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

Why is the Medicaid comparison limited to West Virginia 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. West Virginia (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 Mountain Health Physicians, Inc. (NPI 1659806602)

East Mountain Health Physicians, Inc. is a urgent care clinic/center provider located in Ranson, West Virginia. This profile covers 0 Medicare and 49 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 Mountain Health Physicians, Inc.
Address	100 Oak Lee Drive
City	Ranson
State	WV
ZIP	25438
Taxonomy	Urgent Care Clinic/Center
NPI Enumerated	April 27, 2017

Payer Source	Total Paid
Medicaid	$5.1M
Medicare	$0

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

49 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	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…	29,090	$60	$1.6M
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…	19,780	$80	$1.5M
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…	7,930	$70	$547K
87428	The lab analyst performs an immunoassay to qualitatively or semiquantitatively evaluate the patient specimen for antigens of severe acute respiratory syndrome (SARS) coronavirus, such as SARS–CoV–2…	11,250	$40	$393.8K
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…	3,090	$110	$324.3K
87430	The lab analyst performs an assay to evaluate the patient’s sample for antigens to Streptococcus, group A, using an immunoassay method, such as EIA.	14,350	$10	$186.5K
87880	The analyst performs an immunoassay with direct optical, meaning visual, observation to detect Streptococcus, group A, in a patient sample, typically a throat swab.	8,880	$20	$150.9K
87804	The analyst performs an immunoassay with direct optical, meaning visual, observation to detect influenza, also called flu, in a patient sample, typically a throat or nasal swab or nasal washings.	7,880	$20	$118.2K
87426	The lab analyst performs an immunoassay to qualitatively or semiquantitatively evaluate the patient blood specimen for antigens of severe acute respiratory syndrome coronavirus such as SARS–CoV–2,…	3,580	$30	$118.1K
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…	390	$120	$44.4K

Showing 1–10 of 49

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. West Virginia Distribution

East Mountain Health Physicians, Inc. — 6 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — West Virginia

Full comparison — all codes billed, vs. West Virginia median

49 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
80047	The lab analyst performs a basic metabolic panel (BMP) test in which he measures the blood level of eight chemicals identified in the descriptor including ionized calcium, sodium, potassium,…	7	10	160	$20	$255.3K
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…	72	1,270	1,240	$30	$245K
U0003	Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high…	33	40	730	$60	$224.8K
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…	42	1,030	890	$50	$221K
71046	In this diagnostic procedure, the provider performs a minimum of two radiological views of the chest. He performs this study for the assessment of conditions affecting the chest, its contents, and…	71	140	1,090	$20	$104.5K
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…	24	340	140	$90	$97.5K
85027	The lab analyst performs a blood count on the red and white blood cells and platelets also known as thrombocytes. He also determines the hemoglobin, typically by spectrophotometry, and the…	64	70	1,250	$20	$85K
36415	In this procedure, the provider inserts a needle into a vein to collect a blood sample.	233	330	790	$10	$64.1K
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…	50	190	110	$70	$63.4K
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…	11	440	110	$60	$57.2K

Showing 1–10 of 49

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Brandon Barrett	WA	Cardiovascular Disease Physician	$287.6K	$0
Idean Amirjazil	VA	Cardiovascular Disease Physician	$251.4K	$0
Jeffrey Skiles	VA	Cardiovascular Disease Physician	$250.5K	$0
Ethan Silver	VA	Diagnostic Radiology Physician	$249K	$0
Daniel Hobbs	VA	Cardiovascular Disease Physician	$243.3K	$0
Saif Al-najafi	VA	Cardiovascular Disease Physician	$237.1K	$0
Daniel Alexander	VA	Clinical Cardiac Electrophysiology Physician	$232.3K	$0
Daniel Reese	VA	Cardiovascular Disease Physician	$211.8K	$0
Joseph Cincinnati	WV	Orthopaedic Surgery Physician	$202.9K	$0
Melanie Mattson	VA	Cardiovascular Disease Physician	$193.6K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Jefferson Memorial Hospital	WV	Critical Access Hospital	$0	$21.6M
Jmh Emergency Physicians	WV	Emergency Medicine Physician	$0	$2.6M
Jefferson Pharmacy Inc	WV	Pharmacy	$13.8K	$2.1M
City Hospital, Inc.	WV	Internal Medicine Physician	$0	$1.9M
Jefferson County Council On Aging	WV	Home Health Agency	$0	$1.5M
Jefferson County Emergency Services Agency	WV	Land Ambulance	$336.8K	$638.2K
Jefferson Memorial Hospital	WV	Internal Medicine Physician	$0	$941.1K
Gagan Singh	WV	Ophthalmology Physician	$449K	$0
Said Sana	WV	Family Medicine Physician	$424.4K	$0
Eric Ingersoll	WV	Orthopaedic Surgery Physician	$18.1K	$69.8K

East Mountain Health Physicians, Inc. — 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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