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

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

Community Care Health Network LLC (NPI 1619368842)

Key Findings

Field	Value
Entity Type	Organization
Organization	Community Care Health Network LLC
Address	424 Church St Ste 220
City	Nashville
State	TN
ZIP	37219
Taxonomy	Nurse Practitioner
NPI Enumerated	February 10, 2015

Payer Source	Total Paid
Medicaid	$44.4M
Medicare	$0

This entity has no Medicare billing on file and is effectively a single‑payer (Medicaid) operator: Total Medicaid revenue is $44.4M and there is no reported Medicare revenue. The absence of Medicare claims frames this profile as focused on Medicaid-covered services rather than a mixed Medicare/Medicaid practice mix.

Revenue is highly concentrated in a small set of codes: the top three Medicaid codes (99343, 99349, 99204) together account for 74.7% of the provider’s total Medicaid revenue. Individually those codes generate $14.3M (32.2%), $12.3M (27.6%), and $6.6M (14.8%) respectively, so payer changes or policy edits affecting these codes would materially impact overall revenue.

The code mix indicates a business model centered on home/residence visits and high‑intensity outpatient evaluation and management. Two of the highest revenue drivers are home visit codes (99343 and 99349) and a high‑complexity new‑patient office visit (99204), and additional home visit codes such as 99344 ($3.4M, 7.6%) and 99348 ($100K, 0.2%) further support a strong home‑based care footprint.

This provider is a dominant statewide participant for multiple home‑visit codes: 99343 and 99349 both rank #1 in‑state and are labeled as 100th percentile extreme outliers, and 99344 also ranks #1 (100th percentile). Those rankings indicate volumes far above typical state peers and position the organization as a major provider of home/residence E/M visits in Tennessee.

Operational scale is substantial based on claim volumes for top procedures: 99343 shows 104.6K claims, 99349 has 120.3K claims, and 99204 has 60.4K claims. These large claim counts, combined with the multi‑million dollar revenues tied to each code, indicate high throughput in a focused set of service lines rather than diffuse, low‑volume specialty billing.

Average paid amounts on high‑revenue codes are moderate to high for E/M home visits and new patient visits—reported averages include $137/claim for 99343, $102/claim for 99349, and $109/claim for 99204—contributing to the overall Medicaid revenue mix. At the same time, several codes (1170F and 1159F) show very large claim counts (191.8K and 178.6K) with $0 reported revenue, flagging high‑volume, non‑revenue or zero‑paid encounter/assessment codes in the dataset.

The provider’s statewide competitive standing is unusually concentrated: multiple codes (including 99343, 99349, 99344, 99600, 93922) are described as extreme outliers or at the 100th percentile, while other common outpatient codes (e.g., 99214 at the 98th percentile) register as high but more typical volumes. This pattern reflects dominance in a narrow set of home‑visit and related services while remaining a notable, though less dominant, participant for broader ambulatory E/M codes.

The NPI tenure provides context for these volumes: the provider was enumerated on 2015-02-10 (~11 years ago), indicating an established presence during the multi‑year period reflected by the large cumulative claim counts and concentrated revenue streams. Given the concentrated dependence on a few high‑volume Medicaid codes, the organization’s financial profile appears stable under current Medicaid billing patterns but sensitive to reimbursement or policy changes affecting those codes.

Medicaid: Complete Services Breakdown

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

62 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
99343	N/A	104,580	$140	$14.3M
99349	The provider sees an established patient for a home or residence visit involving evaluation and management (E/M). The visit involves moderate medical decision making or the provider spends at least…	120,300	$100	$12.3M
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…	60,420	$110	$6.6M
99344	The provider sees a new patient for a home or residence visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or the provider spends at least…	19,350	$170	$3.4M
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…	36,980	$80	$3.1M
99600	Use 99600 to report a home visit service or procedure that does not have a specific code.	20,350	$90	$1.9M
92227	The patient undergoes retinal imaging on one or both eyes in a location other than the reviewing clinical staff’s location. The clinical staff analyzes the images remotely and prepares a report. The…	9,870	$70	$651.6K
99383	The provider performs a well–patient visit for a child who is between the ages of 5 and 11 who meets the definition of new patient.	1,280	$280	$353.5K
99309	The provider sees a patient for a subsequent nursing facility care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or the provider…	7,780	$40	$334.5K
99384	The provider performs a well–patient visit for an adolescent who is between the ages of 12 and 17 who meets the definition of new patient.	820	$270	$216.8K

Showing 1–10 of 62

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Tennessee Distribution

Community Care Health Network LLC — 12 of 23 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Tennessee

Full comparison — all codes billed, vs. Tennessee median

62 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99600	Use 99600 to report a home visit service or procedure that does not have a specific code.	1	10	12,590	$150	$1.9M
99343	N/A	1	30	40	$120	$464.7K
92227	The patient undergoes retinal imaging on one or both eyes in a location other than the reviewing clinical staff’s location. The clinical staff analyzes the images remotely and prepares a report. The…	1	10	390	$60	$219.1K
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…	85	3,760	610	$40	$202.3K
99349	The provider sees an established patient for a home or residence visit involving evaluation and management (E/M). The visit involves moderate medical decision making or the provider spends at least…	1	100	180	$70	$141.1K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	397	510	240	$70	$133.7K
99344	The provider sees a new patient for a home or residence visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or the provider spends at least…	1	40	40	$140	$94.5K
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…	3	1,080	120	$80	$90.7K
99383	The provider performs a well–patient visit for a child who is between the ages of 5 and 11 who meets the definition of new patient.	4	110	60	$90	$64.7K
99309	The provider sees a patient for a subsequent nursing facility care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or the provider…	28	360	500	$10	$51.1K

Showing 1–10 of 62

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Julia Kay	NY	Family Nurse Practitioner	$325K	$44K
Lauren Guse	NY	Family Nurse Practitioner	$330.5K	$570
Igor Gutnik	NY	Internal Medicine Physician	$295.3K	$21K
Christina Paddon	NY	Family Nurse Practitioner	$110.8K	$0
Leni Mampallil	PA	Primary Care Nurse Practitioner	$104.4K	$1.7K
Nicholas Gilfus	NY	Family Nurse Practitioner	$72.1K	$23.4K
Penny Knichel	NY	Family Nurse Practitioner	$64.6K	$0
Stephanie Comer-concordia	MD	Nurse Practitioner	$31.7K	$0
Lisa Demarche	NY	Medical Physician Assistant	$7.9K	$0
Joanna Valentine	PA	Adult Health Nurse Practitioner	$4.5K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Camelot Care Centers, LLC	TN	Community/Behavioral Health Agency	$0	$113.1M
Gastroenterology & Surgery Center Of Arkansas, Ii, LLC.	TN	Ambulatory Surgical Clinic/Center	$540K	$2.8M
Ultra Health LLC	TN	Geriatric Medicine (Internal Medicine) Physician	$0	$3.3M
Matrix Medical Plus	TN	Nurse Practitioner	$0	$3.2M

Community Care Health Network LLC — Billing Profile & Reimbursement Data

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Community Care Health Network 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