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 U.S. Virgin Islands for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to U.S. Virgin Islands 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. U.S. Virgin Islands (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.

Plessen Ent (NPI 1609515394)

Field	Value
Entity Type	Organization
Organization	Plessen Ent
Address	4040 Estate La Grande Princesse Ste 1
City	Christiansted
State	VI
ZIP	00820
Taxonomy	Otolaryngology Physician
NPI Enumerated	June 1, 2022

Payer Source	Total Paid
Medicaid	$32.6K
Medicare	$0

Key Findings

This provider has no Medicare billing on file and reports $32.6K in lifetime Medicaid revenue, so its public payer footprint is effectively single-payer (Medicaid) based on the available claims data. Analysts should treat Medicare-related comparisons as inapplicable for this NPI.

Medicaid revenue is highly concentrated: the precomputed top three Medicaid codes account for 90.4% of this provider's total Medicaid revenue, driven by 99204 ($16.9K, 51.7%), 99214 ($7.1K, 21.9%), and 99203 ($5.5K, 16.8%). This concentration indicates a narrow set of services is responsible for the bulk of billed Medicaid dollars.

The code mix is dominated by office/outpatient evaluation and management visits (99204, 99214, 99203), consistent with the provider taxonomy Otolaryngology Physician; this pattern suggests the practice is oriented toward clinic-based diagnostic and consultative care rather than high-volume procedural surgery. The presence of 31575 (flexible laryngoscopy) at much lower share (28 claims, $1.8K, 5.5%) supports the view that procedural diagnostics are present but not a primary revenue driver.

99204 is the single largest revenue driver and appears to reflect higher-intensity new patient evaluations: 167 claims at $101 avg paid/claim generating $16.9K (51.7% of Medicaid revenue). By contrast, established-patient visits such as 99214 (81 claims, $88 avg paid/claim, $7.1K) represent a smaller portion of revenue, suggesting the practice may see a heavier flow of new or referral consults relative to longitudinal follow-up under Medicaid.

Procedure-level volume is limited: 31575 (flexible laryngoscopy) accounts for 28 claims and $1.8K (5.5% of Medicaid revenue) and ranks #2 of 2 in-state but is characterized in the data as typical/unremarkable; because the statewide denominator for that code is very small, the rank should be interpreted cautiously rather than taken as evidence of procedural dominance.

State-level competitive standing on the top codes is modest overall: 99204 ranks #8 of 25 providers in-state (71st percentile), indicating a moderate share for that high-value new-patient code, while 99214 ranks #34 of 43 (21st percentile) and 99203 ranks #12 of 20 (42nd percentile), both described as typical or modest volumes compared with peers. Taken together, the provider is not a dominant statewide player but has above-median positioning for the single highest-revenue code.

The provider’s claim and payment detail show relatively low volume and scale: top-code claim counts are 167 for 99204, 81 for 99214, and 70 for 99203, with average paid-per-claim values of $101, $88, and $78 respectively; these numbers, combined with total Medicaid revenue of $32.6K, point to a small Medicaid practice footprint that could be sensitive to changes in referral patterns or payer mix.

This NPI was enumerated on 2022-06-01 (~4 years ago), indicating a relatively recent tenure; analysts should consider limited historical volume when assessing trends or benchmarking, and verify whether additional affiliations or NPIs exist that might consolidate activity not reflected under this single NPI.

Medicaid: Complete Services Breakdown

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

5 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	170	$100	$16.9K
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	$90	$7.1K
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…	70	$80	$5.5K
31575	The provider uses a flexible laryngoscope to look inside the larynx, or voice box, to detect the presence of any abnormalities. This code applies to diagnostic services.	30	$60	$1.8K
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…	20	$80	$1.4K

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. U.S. Virgin Islands Distribution

Plessen Ent — 0 of 5 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — U.S. Virgin Islands

Full comparison — all codes billed, vs. U.S. Virgin Islands median

5 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average 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…	34	40	560	$140	$322K
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…	38	40	430	$110	$260.9K
31575	The provider uses a flexible laryngoscope to look inside the larynx, or voice box, to detect the presence of any abnormalities. This code applies to diagnostic services.	2	10	560	$90	$52.1K
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…	8	30	80	$150	$27K
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…	12	20	80	$90	$27K

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Lisa Gay	VI	Family Nurse Practitioner	$2.2K	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
St Croix Vision Center Inc	VI	Optometrist	$0	$3.6M
One Dental Practice LLC	VI	Dentist	$0	$3.2M
Governor Juan F. Luis Hospital & Medical Center	VI	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$3M
Js Therapies, LLC	VI	Occupational Therapist	$0	$2.9M
Healthquest, LLC.	VI	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$2.4M
Department Of Health, Ems Stx	VI	Land Ambulance	$0	$2.2M
Lindsy Wagner LLC	VI	Clinical Social Worker	$0	$2.2M
Ophthalmology Consultants, PC	VI	Ophthalmology Physician	$0	$2.1M
Acute Alternative Medical Group	VI	Emergency Medical Services (Emergency Medicine) Physician	$0	$1.9M
Pediatric Care Center LLC	VI	Pediatrics Physician	$0	$1.7M

Plessen Ent — Billing Profile & Reimbursement Data

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Plessen Ent — 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