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NPI 1578529350 · Colchester, VT · Obstetrics & Gynecology Physician
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Planned Parenthood Of Northern New England, Inc is a obstetrics & gynecology physician provider located in Colchester, Vermont. This profile covers 0 Medicare and 38 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 | Planned Parenthood Of Northern New England, Inc |
| Address | 784 Hercules Dr Ste 110 |
| City | Colchester |
| State | VT |
| ZIP | 05446 |
| Taxonomy | Obstetrics & Gynecology Physician |
| NPI Enumerated | April 21, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $3.9M |
| Medicare | $0 |
This provider has no Medicare billing on file and reports $3.9M in lifetime Medicaid revenue, making its claim activity effectively Medicaid‑focused rather than split across traditional Medicare and Medicaid payers. Analysts should treat this entity as a single‑payer (Medicaid) operation for practical purposes when evaluating revenue exposure and payer risk.
Revenue is highly concentrated: the precomputed top three Medicaid codes account for 63.3% of the provider's Medicaid revenue. Those top codes are 99213 ($1.2M, 31.0%), J7307 ($700.3K, 17.8%), and 87491 ($571.7K, 14.5%), indicating that a small set of services drives the majority of billed Medicaid dollars.
The code mix points to a sexual and reproductive health/family‑planning clinic model: high-volume office visits (99213), large volumes of contraceptive device and supply billing (J7307, S4993, J7298, J7297), and routine administration of injectable contraception (J1050). Coupled with very high volumes of NAAT STI testing (87491 and 87591), the pattern is consistent with a clinic workflow built around visit-based contraceptive care, device placement/maintenance, and population-level STI screening.
For sexually transmitted infection testing, the provider is a statewide outlier: 87491 and 87591 each appear with $571.7K in revenue and are listed as ranks of #1 in their peer groups and 100th percentile, described as notably above typical state volume. This indicates the provider is a dominant source of Medicaid‑paid NAAT testing for chlamydia and gonorrhea in the state dataset, and testing services are a material operational focus.
Several contraceptive supply/device codes show no in‑state peers in the dataset: J7307 ($700.3K) and S4993 ($347K) are reported as #1 of 1 providers in‑state (no peer volume comparison available). That suggests this provider may be the sole Medicaid biller captured for certain implant and contraceptive supply items in the state file, positioning it as a unique local source for those devices.
While 99213 is the single largest revenue code with 22.2K claims and $1.2M revenue (31.0% of Medicaid revenue), its rank (#16 of 319; 95th percentile) is described as typical/unremarkable for volume among in‑state peers. In other words, the provider runs a high-throughput outpatient visit volume but that established-visit activity aligns with what other busy in‑state clinics report for this code.
The provider has an extended operational history in the dataset, with NPI enumeration dated 2006-04-21 (~20 years ago), which supports interpretation of the observed coding mix as an established service pattern rather than a transient activity. Given the longevity plus the concentrated code mix, the organization appears to maintain an enduring, clinic‑oriented reproductive health program focused on contraceptive services and high-volume STI screening.
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.
38 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… | 22,220 | $60 | $1.2M |
| J7307 | Etonogestrel (contraceptive) implant system, including implant and supplies | 920 | $760 | $700.3K |
| 87491 | The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique. | 22,870 | $30 | $571.7K |
| 87591 | The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique. | 22,870 | $30 | $571.7K |
| S4993 | Contraceptive pills for birth control | 6,430 | $50 | $346.9K |
| J1050 | Injection, medroxyprogesterone acetate, 1 mg | 4,190 | $20 | $92.1K |
| J7298 | Levonorgestrel-releasing intrauterine contraceptive system (mirena), 52 mg | 150 | $500 | $74.7K |
| J7297 | Levonorgestrel-releasing intrauterine contraceptive system (liletta), 52 mg | 360 | $170 | $59.6K |
| 99202 | The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves straightforward medical decision making, and/or the provider… | 1,150 | $50 | $56.1K |
| 87661 | The lab analyst performs a test for Trichomonas vaginalis using nucleic acid amplified probe technique. | 2,100 | $30 | $52.6K |
Showing 1–10 of 38
How this provider's Medicaid billing volume and revenue compare to other Vermont providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Vermont median
38 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| J7307 | Etonogestrel (contraceptive) implant system, including implant and supplies | 1 | 10 | 920 | $760 | $700.6K |
| S4993 | Contraceptive pills for birth control | 1 | 10 | 6,430 | $50 | $347.9K |
| 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… | 181 | 320 | 680 | $30 | $146.1K |
| 87591 | The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique. | 1 | 10 | 80 | $30 | $98.8K |
| 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… | 16 | 320 | 760 | $20 | $88.2K |
| 87491 | The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique. | 1 | 10 | 60 | $30 | $85.4K |
| J7298 | Levonorgestrel-releasing intrauterine contraceptive system (mirena), 52 mg | 1 | 10 | 150 | $500 | $74.8K |
| J7297 | Levonorgestrel-releasing intrauterine contraceptive system (liletta), 52 mg | 1 | 10 | 360 | $160 | $59.6K |
| 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… | 12 | 70 | 70 | $50 | $36K |
| 87661 | The lab analyst performs a test for Trichomonas vaginalis using nucleic acid amplified probe technique. | 1 | 10 | 1,130 | $30 | $29.8K |
Showing 1–10 of 38
Other providers in the same ZIP code as Planned Parenthood Of Northern New England, Inc, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Vt Center For Dental Implants And Maxillofacial Surgery LLC | VT | Oral and Maxillofacial Surgery Clinic/Center | $0 | $2.6M |
| Kids Rehabgym Inc. | VT | Physical Therapy Clinic/Center | $0 | $2.5M |
| Saint Michaels College Fire And Rescue Inc | VT | Land Ambulance | $281.9K | $1.5M |
| Dennis Sanders | VT | Medical Oncology Physician | $1.3M | $0 |
| Robert Duwors | VT | Clinical Psychologist | $45K | $1.1M |
| Town Of Colchester | VT | Land Ambulance | $163.6K | $638.6K |
| Vermont Center For Responder Wellness LLC | VT | Clinical Social Worker | $0 | $719.1K |
| Actd,llc | VT | Ambulatory Surgical Clinic/Center | $634.9K | $0 |
| Counseling Connection Training Institute, Plc | VT | Mental Health Counselor | $0 | $619.8K |
| Nicholas Hunter | VT | Clinical Psychologist | $0 | $581.2K |
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