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.

John Franklin, M.d., P.C. (NPI 1619398765)

Field	Value
Entity Type	Organization
Organization	John Franklin, M.d., P.C.
Address	9003 Havensight Shopp Ctr
City	St Thomas
State	VI
ZIP	00802
Taxonomy	Urology Physician
NPI Enumerated	December 16, 2013

Payer Source	Total Paid
Medicaid	$45.5K
Medicare	$0

Key Findings

This provider has no Medicare billing on file and is effectively a single-payer Medicaid reporter, with total Medicaid revenue of $45.5K recorded. The absence of Medicare revenue means analyses of cross-payer mix or Medicare-driven service lines are not applicable for this NPI.

Medicaid revenue is highly concentrated: the precomputed top 3 Medicaid codes by revenue account for 100.0% of this provider’s total Medicaid revenue. The single largest contributor is 99214, which alone generates $37.8K (83.1% of Medicaid revenue) from 556 claims at $68 avg paid/claim, indicating extreme reliance on a single E/M visit level for revenue.

The top codes are all evaluation-and-management office visits (99214, 99213, 99204), which signals an outpatient, office-based urology practice focused on established-patient management rather than procedure-driven or facility-based services. The prominence of 99214 (moderate MDM or 30+ minutes) and 99213 (lower MDM or 20+ minutes) suggests routine follow-up and chronic condition management are the core service lines.

Average paid-per-claim amounts are modest for office E/M work in this dataset: $68 avg paid/claim for 99214, $52 for 99213, and $99 for 99204. These payment levels reflect typical Medicaid reimbursement for outpatient E/M visits in this provider’s billing profile and help explain why high claim counts (e.g., 556 claims for 99214) are necessary to generate the reported $45.5K total.

Competitive standing within the state is modest to typical for the practice’s main codes: 99214 ranks #22 of 43 providers in-state at the 50th percentile (characterized in the file as typical, unremarkable volume), 99213 ranks #28 of 41 at the 33th percentile (typical, unremarkable), and 99204 ranks #24 of 25 at the 4th percentile (typical, unremarkable but relatively low volume for that new-patient code). Overall, these ranks indicate the provider is not a dominant statewide performer for these E/M codes but occupies a middle-to-lower range position.

The small absolute Medicaid revenue ($45.5K) combined with long NPI tenure (enumerated 2013-12-16, ~13 years ago) suggests an established clinician with a low to moderate Medicaid caseload rather than a high-volume Medicaid-focused practice. Tenure indicates stability of enrollment even though current Medicaid billing is limited in scale.

Operationally, the billing mix shows minimal procedural or specialist-coded activity among the top revenue drivers—top codes are entirely office E/M—so the practice’s revenue is vulnerable to changes in outpatient visit volume or E/M reimbursement. With almost all Medicaid dollars coming from a narrow set of visit codes, opportunities to diversify revenue would require adding procedure-level services or other payers, neither of which appear in the provided top-code list.

Medicaid: Complete Services Breakdown

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

3 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…	560	$70	$37.8K
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…	120	$50	$6.3K
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…	10	$100	$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

John Franklin, M.d., P.C. — 0 of 3 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

3 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…	22	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…	28	40	430	$110	$260.9K
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…	24	30	80	$150	$27K

Related Providers

Other providers that share a Tax Identification Number (TIN) with John Franklin, M.d., P.C., ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
John Franklin	VI	Urology Physician	$92.3K	$0

Nearby Providers

Other providers in the same ZIP code as John Franklin, M.d., P.C., ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Duanne Jones	VI	Public Health Dentistry	$0	$33.2M
Vi Government Hospital And Health Facilities Corp	VI	General Acute Care Hospital	$0	$23.6M
The St Thomas East End Medical Center Corporation	VI	Federal Public Health Clinic/Center	$0	$12.8M
Aac-air Ambulance Caribbean Inc.	VI	Air Ambulance	$2M	$8.6M
Vi Relocation Services And Rentals LLC	VI	Land Ambulance	$0	$6.8M
Alicia Prentice	VI	Home Health Aide	$0	$3.9M
Stretcher Plus, LLC	VI	Non-emergency Medical Transport (VAN)	$0	$2.8M
Cog Restore, LLC	VI	Rehabilitation Clinic/Center	$0	$2.1M
Dept Of Health, Govt Of Vi Ems St Thomas	VI	Land Ambulance	$0	$1.5M
Vi Oral Surgery, Inc	VI	Oral and Maxillofacial Surgery (Dentist)	$0	$1.4M

John Franklin, M.d., P.C. — Billing Profile & Reimbursement Data

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John Franklin, M.d., P.C. — 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