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

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

Banner Urgent Care Services, LLC (NPI 1609229764)

Key Findings

Field	Value
Entity Type	Organization
Organization	Banner Urgent Care Services, LLC
Address	10330 N Scottsdale Rd # 25
City	Scottsdale
State	AZ
ZIP	85253
Taxonomy	Urgent Care Clinic/Center
NPI Enumerated	July 13, 2016

Payer Source	Total Paid
Medicaid	$85.2M
Medicare	$0

BANNER URGENT CARE SERVICES, LLC reports no Medicare billing on file and $85.2M in lifetime Medicaid revenue, making its public payer footprint effectively single-payer (Medicaid) based on available claims data. The absence of Medicare activity contrasts with the size of its Medicaid program and should be considered when comparing payer mix or network participation strategies.

Revenue is highly concentrated in office/outpatient evaluation-and-management codes: the top three Medicaid codes (99213, 99203, 99214) together account for 91.9% of the provider's Medicaid revenue. Individually, 99213 represents $45.6M (53.6% of Medicaid revenue), 99203 represents $25.7M (30.2%), and 99214 represents $6.9M (8.2%), indicating a business model driven almost entirely by E/M visits.

The code mix (dominant use of 99213, 99203, and 99214) is consistent with an urgent care clinic workflow: frequent low-to-moderate complexity face-to-face encounters, with typical time/decision-making characteristics noted in each code description (e.g., 99213 ~20+ minutes, 99203 ~30+ minutes, 99214 ~30+ minutes). This pattern, coupled with ancillary codes on file, suggests a high-throughput, front-door outpatient service line that focuses on episodic evaluation and management rather than procedure-heavy care.

BANNER is a statewide volume leader for key E/M codes: 99213 ranks #1 of 2775 providers in-state at the 100th percentile (labeled an "extreme outlier"), 99203 ranks #2 of 1025 providers in-state at the 100th percentile ("extreme outlier"), and 99214 ranks #41 of 3041 providers in-state at the 99th percentile ("extreme outlier"). These rankings indicate the provider operates at volumes far above typical peers in Arizona for core urgent care visit codes.

Ancillary and point-of-care testing appears extensive but generates little direct Medicaid revenue on the fee schedule: codes such as 99000 (39.6K claims, $0 revenue; rank #1 of 299, 100th percentile, "extreme outlier"), 81002 (16.5K claims, $0 revenue), 87804 (10.1K claims, $0 revenue; rank #5 of 325, 99th percentile, "extreme outlier"), and 87880 (34.1K claims, $34.1K revenue; rank #1 of 407, 100th percentile, "extreme outlier") show very high claim volumes with minimal reported Medicaid payments. Operationally, this signals frequent specimen collection and rapid testing activity (e.g., influenza and strep tests, urine dipstick) that is billed often but contributes little to reported Medicaid revenue.

Several procedure and injection codes (e.g., 96372, 36415, J1885) are present at modest claim counts but account for negligible revenue in the Medicaid feed, reinforcing that the clinic’s economic value derives primarily from E/M visits rather than billable injectable or DME services. Where present, these codes rank modestly in-state (e.g., 96372 rank #26 of 637, 96th percentile) and do not materially shift the revenue mix away from office visits.

The provider’s NPI has been enumerated since 2016-07-13 (~10 years ago), giving it an established operational tenure in the state. That multi-year presence combined with persistent extreme-volume rankings for core E/M and testing codes suggests a stable urgent care footprint rather than a new or transitory billing pattern.

The extreme concentration of Medicaid revenue in three codes (top 3 = 91.9%) presents both clarity and risk: it clarifies the provider’s service-line orientation toward episodic outpatient E/M visits, but also creates sensitivity to reimbursement or policy changes affecting those specific E/M codes. For payer and contracting analysts, this concentration underscores the importance of evaluating visit definitions, utilization management, and network adequacy relative to urgent care service demand in Arizona.

