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

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

Orthopedic And Sports Medicine Center Of Northern Indiana, Inc (NPI 1710085253)

Orthopedic And Sports Medicine Center Of Northern Indiana, Inc is a orthopaedic surgery physician provider located in Elkhart, Indiana. This profile covers 0 Medicare and 21 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	Orthopedic And Sports Medicine Center Of Northern Indiana, Inc
Address	2310 California Rd Ste A
City	Elkhart
State	IN
ZIP	46514
Taxonomy	Orthopaedic Surgery Physician
NPI Enumerated	September 20, 2006

Payer Source	Total Paid
Medicaid	$3.1M
Medicare	$0

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

21 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…	25,370	$40	$989.6K
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…	9,210	$60	$543.5K
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…	4,220	$100	$417.8K
97110	Therapeutic exercise is a form of physical therapy that utilizes specially designed exercises and activities to help patients gain better mobility and fitness levels. Normally used on patients with…	14,640	$20	$322K
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…	4,180	$60	$267.6K
97530	The provider uses various activities during direct contact with the patient to improve the patient’s functional performance. Use this code for each 15 minutes of activity.	7,090	$30	$177.3K
97112	Neuromuscular reeducation is a therapeutic treatment (exercise) performed by a physician in an attempt to reduce impairments and restore function through the application of clinical skills and/or…	7,480	$20	$171.9K
97140	Manual therapy is a form of physical therapy which uses the controlled movement and pressure of hands to treat various disorders of soft tissues and joints, eg, chronic back pain. Manual therapy…	3,150	$20	$56.7K
20610	In this procedure, the provider inserts a needle through the skin of a patient and into a major joint or bursa and then uses the syringe attachment to the needle to remove fluid or he may inject a…	1,550	$30	$46.6K
J0702	Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg	1,930	$20	$30.8K

Showing 1–10 of 21

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Indiana Distribution

Orthopedic And Sports Medicine Center Of Northern Indiana, Inc — 0 of 20 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Indiana

Full comparison — all codes billed, vs. Indiana median

21 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…	296	2,120	870	$60	$450.6K
11042	The provider uses surgical instruments to remove the dead tissue in skin down to the subcutaneous layer and including the epidermis and dermis, up to the first 20 cm2.	128	140	430	$220	$413.2K
97530	The provider uses various activities during direct contact with the patient to improve the patient’s functional performance. Use this code for each 15 minutes of activity.	67	400	1,100	$40	$382.2K
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…	156	2,380	920	$50	$376.8K
97110	Therapeutic exercise is a form of physical therapy that utilizes specially designed exercises and activities to help patients gain better mobility and fitness levels. Normally used on patients with…	39	490	1,080	$30	$162.7K
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…	45	790	150	$90	$99.4K
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…	52	890	160	$60	$76.8K
97112	Neuromuscular reeducation is a therapeutic treatment (exercise) performed by a physician in an attempt to reduce impairments and restore function through the application of clinical skills and/or…	16	210	640	$20	$74K
97140	Manual therapy is a form of physical therapy which uses the controlled movement and pressure of hands to treat various disorders of soft tissues and joints, eg, chronic back pain. Manual therapy…	75	320	760	$20	$61.7K
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,…	744	880	250	$40	$59.2K

Showing 1–10 of 21

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Asc Surgical Ventures, LLC	IN	Ambulatory Surgical Clinic/Center	$1.5M	$17.2K
Edith Cullen	IN	Sports Medicine (Family Medicine) Physician	$676.7K	$0
Asc Surgical Ventures, LLC	IN	Ambulatory Surgical Clinic/Center	$276.8K	$0
Jason Hix	IN	Sports Medicine (Family Medicine) Physician	$192.6K	$0
Ryan Foreman	IN	Sports Medicine (Family Medicine) Physician	$161.5K	$0
David Liebelt	WI	Orthopaedic Surgery Physician	$118.7K	$0
John Schramm	IN	Orthopaedic Hand Surgery Physician	$95.9K	$0
Sean Henning	IN	Podiatrist	$62.1K	$0
Megan Maloney	IN	Surgical Physician Assistant	$51K	$0
Denise Friedli	IN	Physical Therapist	$43.9K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Elkhart General Hospital, Inc.	IN	General Acute Care Hospital	$0	$25.6M
Elite Emergency Physicians Inc	IN	Emergency Medicine Physician	$0	$21.5M
Beacon Medical Group, Inc.	IN	Critical Care Medicine (Internal Medicine) Physician	$0	$4.6M
Privia Medical Group Indiana, LLC	IN	Multi-Specialty Clinic/Center	$0	$2.6M
Gordon Hughes	IN	Rheumatology Physician	$2M	$0
Ahsanul Haque	IN	Hematology & Oncology Physician	$831K	$0
Whitney Boling	IN	Ophthalmology Physician	$724K	$0
Roger Moore	IN	Dermatology Physician	$693.9K	$0
Northern Indiana Ambulatory Surgery Center	IN	Ambulatory Surgical Clinic/Center	$525.2K	$7K
Elkhart Day Surgery, LLC	IN	Ambulatory Surgical Clinic/Center	$516K	$3.6K

Orthopedic And Sports Medicine Center Of Northern Indiana, 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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