Whc Physician Group LLC — Billing Profile & Reimbursement Data
NPI 1700154226 · Washington, DC · General Practice Physician
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Whc Physician Group LLC is a general practice physician provider located in Washington, District of Columbia. This profile covers 0 Medicare and 129 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 | Whc Physician Group LLC |
| Address | 110 Irving St Nw |
| City | Washington |
| State | DC |
| ZIP | 20010 |
| Taxonomy | General Practice Physician |
| NPI Enumerated | December 12, 2011 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $93.8M |
| Medicare | $0 |
Key Findings
WHC PHYSICIAN GROUP LLC (Washington, DC) is effectively a Medicaid-centric provider: there is no Medicare billing on file while total Medicaid revenue is $93.8M. The absence of Medicare activity indicates the entity operates with a near-single-payer footprint in the available claims data, which should shape payer-mix and network strategy analyses.
Revenue is highly concentrated in a small set of emergency and critical-care codes: the precomputed top 3 Medicaid codes account for 74.6% of the provider's Medicaid revenue, with 99285 alone representing $42.2M (45.5% of Medicaid revenue). This level of concentration signals that a few acute-care services drive most of the organization’s topline Medicaid receipts and should be the focus of utilization review and contract negotiations.
The code mix points to an emergency-department and acute-care operational profile: 99285 (329.6K claims, $128 avg paid/claim, $42.2M) and 99284 (221K claims, $98 avg paid/claim, $21.7M) together dominate revenue and reflect high-volume ED E/M activity at moderate-to-high complexity. The significant presence of 99291 (48.4K claims, $111 avg paid/claim, $5.4M) further indicates that critical care services are a material component of billed activity, consistent with frequent provision of time-intensive, high-acuity interventions.
WHC PHYSICIAN GROUP is a statewide outlier on multiple high-revenue codes: it ranks #1 in-state for 99285, 99284, and 99291 (all 100th percentile; labeled as extreme outlier), indicating the provider is a dominant Medicaid biller in DC for high-acuity ED and critical-care codes. These percentile and rank signals point to a competitive position well above typical in-state peers for those services and suggest market concentration for emergency and critical-care volume.
Beyond ED and critical care, the provider reports substantial inpatient and observation follow-up billing (e.g., 99232: 84.9K claims, $35 avg paid/claim, $3M; 99233: 51.6K claims, $51 avg paid/claim, $2.6M) with top-state percentile standings (99232 ranks #2 of 68 providers, 99th percentile; labeled extreme outlier). This mix of ED-to-inpatient follow-up codes suggests continuity of acute-care management—ED arrivals who then require admitted/observation care—rather than a pure outpatient-only practice.
WHC PHYSICIAN GROUP also bills a significant volume of outpatient E/M and ambulatory care codes (e.g., 99214: 71.8K claims, $53 avg paid/claim, $3.8M; 99213: 46.2K claims, $38 avg paid/claim, $1.8M), with 99214 appearing as an extreme outlier (rank #4 of 305, 99th percentile). The presence of high-volume office E/M codes alongside ED and inpatient codes indicates a blended service model that includes both scheduled ambulatory visits and unscheduled acute care.
Neonatal and newborn services form a modest but notable part of the billing profile (99469: 6.4K claims, $313 avg paid/claim, $2M; 99479, 99460, 99464 among others), with several neonatal codes ranking at or near the top in-state (99469 ranks #1 of 3 providers, 100th percentile). This range of perinatal/neonatal codes implies capability or contractual responsibility for newborn and neonatal critical-care follow-up in addition to adult acute services.
Tenure and operational longevity are established: the NPI was enumerated on 2011-12-12 (~15 years ago). That multi-year presence combined with persistent, high-volume Medicaid billing suggests an entrenched provider in the local Medicaid delivery system whose ED, critical care, inpatient follow-up, and select neonatal services represent the core business lines payers should prioritize for utilization monitoring and network decisions.
Medicaid: Total Revenue Breakdown by CPT/HCPCS Code
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
Medicaid: Complete Services Breakdown
Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.
129 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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. | 329,600 | $130 | $42.2M |
| 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. | 221,020 | $100 | $21.7M |
| 99291 | Critical care services include the treatment of vital organ failure or prevention of further life–threatening conditions. Delivering medical care in a moment of crisis and in time of emergency is… | 48,380 | $110 | $5.4M |
| 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. | 79,360 | $50 | $4.3M |
| 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… | 71,760 | $50 | $3.8M |
| 99232 | The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or… | 84,940 | $40 | $3M |
| 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… | 51,570 | $50 | $2.6M |
| 99469 | The provider evaluates and manages the subsequent care of a newborn or infant less than 28 days of age in a neonatal critical care setting, after the first day. | 6,420 | $310 | $2M |
| 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… | 46,230 | $40 | $1.8M |
| 99223 | The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the… | 13,570 | $100 | $1.4M |
Showing 1–10 of 129
Medicaid: Competitive Analysis & Benchmarks
How this provider's Medicaid billing volume and revenue compare to other District of Columbia providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. District of Columbia median
129 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 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. | 1 | 30 | 4,480 | $140 | $3.5M |
| 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. | 1 | 30 | 540 | $140 | $3.4M |
| 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. | 3 | 40 | 190 | $150 | $3.3M |
| 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. | 9 | 10 | 5,170 | $170 | $1.9M |
| 59025 | In this procedure, the provider measures the fetal heart rate of the fetus in response to its own movements. | 6 | 10 | 2,430 | $230 | $934.7K |
| 99469 | The provider evaluates and manages the subsequent care of a newborn or infant less than 28 days of age in a neonatal critical care setting, after the first day. | 1 | 10 | 820 | $310 | $767.1K |
| 45380 | The provider examines the rectum and colon using a flexible colonoscope, a tubular instrument with a light source and camera, to look for the cause of a patient's symptoms, which may include… | 10 | 10 | 430 | $550 | $722.1K |
| 45385 | The provider examines the colon and rectum using a colonoscope, a long, thin flexible tubular instrument with a light source and camera. He removes one or more tumors, polyps, or other lesions with a… | 9 | 10 | 170 | $770 | $618.1K |
| 43239 | The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum where he removes one or more tissue biopsy specimens for diagnostic analysis. | 14 | 20 | 310 | $530 | $605.1K |
| 99291 | Critical care services include the treatment of vital organ failure or prevention of further life–threatening conditions. Delivering medical care in a moment of crisis and in time of emergency is… | 1 | 30 | 1,050 | $120 | $581.4K |
Showing 1–10 of 129
Nearby Providers
Other providers in the same ZIP code as Whc Physician Group LLC, ranked by combined Medicare and Medicaid revenue.
Frequently Asked Questions
References
- 1.Medicare Physician & Other Practitioner by Provider and Service. CMS.gov.Provider-level Medicare Part B utilization and payment data.
- 2.NPPES NPI Registry. CMS.gov.National Provider Identifier registry used for provider enumeration and taxonomy metadata.
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