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

Why is the Medicaid comparison limited to Florida 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. Florida (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.

Francesca Harris (NPI 1609023654)

Field	Value
Entity Type	Individual
Organization	Francesca Harris
Address	Naval Hospital Jacksonville Florida 2080 Child St
City	Jacksonville
State	FL
ZIP	32214
Taxonomy	Physician Assistant
NPI Enumerated	August 21, 2008

Payer Source	Total Paid
Medicare	$9.2K
Medicaid	$0

Key Findings

FRANCESCA HARRIS is listed as a Physician Assistant in JACKSONVILLE, FL with an NPI enumerated 2008-08-21 (~18 years ago). The provider’s lifetime Medicare revenue on file is $9.2K and there is no Medicaid billing on file, indicating this NPI’s public-payor activity is effectively single-payer Medicare in scale.

Revenue is highly concentrated: the precomputed top 3 Medicare codes account for 99.6% of this provider’s total Medicare revenue. Those codes break down as 99214 ($5.4K; 58.6%), 99204 ($3.3K; 36.1%), and 87426 ($455; 5.0%), with the remainder of listed codes contributing marginal amounts.

The code mix (dominance of 99214 and 99204) indicates the practice’s primary activity is outpatient evaluation-and-management encounters for new and established patients at moderate complexity, consistent with a clinic-based ambulatory care role. Ancillary point-of-care testing appears as a minor component (87426 SARS–CoV–2 antigen testing and 81003 urine dipstick), suggesting testing is performed in support of those visits rather than as a separate lab business line.

On competitive standing, the provider is a modest participant rather than a dominant national player for its top E/M codes: 99214 ranks #282127 of 479517 (41th percentile; typical, unremarkable volume for this code) and 99204 ranks #95057 of 227068 (57th percentile; typical, unremarkable volume for this code). These percentile positions and the relatively small absolute revenue ($5.4K and $3.3K respectively) indicate routine, not high-volume, utilization patterns versus national peers.

Testing and low-revenue lab items are low-volume relative to peers: 87426 ranks #15127 of 17750 (10th percentile; typical, unremarkable volume for this code) and 81003 ranks #36637 of 51536 (26th percentile; typical, unremarkable volume for this code). The COVID antigen testing line contributes $455 (5.0% of Medicare revenue) and 13 claims, so while present it is not a major revenue driver.

Claim counts and unit payments reinforce small scale: 99214 appears on 78 claims at $69 avg paid/claim and 99204 on 39 claims at $85 avg paid/claim, with 87426 on 13 claims at $35 avg paid/claim. Combined with total Medicare revenue of $9.2K, these figures point to a low absolute volume of Medicare encounters under this NPI.

Because there is no Medicaid billing on file, payer-mix risk for public programs is concentrated entirely in Medicare; the provider’s revenue profile is therefore sensitive to Medicare reimbursement and coding changes that affect 99214 and 99204. For analysts benchmarking or monitoring this NPI, the small absolute dollar totals and the 99.6% concentration in three codes should caution against overinterpreting short-term fluctuations as substantive shifts in practice footprint or specialty.

Medicare: Complete Services Breakdown

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

4 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…	80	$70	$5.4K
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…	40	$90	$3.3K
87426	The lab analyst performs an immunoassay to qualitatively or semiquantitatively evaluate the patient blood specimen for antigens of severe acute respiratory syndrome coronavirus such as SARS–CoV–2,…	10	$40	$460
81003	The lab analyst inserts a dip stick into a freshly collected urine specimen, removes the dipstick, and shakes off the excess urine. She places the stick onto a mechanical dip stick reader that will…	20	$1	$40

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 4 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Florida Distribution

Francesca Harris — 0 of 4 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Florida

Full comparison — all codes billed, vs. state median

4 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99214	9	32,760	140	$90	$25K
99204	5	19,040	40	$110	$7K
87426	2	1,290	30	$30	$1.6K
81003	2	3,450	40	$1	$370

Francesca Harris — Billing Profile & Reimbursement Data

Sign up for Francesca Harris — Billing Profile & Reimbursement Data policy alerts

Francesca Harris — Billing Profile & Reimbursement Data

Sign up for Francesca Harris — 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