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.

Community Medical Associates, Inc. (NPI 1588614994)

Key Findings

Field	Value
Entity Type	Organization
Organization	Community Medical Associates, Inc.
Address	4803 Olympia Park Plz Ste 1100
City	Louisville
State	KY
ZIP	40241
Taxonomy	Internal Medicine Physician
NPI Enumerated	May 10, 2006

Payer Source	Total Paid
Medicaid	$135.1M
Medicare	$0

This provider is effectively a Medicaid-only biller at scale: there is no Medicare billing on file while Total Medicaid revenue is $135.1M, so payer exposure is concentrated in Medicaid rather than split across traditional Medicare/Medicaid mix. The absence of Medicare activity makes this entity functionally a single-payer (Medicaid) operation for purposes of competitive and utilization analysis.

Revenue is highly concentrated in a small set of E/M codes: the top three Medicaid codes (99214, 99213, 99233) account for 53.6% of the provider's total Medicaid revenue. Individually those codes are large contributors — 99214 generated $30.3M (28.9%), 99213 generated $17.3M (16.5%), and 99233 generated $8.5M (8.1%) — indicating dependency on high-volume evaluation & management encounters.

The code mix points to a dominant primary care and inpatient follow-up operation with embedded diagnostic capacity. High volumes of established-patient office visits (99214: 720.8K claims; 99213: 525K claims) combined with substantial subsequent inpatient care (99233: 236.9K claims; 99232: 209.5K claims) and discharge management (99239: 56.7K claims) suggest the provider simultaneously manages ambulatory continuity care plus hospital-based follow-up.

The provider shows unusually high investment in diagnostic testing and monitoring consistent with a broad, integrated outpatient practice: 93010 has 262.6K claims ($1.8M), 80061 has 172.1K claims ($1.9M), 82306 has 81.3K claims ($1.9M), and 36415 has 392.7K claims ($1.2M). Many of these lab and EKG codes rank at or near #1 in-state (100th percentile; described as extreme outliers), which indicates routine in-house or closely affiliated lab and cardiac testing volume far above typical state providers.

Obstetric imaging and fetal surveillance are a clear service line for this entity: 76816 generated $3.1M (46.1K claims), 76811 generated $2.6M (22.6K claims), and 76819 generated $2.5M (48.5K claims), each ranking #1 in-state and described as extreme outliers. This pattern — multiple high-volume fetal ultrasound and biophysical profile codes at top ranks — points to a substantial prenatal imaging throughput alongside the primary-care case mix.

Preventive and pediatric services are also prominent: 99391 ($2.3M, 33.4K claims) and 99392 ($2.1M, 28.5K claims) show high-volume preventive visits, and immunization administration 90460 produced $2.3M across 83.9K claims (ranked #2 in-state). These figures, together with strong well-visit volumes, indicate routine longitudinal care for children and adults in addition to problem-focused visits.

From a competitive-standing perspective the practice is a major statewide player for many codes: numerous top-line services (including 99214, 99233, 76816, 76811, 76819, 80061, 82306, 93010, and others) rank #1 in Kentucky and are labeled "extreme outlier" or at the 100th percentile. For a payer or competitor, that rank profile signals this entity dominates supply for several common clinical services in-state rather than being a modest participant.

There is also material inpatient and critical-care involvement beyond routine ambulatory care: high-level initial inpatient visits 99223 produced $3.5M (46.2K claims) and critical care 99291 produced $1.3M (14.4K claims) with the latter noted as "notably above typical" (97th percentile). Combined with long tenure — NPI enumerated 2006-05-10 (~20 years ago) — these data portray an established organization with both ambulatory and hospital-facing service lines that generate sustained high Medicaid revenue.

