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

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

University Primary Care Practices Inc (NPI 1720220098)

Key Findings

Field	Value
Entity Type	Organization
Organization	University Primary Care Practices Inc
Address	3605 Warrensville Center Rd
City	Shaker Heights
State	OH
ZIP	44122
Taxonomy	Internal Medicine Physician
NPI Enumerated	April 1, 2009

Payer Source	Total Paid
Medicaid	$78.7M
Medicare	$0

This provider has no Medicare billing on file and is effectively a single-payer Medicaid billing entity; total Medicaid revenue on file is $78.7M. The absence of Medicare revenue means analyses of Medicare mix or cross‑payer shifts are not possible from this NPI alone and the provider’s financial footprint in the datasets is concentrated entirely in Medicaid.

Revenue concentration is high: the precomputed top three Medicaid codes (99214, 99213, 90460) account for 76.4% of this provider’s total Medicaid revenue. Those three codes alone drive $28.3M (99214), $22.1M (99213), and $6.1M (90460) in revenue, indicating a narrow set of services produces the bulk of receipts.

The code mix signals a primary care practice with a strong preventive and pediatric immunization program: high-volume established-patient office visits 99214 (544.5K claims, $52 avg paid/claim) and 99213 (566.9K claims, $39 avg paid/claim) dominate revenue, and 90460 (292.8K claims, $21 avg paid/claim) reflects very large vaccine administration volume to patients up to age 18. Together these E/M and immunization patterns are consistent with a high-throughput primary care operation that heavily serves children and established ambulatory patients.

Competitive standing in-state is dominant for core Medicaid service lines: 99214 ranks #5 of 4514 providers (100th percentile; extreme outlier, far above typical state volume), 99213 ranks #7 of 5077 providers (100th percentile; extreme outlier, far above typical state volume), and 90460 ranks #1 of 741 providers (100th percentile; extreme outlier, far above typical state volume). Multiple preventive and pediatric E/M codes (for example 99392, 99393, 99391, 99394) also fall in the 98–99th percentiles or better, indicating the provider is a major statewide player for well visits and related services.

Beyond ambulatory E/M and vaccines, the provider bills a range of ancillary and site-of-service codes that indicate operational breadth: notable volumes appear for nursing facility visits (99308, 99309), hospital inpatient/observation care (99232, 99233, 99223), and diagnostic procedures (93306, 93010). Many of these secondary codes are reported at high state percentiles (for example 99308 is an extreme outlier at the 99th percentile; 93306 and 93010 are 98th and 96th percentiles respectively), suggesting the organization delivers services across outpatient, inpatient, and post-acute settings.

The provider’s claims volumes are exceptionally large in absolute terms for Medicaid primary care: 99214 shows 544.5K claims and 99213 shows 566.9K claims, while 90460 shows 292.8K claims. These claim counts, together with the high-percentile rankings, reinforce that this NPI represents a very high-volume Medicaid outpatient practice relative to in-state peers.

Average allowed amounts on the top codes are modest, consistent with primary care and vaccine reimbursement levels: 99214 at $52 avg paid/claim, 99213 at $39 avg paid/claim, and 90460 at $21 avg paid/claim. Given the low per-claim payments, scale (very high claim counts) appears to be the primary mechanism driving the $78.7M Medicaid revenue total.

NPI tenure indicates long-standing presence: NPI enumerated 2009-04-01 (~17 years ago). This extended enumeration period, combined with the concentrated Medicaid footprint and extreme state-level volumes on multiple codes, suggests an established provider organization with sustained Medicaid-focused operations in Ohio.

Medicaid: Complete Services Breakdown

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

366 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…	544,500	$50	$28.3M
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…	566,890	$40	$22.1M
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.	292,780	$20	$6.1M
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…	50,300	$60	$2.9M
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…	53,410	$50	$2.6M
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	37,270	$60	$2.1M
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…	38,690	$50	$1.9M
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	19,630	$60	$1.2M
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…	18,230	$70	$1.2M
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…	42,920	$20	$729.7K

Showing 1–10 of 366

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Ohio Distribution

University Primary Care Practices Inc — 20 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Ohio

Full comparison — all codes billed, vs. Ohio median

366 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
69436	This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia.	30	80	100	$860	$719.1K
J0585	Injection, onabotulinumtoxina, 1 unit	32	60	250	$730	$707.7K
J2357	Injection, omalizumab, 5 mg	11	10	380	$1,250	$681.9K
42820	The provider removes the tonsils and adenoids in a patient younger than 12 years old.	34	40	100	$850	$680.6K
80050	The lab analyst performs testing for the specific group of clinical laboratory procedures in the general health panel. Payers typically consider 80050 to apply only when the clinician orders the…	38	50	220	$30	$675.9K
93303	The provider performs a complete transthoracic echocardiography to obtain images of the heart structures through the chest wall in patients born with heart defects. This study includes visualization…	21	30	620	$130	$428.2K
90837	In this service, the provider performs psychotherapy, a series of technique for treating the psychiatric disorders of the patient. The treatment session typically lasts for a minimum of 53 minutes or…	2,458	2,640	620	$90	$408.2K
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…	5	4,510	500	$60	$377.8K
80053	The lab analyst performs a comprehensive metabolic panel, or CMP test in which he measures the blood level of 14 chemicals the code descriptor lists for the panel.	189	270	8,700	$10	$353.7K
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…	7	5,080	560	$40	$323.9K

Showing 1–10 of 366

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
University Hospitals Medical Group Inc	OH	Multi-Specialty Clinic/Center	$0	$107.5M
Ohiohealth Corporation	OH	Family Medicine Physician	$0	$89.1M
Columbus Radiology Corp	OH	Diagnostic Radiology Physician	$0	$49.9M
Partners Physician Group	OH	Surgery Physician	$0	$28.5M
Behavior Health & Wellness Center, LLC	VA	Behavior Analyst	$0	$15.8M
Lake Hospital System Inc	OH	Family Medicine Physician	$0	$6.9M
Jennifer Muller	FL	Medical Oncology Physician	$1.9M	$0
Amjad Safvi	IL	Vascular & Interventional Radiology Physician	$568.9K	$765.4K
Ashley Simmons	OH	Nurse Practitioner	$783.1K	$0
Kourosh Naeini	CA	Diagnostic Radiology Physician	$709.1K	$120

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Pearl's Hope, LLC	OH	Home Health Agency	$0	$47.8M
Health Care Bridge, Inc	OH	Home Health Agency	$0	$32.3M
Cleveland Clinic Health System - East Region	OH	General Acute Care Hospital	$0	$31.5M
Altimate Care LLC	OH	Home Health Agency	$0	$24M
Signature Health, Inc	OH	Federally Qualified Health Center (FQHC)	$0	$23M
University Hospitals Ahuja Medical Center, Inc	OH	General Acute Care Hospital	$0	$21.1M
Shaker Clinic, LLC	OH	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$15.5M
Psychological & Behavioral Consultants, LLC	OH	Psychiatry Physician	$0	$14.9M
Northeast Home Health Services	OH	Home Health Agency	$0	$11.9M
Retina Associates Of Cleveland, Inc.	OH	Retina Specialist (Ophthalmology) Physician	$0	$11.2M

University Primary Care Practices Inc — 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