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NPI 1699720086 · Milwaukee, WI · Internal Medicine Physician
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The Medical College Of Wisconsin, Inc. is a internal medicine physician provider located in Milwaukee, Wisconsin. This profile covers 3 Medicare and 349 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.
Provider details (source: NPPES NPI Registry)
| Field | Value |
|---|---|
| Entity Type | Organization |
| Organization | The Medical College Of Wisconsin, Inc. |
| Address | 8701 Watertown Plank Rd |
| City | Milwaukee |
| State | WI |
| ZIP | 53226 |
| Taxonomy | Internal Medicine Physician |
| NPI Enumerated | May 23, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $74.8M |
| Medicare | $17.8K |
Payer mix is heavily skewed toward Medicaid: this entity reports $74.8M in lifetime Medicaid revenue versus only $17.8K in lifetime Medicare revenue, indicating Medicaid is by far the dominant payer in this provider’s billing footprint and that Medicare activity is negligible in scale. Analysts should treat this organization as effectively Medicaid-focused when evaluating revenue exposure and contracting priorities.
Medicare revenue is extremely concentrated in pathology/lab services: the top three Medicare codes (88350, 88348, 88346) account for 100.0% of the provider’s Medicare revenue, and the listed procedures are immunofluorescent and electron-microscopy pathology tests. Those three codes show typical, unremarkable national volumes (88350 and 88346 at the 87th percentile; 88348 at the 74th percentile), so the provider’s Medicare footprint appears narrow and specialized rather than broadly clinical.
Medicaid revenue shows substantial concentration in emergency and office E/M care: the top three Medicaid codes (99284, 99214, 99285) account for 48.9% of Medicaid revenue, with reported revenues of $16.4M (27.2%), $8.5M (14.1%), and $4.6M (7.6%) respectively. These codes correspond to moderate-to-high complexity ED visits and established outpatient visits, suggesting core Medicaid throughput is driven by high-volume ED and ambulatory evaluation-and-management activity.
State-level competitive standing is dominant for many Medicaid service lines: 99284 ranks #2 of 432 providers in-state (100th percentile; extreme outlier) and 99214 ranks #6 of 1628 providers in-state (100th percentile; extreme outlier). Multiple additional Medicaid codes— including 99285 (#4 of 331, 99th percentile), 99215 (#1 of 349, 100th percentile), 99233 (#2 of 173, 99th percentile), and several imaging and critical-care codes—are described as extreme outliers or notably above typical state volume, indicating this provider is a major statewide hub for acute, imaging, and higher-acuity services.
Service-line mix across Medicaid indicates a broad acute-care and diagnostic platform: high-volume codes include emergency visits (99282–99285 series), inpatient subsequent care (99233 with 95.4K claims, $2.4M revenue), critical care (99291 with 18.4K claims, $1.2M revenue), advanced imaging (70450, 74177, 70551/70553), procedural anesthesia (01967 and 00170), and specialized diagnostics (95720 EEG). This pattern is consistent with a large clinical operation that handles ED throughput, inpatient care, perioperative services, and high-volume diagnostic testing for Medicaid beneficiaries.
Medicare competitive posture is modest and specialized rather than dominant: although the provider’s Medicare pathology codes are present, their national ranks (88350 #88 of 652, 88348 #67 of 261, 88346 #88 of 700) are characterized as typical, unremarkable volume or mid‑percentile positions, so the provider is not a national leader in Medicare billing beyond concentrated lab services. Analysts evaluating Medicare programs should therefore expect minimal financial exposure and a narrow code mix tied to pathology.
The billing profile shows both concentration and scale risk on Medicaid: nearly half of Medicaid revenue is driven by three codes (48.9%), and many of the high-volume Medicaid codes are labeled “extreme outlier” or “notably above typical state volume.” From a payer perspective this implies substantial cost exposure to this single provider for emergency, inpatient, and high-acuity services within the state and warrants focused utilization and network management oversight.
