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

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

Paul N. Smith, M.d., P.A. (NPI 1629112792)

Paul N. Smith, M.d., P.A. is a specialist provider located in Bangor, Maine. This profile covers 0 Medicare and 12 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	Paul N. Smith, M.d., P.A.
Address	68 Mount Hope Ave
City	Bangor
State	ME
ZIP	04401
Taxonomy	Specialist
NPI Enumerated	February 20, 2007

Payer Source	Total Paid
Medicaid	$750.1K
Medicare	$0

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

12 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	4,970	$80	$402.8K
76816	The provider reexamines the fetus to follow up on a prior abnormal transabdominal ultrasound.	1,770	$60	$113.4K
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.	2,000	$60	$112.1K
76830	The provider performs a transvaginal ultrasound to assess the reproductive organs, that is, the uterus, fallopian tubes, ovaries, cervix, and vagina in a female patient.	490	$70	$33K
76817	The provider performs an ultrasound of the pregnant uterus to examine the fetus and the mother's organs using a transvaginal approach.	470	$60	$28K
76820	The provider performs Doppler ultrasonography for fetal surveillance to determine the velocity of blood flow through the umbilical artery. This test determines the timing of labor induction and when…	870	$30	$27.8K
76805	In this procedure, the provider performs an ultrasound of a pregnant uterus for examination of the first or a single fetus and to examine the mother after the first trimester, or more than 14 weeks…	270	$90	$23K
76813	The provider uses either a transabdominal or transvaginal ultrasound to measure the fetal nuchal translucency, or the clear, fluid–filled space at the back of the neck, of the first or a single…	110	$80	$8.4K
99395	The provider performs an established well–patient visit for a patient who is between the ages of 18 and 39.	10	$60	$710
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	$40	$540

Showing 1–10 of 12

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Maine Distribution

Paul N. Smith, M.d., P.A. — 0 of 12 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Maine

Full comparison — all codes billed, vs. Maine median

12 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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.	11	30	410	$50	$232.4K
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…	463	480	1,030	$20	$128.9K
76816	The provider reexamines the fetus to follow up on a prior abnormal transabdominal ultrasound.	11	30	640	$20	$65.2K
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…	10	170	380	$50	$63.7K
76805	In this procedure, the provider performs an ultrasound of a pregnant uterus for examination of the first or a single fetus and to examine the mother after the first trimester, or more than 14 weeks…	14	30	280	$60	$51K
76830	The provider performs a transvaginal ultrasound to assess the reproductive organs, that is, the uterus, fallopian tubes, ovaries, cervix, and vagina in a female patient.	24	50	400	$60	$45.2K
76817	The provider performs an ultrasound of the pregnant uterus to examine the fetus and the mother's organs using a transvaginal approach.	12	30	280	$30	$41.9K
96372	A therapeutic, prophylactic, or diagnostic substance (a fluid, a drug, etc.) is injected via intramuscular or subcutaneous route into the patient's body. The procedure is performed by the physician…	81	90	400	$10	$32.8K
99395	The provider performs an established well–patient visit for a patient who is between the ages of 18 and 39.	71	70	260	$30	$26.8K
76820	The provider performs Doppler ultrasonography for fetal surveillance to determine the velocity of blood flow through the umbilical artery. This test determines the timing of labor induction and when…	6	10	980	$10	$13.7K

Showing 1–10 of 12

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Eastern Maine Medical Center	ME	General Acute Care Hospital	$0	$159.3M
Creative Options, LLC	ME	Intellectual and/or Developmental Disabilities Residential Treatment Facility	$0	$78.7M
Mas Medical Staffing Corporation	ME	Community/Behavioral Health Agency	$0	$62.5M
Ohi	ME	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$61.9M
Ohi	ME	Mental Illness Community Based Residential Treatment Facility	$0	$39.6M
St. Joseph Hospital	ME	General Acute Care Hospital	$0	$38.8M
Mert Enterprises, Inc.	ME	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$36.3M
Penobscot Community Health Center	ME	Federally Qualified Health Center (FQHC)	$0	$27.3M
Amicus	ME	Developmentally Disabled Services Day Training Agency	$0	$26.1M
Branches, LLC	ME	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$25.4M

Paul N. Smith, M.d., P.A. — 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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