Medicaid: Complete Services Breakdown

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

33 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…	507,140	$90	$45.6M
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…	289,050	$90	$25.7M
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…	80,810	$90	$6.9M
99211	An established patient presents for an office or other outpatient visit that may not require the presence of a physician or other qualified healthcare professional.	36,990	$80	$2.9M
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…	23,500	$90	$2.1M
99212	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,…	19,610	$90	$1.7M
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…	1,150	$90	$97.3K
87880	The analyst performs an immunoassay with direct optical, meaning visual, observation to detect Streptococcus, group A, in a patient sample, typically a throat swab.	34,140	$1	$34.1K
96372	A therapeutic, prophylactic, or diagnostic substance (a fluid, a drug, etc.) is injected via intramuscular or subcutaneous route into the patient's body. The procedure is performed by the physician…	12,660	$1	$12.7K
36415	In this procedure, the provider inserts a needle into a vein to collect a blood sample.	7,960	$1	$8K

Showing 1–10 of 33

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Arizona Distribution

Banner Urgent Care Services, LLC — 8 of 15 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Arizona

Full comparison — all codes billed, vs. Arizona median

33 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99211	An established patient presents for an office or other outpatient visit that may not require the presence of a physician or other qualified healthcare professional.	7	400	200	$120	$403K
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…	41	3,040	750	$50	$343.9K
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…	1	2,780	600	$50	$267K
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…	2	1,030	130	$70	$134.1K
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…	227	1,160	150	$90	$96.5K
99212	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,…	18	850	230	$40	$72.5K
71046	In this diagnostic procedure, the provider performs a minimum of two radiological views of the chest. He performs this study for the assessment of conditions affecting the chest, its contents, and…	152	300	600	$10	$62.6K
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…	2	310	80	$40	$34.6K
73630	In this diagnostic procedure, the provider takes a minimum of three views of the foot to assess injury, fracture, arthritis, tumor, or congenital abnormality.	204	250	440	$20	$27.8K
73110	The provider takes at least three X–ray images of a patient’s complete wrist to check for any fracture, swelling, or reason of pain in the wrist area.	118	130	280	$20	$26.7K

Showing 1–10 of 33

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Banner Urgent Care Arizona LLC	AZ	Urgent Care Clinic/Center	$0	$10.6M
Eric Ogari	AZ	Family Nurse Practitioner	$6.9M	$0
Chelsea Barson	KS	Family Nurse Practitioner	$187.6K	$0
Michael Sassmann	AZ	Medical Physician Assistant	$78.9K	$0
Michael Elson	OH	Physician Assistant	$55.3K	$0
R West	AZ	Medical Physician Assistant	$33.4K	$0
Angela Day	AZ	Family Nurse Practitioner	$30.1K	$0
Rod Genck	AZ	Family Medicine Physician	$26.8K	$0
Jojin Mathews	OK	Physician Assistant	$23.1K	$0
Taylor Kovach	AZ	Physician Assistant	$22.3K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Mga Home Healthcare LLC	AZ	Home Health Agency	$0	$106.5M
Kelsar Inc.	AZ	In Home Supportive Care Agency	$0	$6.7M
Associated Ophthalmologists Ltd	AZ	Ophthalmology Physician	$0	$6.7M
Farid Ghebleh	AZ	Pulmonary Disease Physician	$529.7K	$17.3K
Rajinder Grover	AZ	Medical Oncology Physician	$515.1K	$0
Mark Gruszynski	AZ	Plastic and Reconstructive Surgery Physician	$470.2K	$0
Jay Arora	AZ	Ophthalmology Physician	$320.6K	$0
Gerald Asin	AZ	Internal Medicine Physician	$282.1K	$0
Scottsdale Multispecialty Surgery Center	AZ	Ambulatory Surgical Clinic/Center	$269.8K	$0
Walgreen Co	AZ	Pharmacy	$248K	$0

Banner Urgent Care Services, LLC — 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