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

Why is the Medicaid comparison limited to New Jersey 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. New Jersey (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.

Sovereign Medical Group LLC (NPI 1710282082)

Sovereign Medical Group LLC is a urology physician provider located in Oradell, New Jersey. This profile covers 0 Medicare and 131 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	Sovereign Medical Group LLC
Address	680 Kinderkamack Rd
City	Oradell
State	NJ
ZIP	07649
Taxonomy	Urology Physician
NPI Enumerated	January 18, 2011

Payer Source	Total Paid
Medicaid	$8.3M
Medicare	$0

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

131 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…	45,920	$50	$2.3M
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…	20,810	$80	$1.6M
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…	9,110	$80	$747.3K
L3000	Foot, insert, removable, molded to patient model, 'ucb' type, berkeley shell, each	3,330	$200	$659.5K
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…	5,580	$110	$636.2K
76872	The provider inserts an ultrasound probe into the rectum and performs a transrectal ultrasound to assess disorders of the prostate, rectum, and surrounding tissues.	4,090	$70	$294.7K
52224	The provider inspects the urethra, prostatic urethra (in men), the interior of the bladder, and ureteric openings using a cystoscope passed through the urethra and into the bladder; he destroys…	1,090	$250	$271.7K
95913	In this procedure, the provider performs 13 or more nerve conduction studies, a diagnostic test to evaluate function, especially the electrical conduction ability of the motor and sensory nerves of…	1,150	$190	$222.3K
95886	The provider assesses the electrical activity of a muscle in the extremity and related paraspinal areas. At the same session as a separately reportable nerve conduction study. He studies five or more…	1,430	$130	$188.4K
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,…	4,080	$40	$151.1K

Showing 1–10 of 131

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. New Jersey Distribution

Sovereign Medical Group LLC — 9 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — New Jersey

Full comparison — all codes billed, vs. New Jersey median

131 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
G0481	Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but…	33	40	1,690	$70	$1.4M
87491	The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique.	120	120	900	$20	$971.9K
87591	The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique.	115	120	940	$20	$957.4K
87661	The lab analyst performs a test for Trichomonas vaginalis using nucleic acid amplified probe technique.	49	50	400	$10	$839.8K
87798	The lab analyst performs a test for an infectious agent not specified in another code using an amplified nucleic acid probe technique. Use this code if you know the laboratory technique is amplified…	64	90	630	$30	$806.2K
87624	The lab analyst performs a test to determine the presence of human papillomavirus, or HPV. The provider uses nucleic acid detection for high–risk types and produces a pooled result.	43	50	300	$20	$629.9K
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.	246	280	360	$560	$567.5K
87481	The lab analyst performs a test for Candida species using amplified nucleic acid probe technique.	26	40	390	$20	$564.3K
L3000	Foot, insert, removable, molded to patient model, 'ucb' type, berkeley shell, each	13	110	340	$200	$461.3K
87529	The lab analyst performs a test for Herpes simplex virus, HSV, using amplified nucleic acid probe technique. HSV causes clusters of blisters, or vesicles, on different parts of the body and spreads…	17	20	280	$20	$380.1K

Showing 1–10 of 131

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Hadia Ata	NJ	Anatomic Pathology & Clinical Pathology Physician	$1.8M	$0
Brendan Sullivan	NJ	Cardiovascular Disease Physician	$400.4K	$0
David Zhang	FL	Anatomic Pathology & Clinical Pathology Physician	$341.7K	$52.6K
Glenn Gmyrek	NJ	Urology Physician	$356.9K	$0
Vasiliki Saitas	NJ	Anatomic Pathology & Clinical Pathology Physician	$334.4K	$0
Ryan Cristelli	PA	Anatomic Pathology & Clinical Pathology Physician	$311.1K	$0
Alan Shienbaum	NJ	Anatomic Pathology & Clinical Pathology Physician	$302.4K	$1.1K
Nilay Shah	NJ	Clinical Neurophysiology Physician	$258.2K	$2.7K
Andranik Howhannesian	NJ	Urology Physician	$253.8K	$0
Harry Katz	NJ	Specialist	$228.7K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Sovereign Laboratory Services, LLC	NJ	Clinical Medical Laboratory	$641.8K	$1.5M
Surgicare Surgical Associates Of Oradell, LLC	NJ	Ambulatory Surgical Clinic/Center	$488.8K	$256.9K
Andrew Prince	NJ	Ophthalmology Physician	$391.2K	$1.2K
Vincent Giacalone	NJ	Foot & Ankle Surgery Podiatrist	$161.5K	$0
Fiona Gupta	NJ	Neurology Physician	$148.9K	$300
Cristina Saiz Rodriguez	NJ	Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician	$117.7K	$0
Jay Rosen	NJ	Urology Physician	$115.7K	$0
Hooman Azmi-ghadimi	NJ	Neurological Surgery Physician	$97.7K	$0
Daniel Wilkin	NJ	Family Medicine Physician	$90.5K	$0
Giorgio Rotoli	NJ	Neurological Surgery Physician	$80.9K	$0

Sovereign Medical Group LLC — 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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