lab analyst performs a blood count on the red and white blood cells and platelets also known as thrombocytes. He also determines the hemoglobin, typically by spectrophotometry, and the… | 8,710 | $10 | $52.3K |
| G0103 | Prostate cancer screening; prostate specific antigen test (psa) | 1,450 | $20 | $27.5K |
| 85610 | Prothrombin time is most commonly measured using the blood plasma. Chemicals like calcium and tissue factor are added to the plasma sample and then the time is noted when the plasma clots. To analyze… | 6,620 | $1 | $26.5K |
Showing 1–10 of 65
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 65 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
Medicaid revenue breakdown by year and by CPT/HCPCS procedure code, including monthly billing trends and the top codes driving revenue.
View: By Year1 / 3
Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.
211 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… | 153,180 | $40 | $5.5M |
| 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… | 88,030 | $30 | $2.4M |
| 97110 | Therapeutic exercise is a form of physical therapy that utilizes specially designed exercises and activities to help patients gain better mobility and fitness levels. Normally used on patients with… | 23,810 | $20 | $523.8K |
| 84443 | The lab analyst performs a test to measure the amount of thyroid–stimulating hormone (TSH), a hormone produced in the pituitary gland that helps regulate thyroid function. The typical specimen is the… | 22,580 | $10 | $316.1K |
| 80061 | The lab analyst performs a lipid panel test in which he measures the blood level of cholesterol and fats called triglycerides in the blood. | 28,430 | $10 | $312.8K |
| 80053 | The lab analyst performs a comprehensive metabolic panel, or CMP test in which he measures the blood level of 14 chemicals the code descriptor lists for the panel. | 33,630 | $10 | $302.7K |
| 82306 | The lab analyst measures the vitamin D level, typically on a serum specimen. This analyte, commonly known as vitamin D, is not really a vitamin, but is an important steroid hormone that is produced… | 12,350 | $20 | $284.1K |
| 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… | 6,660 | $40 | $279.8K |
| 90834 | In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere… | 10,180 | $30 | $264.7K |
| 85025 | A complete blood count (better known as a CBC) is a blood test request by a doctor that provides detailed information about various types of cells in a patient's blood. Usually a pathologist or a… | 37,190 | $10 | $223.2K |
Showing 1–10 of 211
How this provider's Medicaid billing volume and revenue compare to other Wisconsin providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Wisconsin median
211 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| T1016 | Case management, each 15 minutes | 193 | 220 | 7,110 | $70 | $1.7M |
| 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. | 237 | 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. | 154 | 430 | 760 | $60 | $484.6K |
| 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. | 297 | 330 | 1,350 | $60 | $338K |
| 90960 | The provider manages all the services associated with the monthly care of a patient who is 20 years old or older and has a condition known as end stage renal disease or ESRD. For this service, the… | 19 | 30 | 1,050 | $70 | $320.9K |
| 87637 | The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, influenza B, and respiratory syncytial virus (RSV)… | 71 | 80 | 650 | $110 | $244.4K |
| 80053 | The lab analyst performs a comprehensive metabolic panel, or CMP test in which he measures the blood level of 14 chemicals the code descriptor lists for the panel. | 27 | 260 | 3,590 | $20 | $232.2K |
| 76811 | The provider performs an ultrasound study using a transabdominal approach to examine the fetus and mother, along with additional examination of the fetal anatomy, such as the heart rate, amniotic… | 28 | 40 | 930 | $100 | $214.5K |
| 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. | 191 | 220 | 1,140 | $70 | $213.3K |
| 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… | 10 | 1,630 | 270 | $40 | $205.3K |
Showing 1–10 of 211
Other providers in the same ZIP code as Froedtert &the Medical College Of Wisconsin Community Physicians, Inc., ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Community Memorial Hospital Of Menomonee Falls Inc | WI | General Acute Care Hospital | $0 | $10M |
| Superior Air-ground Ambulance Services Of Wisconsin, Inc | WI | Ambulance | $3.1M | $3.7M |
| Bioresolutions LLC | WI | Durable Medical Equipment & Medical Supplies | $0 | $2.4M |
| Menomonee Falls School District | WI | Local Education Agency (LEA) | $0 | $1.6M |
| Oxygen One, Inc. | WI | Oxygen Equipment & Supplies (DME) | $0 | $1.3M |
| Ammar Taha | WI | Diagnostic Radiology Physician | $410.5K | $380K |
| Village Of Menomonee Falls | WI | Land Ambulance | $259.1K | $343.3K |
| Fahad Iqbal | WI | Cardiovascular Disease Physician | $142.2K | $157.7K |
| Menomonee Falls Ambulatory Surgery Center, LLC | WI | Ambulatory Surgical Clinic/Center | $279.8K | $3.1K |
| Christopher Marowski | WI | Interventional Cardiology Physician | $200.5K | $0 |
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