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

Why is the Medicaid comparison limited to Unspecified Location 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. Unspecified Location (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.

Sarah Andersen (NPI 1578172425)

NPI 1578172425 · Vancouver, XX · Critical Care Medicine (Internal Medicine) Physician

Sarah Andersen is a critical care medicine (internal medicine) physician provider located in Vancouver, Unspecified Location. This profile covers 1 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.

NPI 1578172425 · Vancouver, XX · Critical Care Medicine (Internal Medicine) Physician

Provider details (source: NPPES NPI Registry)

Field	Value
Entity Type	Individual
Organization	Sarah Andersen
Address	4048 West 32nd Avenue
City	Vancouver
State	XX (Unspecified Location)
ZIP	V6S1Z
Taxonomy	Critical Care Medicine (Internal Medicine) Physician
NPI Enumerated	July 27, 2020

Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)

Payer Source	Total Paid
Medicare	$2.8K
Medicaid	$0

The provider’s Medicare billing is concentrated in high-intensity critical care: all reported Medicare revenue is tied to critical care services represented by code 99291, a code used for initial critical care (first 30–74 minutes) typically provided in ICU/CCU or similar settings. The exclusive presence of 99291 in the reported Medicare activity indicates the clinician’s billed services are episodic, high-acuity interventions rather than routine ambulatory office visits or procedure-driven outpatient care.

Revenue concentration is extreme on the Medicare side: the precomputed top-3 share shows that the top 3 Medicare codes account for 100.0% of this provider’s total Medicare revenue, and the single listed code 99291 alone accounts for $2.8K of lifetime Medicare revenue. This level of concentration implies the provider’s Medicare business is narrowly focused and that revenue exposure is driven by a very small set of encounters.

Medicare billing volume is modest in absolute terms: the record shows 17 claims for 99291 with an average paid per claim of $164 and total Medicare revenue of $2.8K. These counts and dollar amounts indicate a very limited Medicare footprint compared with typical providers and suggest the provider is a low-volume biller at the Medicare payer level.

The provider has no Medicaid billing on file ("none below"), making their effective payer mix single-payer in the dataset: $2.8K in Medicare revenue versus no reported Medicaid revenue. From a payer or network perspective, this should be treated as a Medicare-only profile for historical analysis and risk exposure.

Competitive standing on the national Medicare distribution is modest: 99291 activity ranks #61139 of 71290 providers nationally (12th percentile; labeled "typical, unremarkable volume for this code"). That percentile placement characterizes the provider as a modest participant rather than a regional or national leader in billing for critical care services.

Tenure is relatively recent: the NPI was enumerated on 2020-07-27 (~6 years ago). That enumeration date, combined with the small billing totals, suggests either a recently established practice pattern in critical care or limited participation in fee-for-service billing since enrollment.

Clinical/operational implication: exclusive 99291 billing suggests the clinician practices in an acute inpatient setting (ICU/ED or similar) or provides time-limited critical care consults rather than longitudinal outpatient care. For payers and contracting teams, this profile points toward hospital-based or consult-focused arrangements rather than office-based networks.

From a monitoring and contracting perspective, the combination of very low aggregate Medicare dollars ($2.8K), only 17 claims, and 100.0% revenue concentration in the top codes indicates minimal current financial impact to payers but a skewed service mix that merits routine review if activity increases. Any future growth in critical care billing would materially change the provider’s financial and utilization profile because the baseline is narrowly concentrated and low in volume.

Medicare revenue breakdown by CPT/HCPCS procedure code.

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

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	20	$160	$2.8K

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 1 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.

Full comparison — all codes billed, vs. state median

Sarah Andersen — Billing Profile & Reimbursement Data

Sign up for Sarah Andersen — Billing Profile & Reimbursement Data policy alerts

Sarah Andersen — Billing Profile & Reimbursement Data

Sign up for Sarah Andersen — Billing Profile & Reimbursement Data policy alerts

Key Findings

Medicare: Total Revenue Breakdown by CPT/HCPCS Code

Medicare: Complete Services Breakdown

Medicare: Competitive Analysis & Benchmarks

Frequently Asked Questions

References