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

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

East Falls Family Medicine, LLC (NPI 1619221405)

East Falls Family Medicine, LLC is a family medicine physician provider located in Idaho Falls, Idaho. This profile covers 0 Medicare and 16 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	East Falls Family Medicine, LLC
Address	3200 Channing Way
City	Idaho Falls
State	ID
ZIP	83404
Taxonomy	Family Medicine Physician
NPI Enumerated	November 1, 2012

Payer Source	Total Paid
Medicaid	$1.1M
Medicare	$0

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

16 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
99222	The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	3,310	$90	$307.6K
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…	5,700	$50	$301.9K
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…	3,620	$70	$253.1K
99221	The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a straightforward or low level of medical…	980	$70	$68.3K
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…	1,060	$50	$53.2K
99223	The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	270	$140	$38.5K
99231	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a straightforward or low level of medical…	720	$30	$19.5K
36415	In this procedure, the provider inserts a needle into a vein to collect a blood sample.	1,380	$1	$4.1K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	180	$20	$2.8K
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…	170	$10	$1.7K

Showing 1–10 of 16

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Idaho Distribution

East Falls Family Medicine, LLC — 0 of 13 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Idaho

Full comparison — all codes billed, vs. Idaho median

16 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average 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…	99	670	740	$40	$193.6K
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…	102	620	560	$60	$191.8K
99222	The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	4	20	200	$90	$158.3K
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…	33	60	1,370	$50	$151.3K
99231	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a straightforward or low level of medical…	16	30	1,070	$30	$73.5K
99233	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	41	40	480	$60	$71.5K
99223	The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	26	40	300	$120	$66.3K
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…	187	220	90	$80	$51.4K
99221	The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a straightforward or low level of medical…	3	10	30	$60	$31K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	84	180	140	$10	$28.4K

Showing 1–10 of 16

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Mountain View Hospital LLC	ID	General Acute Care Hospital	$0	$45.7M
Eastern Idaho Health Services Inc	ID	General Acute Care Hospital	$0	$12.1M
Rm Lab LLC	ID	Clinical Medical Laboratory	$1.1M	$8.2M
Medical Center For Children & Adolescents, PA	ID	Pediatrics Physician	$0	$8.8M
Aaa American Healthcare LLC	ID	Mental Health Counselor	$0	$8.7M
Intermountain Emergency Physicians	ID	Emergency Medicine Physician	$0	$6.6M
24-7 Professional Solutions	ID	In Home Supportive Care Agency	$0	$5.9M
Just 4 Kids Health LLC	ID	Urgent Care Clinic/Center	$0	$5.2M
Foothills Rehabilitation & Performance Services, PLLC	ID	Physical Therapist	$0	$5M
Innovative Health Care Concepts, Inc	ID	Developmental Disabilities Clinic/Center	$0	$4.8M

East Falls Family Medicine, LLC — Billing Profile & Reimbursement Data

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East Falls Family Medicine, 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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Frequently Asked Questions

References

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
West Valley Medical Group LLC	ID	Internal Medicine Physician	$0	$2.1M
West Valley Medical Group Specialty Services LLC	ID	Obesity Medicine (Obstetrics & Gynecology) Physician	$0	$482K
David Hill	ID	Family Medicine Physician	$102.4K	$0
Matthew Payne	ID	Family Medicine Physician	$93K	$0
Sean Huggins	ID	Internal Medicine Physician	$82.7K	$0