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

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

Sussex Pulmonary And Endocrine Consultants, PA (NPI 1730355678)

Field	Value
Entity Type	Organization
Organization	Sussex Pulmonary And Endocrine Consultants, PA
Address	18947 John J Williams Hwy Unit 305
City	Rehoboth Beach
State	DE
ZIP	19971
Taxonomy	Pulmonary Disease Physician
NPI Enumerated	April 30, 2008

Payer Source	Total Paid
Medicaid	$179.7K
Medicare	$0

Medicaid: Complete Services Breakdown

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

11 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…	2,680	$50	$125.9K
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…	1,600	$30	$48K
95251	A provider analyzes and interprets data from a patient’s continuous glucose monitor (CGM) and writes a report based on interpretation. This code represents the professional component of the service…	180	$20	$3.6K
94060	The spirometry test is performed with a spirometer. The instrument displays a graphical representation, known as a spirogram, of the test results. The basic forced volume vital capacity (FVC) test is…	140	$10	$1.3K
94729	In this add on procedure, the provider tests the lungs’ diffusing capacity, the ability to exchange gases, moving oxygen into the bloodstream and letting in carbon dioxide from the bloodstream.	40	$10	$480
0012A	N/A	10	$30	$400
36416	In this procedure, the provider pricks the patient’s finger, heel, or ear with a pointed instrument and collects specimen of droplets of blood by pressing the pricking site.	1,190	$0	$0
82962	Blood glucose monitoring at home with small electronic devices is an easy method to check blood sugar level on a daily basis. The patient himself can perform the procedure and the result is obtained…	1,180	$0	$0
83036	Sugar in the bloodstream can get attached to the hemoglobin in red blood cells. Once the sugar is attached, it stays there for the lifetime of the red blood cell (around 120 days or over 3 months).…	20	$0	$0
91301	N/A	30	$0	$0

Showing 1–10 of 11

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Delaware Distribution

Sussex Pulmonary And Endocrine Consultants, PA — 0 of 6 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Delaware

Full comparison — all codes billed, vs. Delaware median

11 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…	175	500	1,130	$50	$235.1K
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…	229	540	1,100	$40	$185.3K
94060	The spirometry test is performed with a spirometer. The instrument displays a graphical representation, known as a spirogram, of the test results. The basic forced volume vital capacity (FVC) test is…	15	20	370	$50	$35.7K
83036	Sugar in the bloodstream can get attached to the hemoglobin in red blood cells. Once the sugar is attached, it stays there for the lifetime of the red blood cell (around 120 days or over 3 months).…	37	40	910	$10	$27.5K
95251	A provider analyzes and interprets data from a patient’s continuous glucose monitor (CGM) and writes a report based on interpretation. This code represents the professional component of the service…	6	10	440	$30	$23.3K
94729	In this add on procedure, the provider tests the lungs’ diffusing capacity, the ability to exchange gases, moving oxygen into the bloodstream and letting in carbon dioxide from the bloodstream.	13	10	180	$20	$14K
82962	Blood glucose monitoring at home with small electronic devices is an easy method to check blood sugar level on a daily basis. The patient himself can perform the procedure and the result is obtained…	8	20	560	$1	$9.5K
0012A	N/A	29	30	30	$10	$970
99072	The provider uses items, supplies materials, or requires clinical staff time in excess of what is normally used or provided for an office visit or other nonfacility encounter. These additional items…	9	40	140	$1	$260
36416	In this procedure, the provider pricks the patient’s finger, heel, or ear with a pointed instrument and collects specimen of droplets of blood by pressing the pricking site.	6	10	280	$1	$100

Showing 1–10 of 11

Related Providers

Other providers that share a Tax Identification Number (TIN) with Sussex Pulmonary And Endocrine Consultants, PA, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Vikas Batra	DE	Pulmonary Disease Physician	$656.4K	$0
Reetu Singh	DE	Endocrinology, Diabetes & Metabolism Physician	$267.2K	$0
Zouhair Harb	DE	Internal Medicine Physician	$132.6K	$0
Caryn Chasanov	DE	Family Nurse Practitioner	$64.4K	$0

Nearby Providers

Other providers in the same ZIP code as Sussex Pulmonary And Endocrine Consultants, PA, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Coastal Kids Pediatric Dentistry, LLC	DE	Pediatric Dentistry	$0	$9.7M
Beacon Pediatrics LLC	DE	Pediatrics Physician	$0	$3.7M
Ams Of Delaware, LLC	DE	Substance Use Disorder Rehabilitation Hospital Unit	$123.6K	$3.3M
Nouman Asif	DE	Hematology & Oncology Physician	$1.5M	$0
Delaware Eye Surgery Center, LLC	DE	Ambulatory Surgical Clinic/Center	$1.3M	$20.1K
Charles Curry	DE	Ophthalmology Physician	$605.3K	$0
Rehoboth Beach Volunteer Fire Co., Inc.	DE	Ambulance	$459.2K	$62.8K
Scott Fudemberg	DE	Ophthalmology Physician	$353.5K	$0
Arthur Belson	DE	Ophthalmology Physician	$316.3K	$0
Matthew Tulloch	DE	Family Medicine Physician	$257K	$0

Sussex Pulmonary And Endocrine Consultants, PA — Billing Profile & Reimbursement Data

Sign up for Sussex Pulmonary And Endocrine Consultants, PA — Billing Profile & Reimbursement Data policy alerts

Sussex Pulmonary And Endocrine Consultants, PA — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References