Medicaid: Complete Services Breakdown

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

410 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…	720,820	$40	$30.3M
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…	525,050	$30	$17.3M
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…	236,920	$40	$8.5M
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…	209,460	$30	$5.7M
99223	The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	46,210	$80	$3.5M
76816	The provider reexamines the fetus to follow up on a prior abnormal transabdominal ultrasound.	46,050	$70	$3.1M
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…	22,610	$120	$2.6M
99239	The provider sees a patient for hospital inpatient or observation discharge day management, involving evaluation and management (E/M). The provider spends more than 30 minutes on the service on the…	56,650	$50	$2.5M
76819	The provider performs a biophysical profile test to measure the health of the baby during pregnancy using only ultrasound and not a nonstress test.	48,490	$50	$2.5M
99204	The provider sees a new 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 provider…	33,200	$70	$2.4M

Showing 1–10 of 410

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

Community Medical Associates, Inc. — 23 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

410 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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.	45	280	7,150	$150	$3M
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.	51	240	4,710	$150	$2.6M
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.	118	280	5,700	$120	$2M
74177	The provider performs computed tomography of the abdomen and pelvis with contrast material to diagnose the cause of abdominal or pelvic pain or other abnormalities of the internal organs.	152	180	1,870	$280	$1.5M
99469	The provider evaluates and manages the subsequent care of a newborn or infant less than 28 days of age in a neonatal critical care setting, after the first day.	6	10	600	$260	$1.1M
99472	The provider performs follow up care of a critically ill infant or young child, 29 days through 24 months of age, in an inpatient setting.	5	10	120	$250	$878.8K
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.	88	180	2,960	$110	$672.4K
99282	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a straightforward level of medical decision making.	130	160	2,900	$110	$610.8K
93306	The provider uses transducers to obtain two–dimensional (2D) images of the heart structures through the chest wall. He evaluates the anatomy and function of all four heart chambers, valves, adjacent…	1	210	1,340	$160	$568K
93458	In this procedure, the provider performs imaging supervision and interpretation for a coronary angiography with left heart catheterization and intraprocedural injections for left ventriculography. He…	35	60	170	$780	$500.2K

Showing 1–10 of 410

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Community Medical Associates, Inc.	KY	Multi-Specialty Clinic/Center	$0	$49M
Norton Hospitals Inc	KY	Multi-Specialty Clinic/Center	$0	$3.4M
Patricia Hansen	KY	Internal Medicine Physician	$2.6M	$0
Roneka Ravenell	IN	Rheumatology Physician	$1.3M	$0
Jennifer Teeter	IN	Sports Medicine (Family Medicine) Physician	$1.2M	$0
Topeka Physician Group, LLC	KS	Internal Medicine Physician	$0	$963.7K
Robin Curry	KY	Sports Medicine (Family Medicine) Physician	$628.2K	$0
John Fleming	CA	Orthopaedic Surgery of the Spine Physician	$618.3K	$0
Christopher Graves	IL	Orthopaedic Surgery of the Spine Physician	$533.3K	$83K
Brandon Cook	FL	Orthopaedic Surgery Physician	$572.7K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Norton Childrens Medical Group, LLC	KY	Pediatrics Physician	$0	$107.3M
Motc - Louisville LLC	KY	Prosthetic/Orthotic Supplier	$0	$5.4M
Gml Pain Md Psc	KY	Durable Medical Equipment & Medical Supplies	$0	$3.9M
Jacob Yunker	KY	Ophthalmology Physician	$3.8M	$0
Thomas Harper	KY	Ophthalmology Physician	$3.3M	$0
Aspire Case Management LLC	KY	Case Management Agency	$0	$3.2M
Victor Neamtu	KY	Ophthalmology Physician	$1.5M	$980
Michael Mccall	KY	Dermatology Physician	$938.6K	$0
Timothy Brown	KY	Dermatology Physician	$874.6K	$0
Mark Haeberle	KY	Dermatology Physician	$651.4K	$23K

Community Medical Associates, Inc. — Billing Profile & Reimbursement Data

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Community Medical Associates, Inc. — Billing Profile & Reimbursement Data

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Key Findings

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References