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NPI 1609881077 · Glendale, WI · Internal Medicine Physician
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Ascension Medical Group-southeast Wisconsin Inc is a internal medicine physician provider located in Glendale, Wisconsin. This profile covers 0 Medicare and 237 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.
Provider details (source: NPPES NPI Registry)
| Field | Value |
|---|---|
| Entity Type | Organization |
| Organization | Ascension Medical Group-southeast Wisconsin Inc |
| Address | 400 W River Woods Pkwy |
| City | Glendale |
| State | WI |
| ZIP | 53212 |
| Taxonomy | Internal Medicine Physician |
| NPI Enumerated | July 31, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $44.8M |
| Medicare | $0 |
This provider has no Medicare billing on file and reports $44.8M in lifetime Medicaid revenue, making its public billing footprint effectively single-payer (Medicaid) based on the available data. Analysts should treat Medicaid as the dominant and sole recorded public payer when modeling this entity’s reimbursement exposure or network value.
Revenue is highly concentrated in a small set of outpatient E/M and behavioral-health codes: the precomputed top three Medicaid codes account for 63.9% of the provider’s Medicaid revenue, with 99214 alone generating $17.4M (42.9% of Medicaid revenue) from 470.1K claims. This concentration indicates financial sensitivity to utilization patterns or policy changes that affect these few high-volume codes.
The code mix points to a large ambulatory primary care operation with embedded behavioral health: very high volumes of established office visits 99214 (470.1K claims, $37 avg) and 99213 (232.1K claims, $26 avg) together form the core revenue drivers, while psychotherapy 90834 (63.1K claims, $39 avg, $2.5M) indicates integrated or co-located mental health services. The presence of multiple preventive medicine codes (99391, 99392, 99393, 99394, 99395) further supports a broad primary care/wellness service line across age groups.
The provider also appears to maintain substantial prenatal imaging and obstetric support services: high volumes and dollars for 76811 ($1M, 12.9K claims), 76819 ($773.8K, 22.1K claims), and 76816 ($718.5K, 23.9K claims) rank at or near the top of in-state peers (mostly #2 and high percentiles). These placements (many described as extreme outlier or notably above typical state volume) suggest a large prenatal imaging program or referral hub for obstetric ultrasound within the state.
Inpatient and observation E/M is a meaningful secondary line: 99232 (90.4K claims, $1.4M), 99233 (16.9K claims, $389.2K), 99223 ($648.6K), and 99239 ($690.6K) all appear in the top Medicaid code list and rank highly statewide. This mix indicates the organization bills across care settings (ambulatory, hospital inpatient/observation, and discharge management), not solely clinic visits.
Competitive standing in-state is dominant for many high-volume codes: 99214 ranks #2 of 1628 providers (100th percentile; extreme outlier) and 99213 ranks #4 of 1755 providers (100th percentile; extreme outlier), while preventive and imaging codes repeatedly fall in the 97–100th percentiles. These ranks characterize the provider as a major statewide participant and frequent top outlier for routine E/M, preventive care, and prenatal imaging.
Beyond E/M and imaging, the revenue base includes a range of ancillary and procedural services that diversify Medicaid receipts: J0585 (onabotulinumtoxina) contributed $803.5K, 93306 (echocardiography) $490.1K, 90960 (ESRD monthly management) $241.2K, and influenza vaccination 90686 generated $222.5K. Some of these codes rank in high percentiles (e.g., 93306 at 99th, 90686 at 100th), indicating the provider’s scope extends into procedural, chronic-disease management, and preventive-immunization activity.
The provider’s NPI was enumerated on 2006-07-31 (~20 years ago), indicating long tenure in the market; that longevity, combined with persistent extreme outlier volumes and high statewide ranks, supports the interpretation of established referral and patient-volume pipelines underpinning the observed Medicaid billing patterns.
Medicaid revenue breakdown by year and by CPT/HCPCS procedure code, including monthly billing trends and the top codes driving revenue.
View: By Year1 / 3
Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.
237 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… | 470,060 | $40 | $17.4M |
| 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… | 232,070 | $30 | $6M |
| 90834 | In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere… | 63,100 | $40 | $2.5M |
| 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… | 26,290 | $60 | $1.5M |
| 99232 | The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or… | 90,410 | $20 | $1.4M |
| 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… | 22,510 | $60 | $1.3M |
| 76811 | The provider performs an ultrasound study using a transabdominal approach to examine the fetus and mother, along with additional examination of the fetal anatomy, such as the heart rate, amniotic… | 12,880 | $80 | $1M |
| 99393 | The provider performs an established well–patient visit for a child who is between the ages of 5 and 11. | 16,010 | $60 | $944.4K |
| 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… | 18,320 | $50 | $934.1K |
| J0585 | Injection, onabotulinumtoxina, 1 unit | 1,490 | $540 | $803.5K |
Showing 1–10 of 237
How this provider's Medicaid billing volume and revenue compare to other Wisconsin providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Wisconsin median
237 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| J0585 | Injection, onabotulinumtoxina, 1 unit | 10 | 30 | 550 | $240 | $428.8K |
| 90960 | The provider manages all the services associated with the monthly care of a patient who is 20 years old or older and has a condition known as end stage renal disease or ESRD. For this service, the… | 8 | 30 | 1,050 | $70 | $320.9K |
| 76811 | The provider performs an ultrasound study using a transabdominal approach to examine the fetus and mother, along with additional examination of the fetal anatomy, such as the heart rate, amniotic… | 2 | 40 | 930 | $100 | $214.5K |
| 42820 | The provider removes the tonsils and adenoids in a patient younger than 12 years old. | 14 | 20 | 20 | $660 | $205.5K |
| 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… | 2 | 1,630 | 270 | $40 | $205.3K |
| 43239 | The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum where he removes one or more tissue biopsy specimens for diagnostic analysis. | 26 | 120 | 400 | $180 | $186.8K |
| 76819 | The provider performs a biophysical profile test to measure the health of the baby during pregnancy using only ultrasound and not a nonstress test. | 2 | 40 | 640 | $50 | $178.5K |
| 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… | 4 | 1,760 | 250 | $40 | $173.2K |
| 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. | 348 | 350 | 300 | $50 | $157.9K |
| 97110 | Therapeutic exercise is a form of physical therapy that utilizes specially designed exercises and activities to help patients gain better mobility and fitness levels. Normally used on patients with… | 282 | 630 | 2,500 | $20 | $135.5K |
Showing 1–10 of 237
Other providers in the same ZIP code as Ascension Medical Group-southeast Wisconsin Inc, ranked by combined Medicare and Medicaid revenue.
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