Provider tenure is long-standing: the NPI was enumerated on 2006-05-23 (approximately 20 years ago), indicating a sustained presence in the claims data and suggesting the observed high Medicaid volumes reflect an established operational footprint rather than a new entrant or short-term anomaly.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
3 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 88350 | The analyst performs an immunofluorescent study using a single antibody stain procedure to detect autoimmune disease or an infectious organism in a tissue or cellular sample. Code +88350 describes… | 550 | $20 | $12K |
| 88348 | The analyst performs a procedure using a diagnostic electron microscope, which is a conventional transmission electron microscope, CTEM, to evaluate a patient’s specimen such as kidney biopsies,… | 60 | $60 | $3.2K |
| 88346 | The analyst performs an immunofluorescent study using a single antibody stain procedure to detect autoimmune disease or an infectious organism in a tissue or cellular sample. | 100 | $30 | $2.7K |
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 3 CPT/HCPCS codes.
Medicaid revenue breakdown by year and by CPT/HCPCS procedure code, including monthly billing trends and the top codes driving revenue.
View: By Year1 / 3
Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.
349 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 99284 | The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making. | 249,060 | $70 | $16.4M |
| 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… | 208,330 | $40 | $8.5M |
| 99285 | The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a high level of medical decision making. | 70,470 | $70 | $4.6M |
| 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… | 63,480 | $60 | $3.8M |
| 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… | 137,180 | $30 | $3.6M |
| 99233 | The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the… | 95,430 | $30 | $2.4M |
| 88305 | The physician, typically a pathologist, performs a level IV examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally… | 55,710 | $40 | $2.3M |
| 99282 | The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a straightforward level of medical decision making. | 66,400 | $30 | $2.2M |
| 70450 | The provider performed computed tomography, or CT scanning, of the head or brain, without contrast. He performs the procedure to diagnose any brain or intracranial abnormalities. | 51,440 | $30 | $1.6M |
| 74177 | The provider performs computed tomography of the abdomen and pelvis with contrast material to diagnose the cause of abdominal or pelvic pain or other abnormalities of the internal organs. | 29,990 | $50 | $1.4M |
Showing 1–10 of 349
How this provider's Medicaid billing volume and revenue compare to other Wisconsin providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Wisconsin median
349 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 99199 | Use this code to report other medicine services or procedures for which there is no specific code available. | 56 | 60 | 16,890 | $60 | $2.9M |
| 99283 | The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a low level of medical decision making. | 36 | 360 | 1,550 | $70 | $614.4K |
| 99284 | The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making. | 2 | 430 | 760 | $60 | $484.6K |
| 99282 | The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a straightforward level of medical decision making. | 2 | 190 | 1,790 | $90 | $390.9K |
| 96040 | Medical genetics and genetic counseling services, each 30 minutes face‑to‑face with patient/family | 5 | 10 | 2,780 | $100 | $381K |
| 36512 | Apheresis (also known as pheresis or therapeutic pheresis) is a medical procedure utilizing specialized equipment to remove selected blood constituents (plasma, leukocytes, platelets, or cells) from… | 2 | 10 | 980 | $380 | $371.5K |
| 99285 | The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a high level of medical decision making. | 4 | 330 | 1,350 | $60 | $338K |
| 90960 | The provider manages all the services associated with the monthly care of a patient who is 20 years old or older and has a condition known as end stage renal disease or ESRD. For this service, the… | 4 | 30 | 1,050 | $70 | $320.9K |
| 95720 | A physician or other QHCP reviews recorded events and analyzes spike and seizure detection of a continuous electroencephalography, a study of the electrical activity of the brain. A video is… | 1 | 10 | 1,090 | $120 | $277.4K |
| 95951 | N/A | 1 | 10 | 380 | $200 | $271.9K |
Showing 1–10 of 349
Other providers in the same ZIP code as The Medical College Of Wisconsin, Inc., ranked by combined Medicare and Medicaid revenue.
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