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

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

Edward Madsen (NPI 1689635914)

Field	Value
Entity Type	Individual
Organization	Edward Madsen
Address	590 E 100 N
City	Price
State	UT
ZIP	84501
Taxonomy	Pediatrics Physician
NPI Enumerated	March 28, 2006

Payer Source	Total Paid
Medicaid	$409.7K
Medicare	$0

Medicaid: Complete Services Breakdown

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

8 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…	4,560	$60	$278.2K
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…	1,020	$90	$87.5K
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…	430	$70	$27.7K
99212	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,…	180	$40	$7K
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…	90	$80	$6.5K
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.	270	$10	$1.6K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	10	$70	$890
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.	70	$1	$280

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Utah Distribution

Edward Madsen — 0 of 8 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Utah

Full comparison — all codes billed, vs. Utah median

8 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…	316	1,340	200	$80	$144K
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…	98	1,360	190	$70	$125K
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…	78	220	200	$80	$74K
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…	108	190	150	$80	$58.1K
99212	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,…	51	170	80	$100	$35.2K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	132	150	60	$70	$32.2K
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.	78	200	150	$10	$5.7K
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.	61	120	70	$10	$1.5K

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Four Corners Community Behavioral Health, Inc.	UT	Community/Behavioral Health Agency	$0	$19.5M
Castleview Hospital LLC	UT	Rural Acute Care Hospital	$0	$6M
Four Corners Community Behavioral Health, Inc.	UT	Community/Behavioral Health Agency	$0	$2.8M
Shane D Gagon Md, PC	UT	Family Medicine Physician	$0	$2.5M
County Of Carbon	UT	Land Ambulance	$322.9K	$1.8M
A Perfect Smile	UT	Dental Clinic/Center	$0	$1M
Four Corners Community Behavioral Health Inc	UT	Methadone Clinic	$0	$817.1K
West Emergency Services, LLC	UT	Emergency Medicine Physician	$0	$810.3K
Southeastern Utah District Health Department	UT	Public Health or Welfare Agency	$28.8K	$666.5K
Castleview Physician Practice, LLC	UT	Family Medicine Physician	$0	$653.9K

Edward Madsen — Billing Profile & Reimbursement Data

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Edward Madsen — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Nearby Providers

Frequently Asked Questions

References