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

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

Penn State Health Medical Group, LLC (NPI 1609347152)

Penn State Health Medical Group, LLC is a pediatrics physician provider located in West Reading, Pennsylvania. This profile covers 0 Medicare and 50 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.

Medicaid: Complete Services Breakdown

Field	Value
Entity Type	Organization
Organization	Penn State Health Medical Group, LLC
Address	655 Walnut St
City	West Reading
State	PA
ZIP	19611
Taxonomy	Pediatrics Physician
NPI Enumerated	December 10, 2018

Payer Source	Total Paid
Medicaid	$7.7M
Medicare	$0

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

50 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…	31,880	$80	$2.5M
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…	11,550	$110	$1.3M
99392	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	10,150	$100	$1M
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	8,970	$100	$879.4K
99391	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	7,070	$90	$657.3K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	5,380	$110	$570K
92551	The provider delivers a limited series of tones or sounds to a patient to determine if the patient’s hearing is in an acceptable range to detect hearing problems.	13,500	$10	$121.5K
99177	The provider uses instruments to conduct a vision screening exam to analyze both eyes to diagnose ocular or eye–related diseases. Both the screening and analysis take place on–site.	17,380	$10	$86.9K
99188	The provider applies a fluoride adhesive over the tooth surface to prevent tooth decay, provide remineralization, or treat hypersensitivity.	5,710	$10	$79.9K
90686	This code represents a vaccine product administered into the muscle to protect against four strains of influenza (flu). It is preservative free, uses split virus technology, and is given as a 0.5 mL…	10,150	$10	$71K

Showing 1–10 of 50

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Pennsylvania Distribution

Penn State Health Medical Group, LLC — 21 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Pennsylvania

Full comparison — all codes billed, vs. Pennsylvania median

50 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
96151	N/A	14	20	3,710	$130	$750.3K
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.	512	980	310	$50	$136.6K
99392	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	12	820	230	$80	$71.7K
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…	123	8,160	210	$60	$68.4K
99391	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	16	660	180	$70	$63.7K
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…	47	8,870	240	$40	$56.1K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	9	870	160	$70	$48.2K
99215	The provider sees an established 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…	518	1,210	100	$90	$45K
80061	The lab analyst performs a lipid panel test in which he measures the blood level of cholesterol and fats called triglycerides in the blood.	371	410	320	$10	$37.4K
99460	The provider evaluates and manages the care of a normal newborn infant, typically immediately after birth, in a hospital or birthing center.	76	100	70	$60	$34.8K

Showing 1–10 of 50

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
The Milton S. Hershey Medical Center Physicians Group	PA	Sports Medicine (Neuromusculoskeletal Medicine) Physician	$0	$26.6M
Michael Morris	MD	Diagnostic Radiology Physician	$12M	$0
Amit Khaneja	NY	Clinical Neurophysiology Physician	$1.3M	$301K
Pejman Rohani	MD	Vascular Surgery Physician	$1M	$0
John Dellabadia	NC	Neurology Physician	$232.2K	$808.8K
Joshua Shipley	PA	Hematology & Oncology Physician	$739.9K	$0
Jihua Cheng	PA	Hematology & Oncology Physician	$685.8K	$0
Kumudini Rao	PA	Hematology & Oncology Physician	$444K	$0
Kok Chye Tan	CA	Neuroradiology Physician	$401.1K	$13.5K
Nicholas Wright	PA	Hematology & Oncology Physician	$363.7K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Reading Hospital	PA	General Acute Care Hospital	$0	$58.4M
Tower Health Medical Group	PA	Emergency Medicine Physician	$0	$8M
New Directions Treatment Services	PA	Methadone Clinic	$0	$6.3M
Tower Direct LLC	PA	Land Ambulance	$1.4M	$1.9M
William Kimmel	PA	Anatomic Pathology & Clinical Pathology Physician	$1.7M	$131.8K
Stephen Longenecker	PA	Orthopaedic Surgery Physician	$543.9K	$0
Eric Slotkin	PA	Orthopaedic Surgery Physician	$360.4K	$0
Arun Kundra	PA	Clinical Cardiac Electrophysiology Physician	$257.8K	$8.3K
Kenneth Mcalpine	PA	Orthopaedic Surgery Physician	$261.8K	$0
Nathan Tiedeken	PA	Orthopaedic Surgery Physician	$247.9K	$0

Penn State Health Medical Group, LLC — Billing Profile & Reimbursement Data

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Penn State Health Medical Group, LLC — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

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