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 Armed Forces Pacific for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to Armed Forces Pacific 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. Armed Forces Pacific (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.

Kimberly Caldwell (NPI 1609001346)

Field	Value
Entity Type	Individual
Organization	Kimberly Caldwell
Address	Psc 80 Box 10838
City	Apo
State	AP (Armed Forces Pacific)
ZIP	96367
Taxonomy	Family Medicine Physician
NPI Enumerated	May 26, 2009

Payer Source	Total Paid
Medicare	$22.4K
Medicaid	$0

Key Findings

This provider’s Medicare footprint is small in absolute terms: total Medicare revenue is $22.4K and there is no Medicaid billing on file, so the practice is effectively single‑payer with Medicare as the only recorded public payer. The absence of any Medicaid claims eliminates Medicaid as a revenue or contract consideration for payer/provider comparisons and network planning for this NPI.

Revenue is highly concentrated in three inpatient/critical‑care E/M codes: the precomputed top 3 Medicare codes account for 100.0% of this provider’s total Medicare revenue. Those codes are 99223 (39.5% of Medicare revenue), 99222 (37.4%), and 99291 (23.1%), indicating virtually all billed Medicare dollars derive from these hospital‑level services.

The CPT mix strongly indicates a hospital‑based service line: 99223 and 99222 are initial hospital inpatient/observation E/M visits (high and moderate complexity, respectively) and 99291 is a critical care service. Together these codes and their shares suggest the provider’s Medicare work is concentrated in admitting/initial inpatient evaluation and critical care encounters rather than office‑based primary care or outpatient procedural services.

Code‑level volume and payment detail underline the operational profile: 99223 shows 67 claims at $132 avg paid/claim generating $8.8K revenue, 99222 shows 89 claims at $94 avg paid/claim generating $8.4K revenue, and 99291 shows 32 claims at $162 avg paid/claim generating $5.2K revenue. These three lines together explain the full $22.4K Medicare revenue and confirm a compact portfolio of high‑acuity inpatient services.

Competitive standing by code is modest and characterized in peer data as typical: 99223 ranks #43219 of 139583 providers nationally (69th percentile; typical, unremarkable volume for this code), 99222 ranks #13165 of 117621 (89th percentile; typical, unremarkable volume for this code), and 99291 ranks #44625 of 71290 (36th percentile; typical, unremarkable volume for this code). For payer/provider analysts, this means the provider is not a dominant national volume outlier on these codes but does have relatively stronger placement on 99222 versus peers.

Tenure is long enough to evaluate longitudinal trends: the NPI was enumerated on 2009-05-26 (~17 years ago), indicating a stable enrollment history. Given the long enumeration but limited Medicare revenue, analysts should treat this as a long‑standing, low‑throughput hospital‑based clinician rather than a newly entered high‑volume practice.

From a contracting and risk perspective, the combination of very concentrated revenue (100.0% from three inpatient/critical‑care codes) and an absence of Medicaid activity increases sensitivity to changes in hospital assignments, inpatient utilization patterns, or Medicare policy affecting inpatient/critical‑care E/M payments. Any shift in hospital privileges, staffing, or referral patterns that affects those specific codes could materially change this provider’s recorded Medicare revenue.

For follow‑up analysis, focus data pulls on hospital affiliation and inpatient episode detail: because billing is dominated by initial inpatient E/M and critical care codes, payer and provider analysts should prioritize hospital claims, admission source, and ICU/observation usage to understand case mix and utilization drivers; Medicaid claims data will not be informative because there is no Medicaid billing on file.

Medicare: Complete Services Breakdown

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

3 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	70	$130	$8.8K
99222	The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	90	$90	$8.4K
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…	30	$160	$5.2K

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 3 CPT/HCPCS codes. Note: this provider's state, "AP," is a US military postal designation for Armed Forces stationed in the Asia-Pacific region — not a traditional US state; the State panel below benchmarks against other providers coded under the same designation.

View: State1 / 2

Claims Volume vs. Armed Forces Pacific Distribution

Kimberly Caldwell — 1 of 3 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Armed Forces Pacific

Full comparison — all codes billed, vs. state median

3 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99291	4	10	70	$180	$13.8K
99223	2	10	40	$140	$6.9K
99222	1	10	40	$100	$4.6K

Related Providers

Other providers that share a Tax Identification Number (TIN) with Kimberly Caldwell, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Tidewater Physicians Multispecialty Group PC	VA	Family Medicine Physician	$0	$5.9M
Kristi Mizelle	VA	Rheumatology Physician	$1.5M	$0
Ivan Marchena- Mendez	PA	Rheumatology Physician	$1M	$0
Michael Gen	VA	Interventional Cardiology Physician	$705.1K	$0
Audra Albert	VA	Family Nurse Practitioner	$639.8K	$0
Aleisha Johnson	VA	Diagnostic Radiology Physician	$626.6K	$0
Pranav Parikh	VA	Internal Medicine Physician	$579K	$0
Jeffrey Vandesand	VA	Diagnostic Radiology Physician	$550.4K	$0
Matthew Doherty	VA	Diagnostic Ultrasound Physician	$540.2K	$0
Stephen Cummings	VA	Orthopaedic Surgery Physician	$493.5K	$0

Nearby Providers

Other providers in the same ZIP code as Kimberly Caldwell, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Douglas Olson	AP (Armed Forces Pacific)	Orthodontics and Dentofacial Orthopedics Dentistry	$0	$52K
Shobha Sem	—	Family Medicine Physician	$5.6K	$0

Kimberly Caldwell — Billing Profile & Reimbursement Data

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Kimberly Caldwell — Billing Profile & Reimbursement Data

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Key Findings

Medicare: Total Revenue Breakdown by CPT/HCPCS Code

Medicare: Complete Services Breakdown

Medicare: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References