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    v1.0.28
    OpenPayerNPI Medicare & MedicaidOphelia Medical Group Fl, P.A.
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    Ophelia Medical Group Fl, P.A. — Billing Profile & Reimbursement Data

    NPI 1588244750 · Philadelphia, PA · Addiction Medicine (Family Medicine) Physician

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    Ophelia Medical Group Fl, P.A. is a addiction medicine (family medicine) physician provider located in Philadelphia, Pennsylvania. This profile covers 0 Medicare and 18 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.

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    Provider details (source: NPPES NPI Registry)

    FieldValue
    Entity TypeOrganization
    OrganizationOphelia Medical Group Fl, P.A.
    Address161 Cecil B Moore Ave Apt 204
    CityPhiladelphia
    StatePA
    ZIP19122
    TaxonomyAddiction Medicine (Family Medicine) Physician
    NPI EnumeratedApril 12, 2021

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

    Payer SourceTotal Paid
    Medicaid$10.7M
    Medicare$0

    Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

    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

    Medicaid: Complete Services Breakdown

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

    18 rows

    CPT/HCPCS CodeDescriptionClaimsAvg PaidRevenue
    G9012Other specified case management service not elsewhere classified13,880$270$3.8M
    99214The 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…61,780$50$3.2M
    99211An established patient presents for an office or other outpatient visit that may not require the presence of a physician or other qualified healthcare professional.6,900$250$1.7M
    99213The 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…17,890$40$697.7K
    99491The provider, a physician or other healthcare professional, personally directs the evaluation and management of a patient with two or more chronic A physician or other qualified healthcare…3,710$100$367.3K
    99340N/A1,770$160$290.1K
    99437A physician or other qualified healthcare professional personally performs management and care plan services for a patient with two or more chronic conditions, expected to last at least one year or…3,650$70$251.6K
    H0006Alcohol and/or drug services; case management470$270$128.8K
    G2087Office-based treatment for opioid use disorder, including care coordination, individual therapy and group therapy and counseling; at least 60 minutes in a subsequent calendar month280$260$73K
    99205The provider sees a new 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 provider…590$120$70.1K

    Showing 1–10 of 18

    Medicaid: Competitive Analysis & Benchmarks

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

    Full comparison — all codes billed, vs. Pennsylvania median

    18 rows

    CPT/HCPCS CodeDescriptionRankProvider CountMedian ClaimsAvg PaidAverage Revenue
    G9012Other specified case management service not elsewhere classified12320770$260$758K
    H0006Alcohol and/or drug services; case management27402,140$110$606.6K
    99340N/A9301,010$150$289.8K
    G2087Office-based treatment for opioid use disorder, including care coordination, individual therapy and group therapy and counseling; at least 60 minutes in a subsequent calendar month410730$260$206.6K
    99211An established patient presents for an office or other outpatient visit that may not require the presence of a physician or other qualified healthcare professional.105980310$50$136.6K
    H0001Alcohol and/or drug assessment7180690$110$135.8K
    99437A physician or other qualified healthcare professional personally performs management and care plan services for a patient with two or more chronic conditions, expected to last at least one year or…2101,360$70$103.1K
    99214The 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…98,160210$60$68.4K
    99213The 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…1188,870240$40$56.1K
    99491The provider, a physician or other healthcare professional, personally directs the evaluation and management of a patient with two or more chronic A physician or other qualified healthcare…250210$90$54.6K

    Showing 1–10 of 18

    Related Providers

    Other providers that share a Tax Identification Number (TIN) with Ophelia Medical Group Fl, P.A., ranked by combined Medicare and Medicaid revenue.

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    Sydney ScottMEPhysician Assistant$29.2K$0

    Nearby Providers

    Other providers in the same ZIP code as Ophelia Medical Group Fl, P.A., ranked by combined Medicare and Medicaid revenue.

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    The Behavioral Wellness Center At GirardPASubstance Use Disorder Rehabilitation Clinic/Center$0$30.6M
    The Behavioral Wellness Center At GirardPAMethadone Clinic$131.1K$16.5M
    The Behavioral Wellness Center At GirardPASubstance Use Disorder Rehabilitation Clinic/Center$0$14.9M
    Public Health Management CorporationPAFederally Qualified Health Center (FQHC)$0$9.2M
    Delaware Valley Community Health, Inc.PAFederally Qualified Health Center (FQHC)$0$8.9M
    The Behavioral Wellness Center At GirardPASubstance Use Disorder Rehabilitation Clinic/Center$0$8.8M
    Merakey Parkside RecoveryPACommunity/Behavioral Health Agency$34.6K$6.1M
    Icare Home Health LLCPAHome Health Agency$0$5.5M
    Megan RitzPAPhysical Therapist$189.5K$0
    Lester FogelsangerPAPsychiatry Physician$70.9K$0

    Frequently Asked Questions

    References

    1. 1.Medicare Physician & Other Practitioner by Provider and Service. CMS.gov.Provider-level Medicare Part B utilization and payment data.
    2. 2.NPPES NPI Registry. CMS.gov.National Provider Identifier registry used for provider enumeration and taxonomy metadata.

    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

    Medicaid Revenue by Year vs. Pennsylvania Providers
    2 of 3 years billed far more than typical (above p95)
    p5–p95 (all providers)p25–p75MedianThis providerOutlier
    Claims Volume vs. Pennsylvania Distribution
    Ophelia Medical Group Fl, P.A. — 5 of 18 codes billed far more than typical (above p95)
    p5–p95 (all providers)p25–p75MedianThis providerOutlier
    Rank Distribution — Pennsylvania