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.

Mainehealth (NPI 1629382601)

Field	Value
Entity Type	Organization
Organization	Mainehealth
Address	5 Bucknam Rd
City	Falmouth
State	ME
ZIP	04105
Taxonomy	Pediatrics Physician
NPI Enumerated	August 2, 2010

Payer Source	Total Paid
Medicaid	$6.6M
Medicare	$0

Medicaid: Complete Services Breakdown

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

101 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
G0463	Hospital outpatient clinic visit for assessment and management of a patient	32,820	$100	$3.1M
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…	8,990	$60	$548.6K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	15,290	$30	$473.8K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	7,580	$60	$462.1K
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…	6,890	$60	$413.3K
G0008	Administration of influenza virus vaccine	12,220	$30	$403.4K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	5,190	$60	$326.9K
90832	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…	2,330	$110	$258.5K
G0009	Administration of pneumococcal vaccine	4,300	$30	$137.4K
99395	The provider performs an established well–patient visit for a patient who is between the ages of 18 and 39.	1,140	$60	$72.1K

Showing 1–10 of 101

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

Mainehealth — 6 of 25 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

101 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
G0463	Hospital outpatient clinic visit for assessment and management of a patient	21	60	18,740	$60	$4.6M
87636	The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, and influenza B using a multiplex amplified nucleic…	27	30	2,740	$40	$102.8K
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…	7	70	1,060	$40	$97K
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…	6	70	1,000	$40	$91K
90847	A provider meets with the patient’s family with the patient present to counsel the family on the psychological issues affecting the patient and the family. The provider supplies psychotherapy to the…	22	30	240	$60	$74.9K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	3	80	540	$40	$61.6K
90791	In this service, the provider performs a psychiatric evaluation of the patient with the aim of making a diagnosis.	21	80	90	$50	$53.3K
90832	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…	40	140	670	$20	$48.8K
80061	The lab analyst performs a lipid panel test in which he measures the blood level of cholesterol and fats called triglycerides in the blood.	53	60	6,050	$10	$47.4K
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…	121	130	760	$20	$46.4K

Showing 1–10 of 101

Related Providers

Other providers that share a Tax Identification Number (TIN) with Mainehealth, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Mainehealth	ME	General Acute Care Hospital	$0	$142.6M
Mainehealth	ME	Community/Behavioral Health Agency	$0	$115M
Mainehealth	ME	General Acute Care Hospital	$0	$70.7M
Mainehealth	ME	General Acute Care Hospital	$0	$40M
Mainehealth	ME	General Acute Care Hospital	$0	$31.5M
Mainehealth	ME	General Acute Care Hospital	$0	$22.7M
Mainehealth	ME	Rural Health Clinic/Center	$0	$16.7M
Mainehealth	ME	Multi-Specialty Clinic/Center	$0	$10.9M
Mainehealth	ME	Rural Health Clinic/Center	$0	$10M
Mainehealth	ME	Rural Health Clinic/Center	$0	$9.8M

Nearby Providers

Other providers in the same ZIP code as Mainehealth, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Community Dental	ME	Dentist	$0	$11.3M
Falmouth Pediatric Dentistry	ME	Pediatric Dentistry	$0	$5.2M
Medco Respiratory Instruments, Inc	ME	Durable Medical Equipment & Medical Supplies	$0	$4.3M
Mainehealth	ME	Orthopaedic Surgery Physician	$0	$2.1M
Children's Dentistry Of Maine	ME	Pediatric Dentistry	$0	$965.3K
Storeysmith Pediatric Clinic	ME	Speech-Language Pathologist	$0	$499.8K
Town Of Falmouth	ME	Land Ambulance	$154.9K	$76.1K
Adam Rana	ME	Orthopaedic Surgery Physician	$159.4K	$0
Nicholas Colacchio	ME	Orthopaedic Surgery Physician	$143.4K	$0
Stephen Rodrigue	ME	Orthopaedic Surgery Physician	$120.5K	$0

Mainehealth — Billing Profile & Reimbursement Data

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Mainehealth — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References