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

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

Prohealth Physicians PC (NPI 1720194053)

Key Findings

Field	Value
Entity Type	Organization
Organization	Prohealth Physicians PC
Address	3 Farm Glen Blvd
City	Farmington
State	CT
ZIP	06032
Taxonomy	Family Medicine Physician
NPI Enumerated	August 21, 2006

Payer Source	Total Paid
Medicaid	$80.5M
Medicare	$0

PROHEALTH PHYSICIANS PC is effectively a single‑payer Medicaid operation: there is no Medicare billing on file and the provider reports $80.5M in lifetime Medicaid revenue, indicating Medicaid dominates this entity’s payer mix and revenue base. This concentration implies business and contracting activity will be driven almost entirely by state Medicaid policy and managed‑care arrangements.

Revenue is highly concentrated in a small set of outpatient evaluation and management and immunization codes: the precomputed top three Medicaid codes account for 75.6% of total Medicaid revenue, led by 99214 ($34.3M, 43.6%), 99213 ($19.9M, 25.3%), and 90460 ($5.2M, 6.7%). These three codes alone drive the majority of dollars reported and should be the focus when modeling revenue sensitivity to utilization or reimbursement changes.

The code mix and top revenue drivers indicate a high‑volume primary care practice with strong pediatric and preventive services. Heavy use of 99214 and 99213 (combined clinical E/M volume of hundreds of thousands of claims) together with high volumes of well‑visit codes such as 99392 (37.4K claims, $4.3M, 5.4%) and 99393 (32K claims, $3.6M, 4.6%) and immunization codes 90460/90471 point to integrated family medicine care that serves both adults and children and runs significant immunization throughput.

Competitive standing in Connecticut is dominant for core primary‑care activity: 99214 ranks #1 of 1589 providers in‑state (100th percentile; extreme outlier, far above typical state volume for this code) and 99213 ranks #4 of 1714 providers in‑state (100th percentile; extreme outlier). Several other high‑volume codes also sit at top state percentiles (for example, 90460 #2 of 244, 36416 #1 of 149), signaling this practice is an outlier and a major regional provider for routine office visits and point‑of‑care procedures.

Beyond routine E/M and well visits, the practice bills substantial preventive screening, behavioral/developmental, and common laboratory services on Medicaid. Codes 96127 (67.9K claims, $1.2M, 1.6%) and 96110 (18.2K claims, $346.7K, 0.4%) show high behavioral/developmental screening activity, while lab panels like 80061 (41.2K claims, $371K, 0.5%) and 80053 (40.6K claims, $284.2K, 0.4%) indicate routine in‑office or ordered laboratory testing supporting primary‑care management.

The provider also supported high volumes of COVID testing and diagnostic services during the pandemic period, suggesting testing capacity and throughput: 87635 appears with 26K claims ($1.1M, 1.4%) and U0003 with 13.4K claims ($895.7K, 1.1%). In addition, the presence of sleep study codes 95810 (936 claims, $224.6K, 0.3%) and 95806 (1.8K claims, $161.6K, 0.2%) suggests the organization offers or coordinates select specialty diagnostic services beyond routine primary care.

Operationally, the mix of very high claim counts for low‑unit lab/point‑of‑care codes (for example, 36416 at 45K claims, $134.9K, and 85025 at 26.1K claims, $130.7K) alongside large‑dollar E/M volume implies a high‑throughput clinic model with many brief visits and on‑site specimen collection and immunization workflows. This pattern is consistent with a multi‑site or high‑panel primary care practice that manages large Medicaid patient panels and standardized preventive care workflows.

The practice’s NPI was enumerated on 2006‑08‑21 (~20 years ago), indicating long tenure in the market; combined with the provider’s extreme state rankings on multiple codes, this longevity supports the interpretation of an established, high‑volume Medicaid‑focused family medicine operation with significant competitive scale in Connecticut.

Medicaid: Complete Services Breakdown

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

186 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	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…	462,930	$70	$34.3M
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…	320,310	$60	$19.9M
90460	In this procedure, the provider administers a single live attenuated vaccine through a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age.	137,930	$40	$5.2M
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…	37,390	$110	$4.3M
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	32,000	$110	$3.6M
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…	25,240	$110	$2.8M
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	15,060	$120	$1.8M
96127	The provider performs a brief emotional/behavioral assessment of the patient using a standardized instrument (such as a recognized form). The provider scores and documents the assessment.	67,910	$20	$1.2M
87635	Using an amplified nucleic acid probe technique, the lab analyst performs the necessary steps to identify the nucleic acids from the severe acute respiratory syndrome coronavirus 2 (SARS–COV–2) virus…	26,000	$40	$1.1M
U0003	Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high…	13,370	$70	$895.7K

Showing 1–10 of 186

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Connecticut Distribution

Prohealth Physicians PC — 14 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Connecticut

Full comparison — all codes billed, vs. Connecticut median

186 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
U0003	Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high…	13	50	3,340	$60	$1M
95810	Polysomnography refers to the continuous and simultaneous monitoring and recording of various physiological and pathophysiological parameters of sleep for six or more hours with physician review,…	24	50	870	$510	$687.2K
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…	302	350	1,820	$40	$537.3K
87491	The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique.	35	50	4,240	$30	$410.4K
87591	The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique.	35	50	4,240	$30	$409.9K
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	1,590	740	$50	$331.8K
U0005	Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, cdc or non-cdc,…	16	50	4,960	$20	$273.9K
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	1,710	750	$30	$243.3K
95811	During the study, the physician monitors the sleep pattern of the patient, along with different bodily functions during the sleep cycle extending over a period of six hours or more.	29	40	210	$510	$241.3K
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…	1	170	850	$80	$203.5K

Showing 1–10 of 186

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Joshua Kellerman	NJ	Diagnostic Radiology Physician	$525K	$0
Jeffrey Wesolowski	MI	Diagnostic Radiology Physician	$251.3K	$0
William Poole	CT	Diagnostic Radiology Physician	$229.1K	$610
Talitha Travis	MN	Diagnostic Radiology Physician	$226.8K	$0
Serle Epstein	CT	Internal Medicine Physician	$203.7K	$0
David Pazer	CT	Internal Medicine Physician	$179K	$0
Emmet Ferriter	CT	Internal Medicine Physician	$172.7K	$0
Allen Davis	CT	Internal Medicine Physician	$166.3K	$0
Brian Rau	ND	Diagnostic Radiology Physician	$158.9K	$0
Stuart Genser	CT	Internal Medicine Physician	$152.8K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Interim Healthcare Of Hartford, Inc.	CT	Home Health Agency	$0	$7.9M
New Britain Medical Supplies Inc	CT	Durable Medical Equipment & Medical Supplies	$0	$3.2M
Pediatric Associates Of Farmington LLC	CT	Pediatrics Physician	$0	$2.3M
Wound Surgeons LLC	CT	General Practice Physician	$0	$2M
Thomas Ward	CT	Ophthalmology Physician	$1.3M	$0
Consulting Ophthalmologists, PC	CT	Ophthalmology Physician	$0	$1.2M
Connecticut Mental Health Specialists Inc	CT	Psychiatry Physician	$0	$1.1M
Dialysis Clinic Inc.	CT	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$1.1M
University Of Connecticut Health Center	CT	Clinical Medical Laboratory	$396.3K	$580.4K
Nauman Piracha	CT	Hospitalist Physician	$489.5K	$104.3K

Prohealth Physicians PC — Billing Profile & Reimbursement Data

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Key Findings

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References