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.

Urgent Care Medical Associates, LLC (NPI 1730479254)

Key Findings

Field	Value
Entity Type	Organization
Organization	Urgent Care Medical Associates, LLC
Address	31 Old Route 7
City	Brookfield
State	CT
ZIP	06804
Taxonomy	Urgent Care Clinic/Center
NPI Enumerated	April 18, 2011

Payer Source	Total Paid
Medicaid	$39.9M
Medicare	$0

This provider is effectively a Medicaid-only biller: there is no Medicare revenue on file and the provider reports $39.9M in lifetime Medicaid revenue, so payer analysis and contracting should treat this entity as single‑payer (Medicaid)-focused. The practice has an NPI enumerated 2011-04-18 (~15 years ago), indicating an established presence in the market.

Revenue is highly concentrated in office/outpatient evaluation-and-management codes: the precomputed top three Medicaid codes (99214, 99213, 99203) account for 61.8% of the provider’s total Medicaid revenue. Specifically, 99214 generated $11.5M (28.7%), 99213 generated $6.8M (16.9%), and 99203 generated $6.5M (16.2%), showing E/M visits are the primary revenue drivers.

The specific code mix — dominated by high volumes of 99214, 99213, 99203 and other E/M codes like 99204 and 99202 — plus large volumes of point-of-care and multiplex respiratory testing (87636, 87426, 87631) is consistent with an urgent care clinic model that prioritizes high patient throughput, walk-in/episodic care, and on-site diagnostic testing. The presence of pregnancy testing (81025), strep testing (87651, 87880), and chest x-ray (71046) further supports a broad urgent-care service line offering.

Competitive standing within Connecticut is dominant for core E/M codes: 99214 is ranked #13 of 1589 providers (99th percentile; extreme outlier), 99213 is #24 of 1714 (99th percentile; extreme outlier), and 99203 is #2 of 475 (100th percentile; extreme outlier). These ranks indicate this provider operates at far higher state volume for these outpatient visit codes than typical peers and should be viewed as a statewide volume leader for E/M visits.

The practice is also a clear statewide leader in diagnostic testing and after-hours services. 87636 (multiplex SARS–CoV–2/Influenza A/B testing) is ranked #1 of 28 providers (100th percentile; extreme outlier) with $2.6M revenue, 87651 (Strep A NAAT) is #1 of 61 providers (100th percentile; extreme outlier) with $720.9K revenue, and 99051 (after-hours visits) has 147.3K claims and ranks #1 of 104 providers (100th percentile; extreme outlier), signaling unusually high offering of extended-hour access and test-driven visits.

Operational scale is evident in claim volumes and low average paid-per-claim economics: examples include 150.7K claims for 99214 at $76 avg paid/claim, 129.8K claims for 99213 at $52 avg paid/claim, and 147.3K claims for 99051 at $6 avg paid/claim. These figures suggest the business model relies on very high visit and test throughput to generate the reported $39.9M Medicaid revenue.

Although the top three codes are the largest concentration (61.8%), the provider also reports sizable revenue from additional high-complexity new-patient visits: 99204 generated $6.4M (16.0%) and ranks #1 of 476 providers (100th percentile; extreme outlier). This indicates the operation handles a substantial share of moderate-complexity new-patient encounters in-state, not just low-complexity walk-in visits.

For payers and network planners, the combination of long tenure (~15 years), Medicaid-only revenue, and repeated extreme-outlier rankings across both E/M and diagnostic codes suggests this location is a major Medicaid network asset for urgent-care access and testing capacity in Connecticut; risk assessment, rate setting, and network adequacy reviews should account for its outsized visit and testing volumes relative to peers.

Medicaid: Complete Services Breakdown

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

36 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…	150,740	$80	$11.5M
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…	129,820	$50	$6.8M
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…	82,790	$80	$6.5M
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…	55,840	$110	$6.4M
87636	The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, and influenza B using a multiplex amplified nucleic…	24,810	$110	$2.6M
87426	The lab analyst performs an immunoassay to qualitatively or semiquantitatively evaluate the patient blood specimen for antigens of severe acute respiratory syndrome coronavirus such as SARS–CoV–2,…	50,940	$30	$1.4M
99051	The provider sees a patient during regular office hours that occur outside of traditional office hours, i.e., in the evening, on a weekend, or on a holiday.	147,320	$10	$883.9K
87631	The lab analyst performs the technical steps to detect three to five types or subtypes of pathogens, such as adenovirus, influenza virus, coronavirus, metapneumovirus, parainfluenza virus,…	7,650	$100	$742.3K
99202	The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves straightforward medical decision making, and/or the provider…	12,910	$60	$723.1K
87651	The lab analyst performs a test for the bacteria Streptococcus, group A, using amplified nucleic acid probe technique. Strep A commonly causes acute pharyngitis, or strep throat.	26,700	$30	$720.9K

Showing 1–10 of 36

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

Urgent Care Medical Associates, LLC — 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

36 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
87636	The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, and influenza B using a multiplex amplified nucleic…	1	30	730	$110	$343.7K
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…	13	1,590	740	$50	$331.8K
71046	In this diagnostic procedure, the provider performs a minimum of two radiological views of the chest. He performs this study for the assessment of conditions affecting the chest, its contents, and…	74	130	600	$30	$329.2K
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…	24	1,710	750	$30	$243.3K
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…	13	140	780	$40	$163.2K
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…	2	480	200	$60	$112.1K
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…	1	480	150	$90	$100.9K
87426	The lab analyst performs an immunoassay to qualitatively or semiquantitatively evaluate the patient blood specimen for antigens of severe acute respiratory syndrome coronavirus such as SARS–CoV–2,…	3	90	380	$30	$100.9K
87811	The lab analyst performs the technical lab test to analyze for the presence of severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2) (Coronavirus disease [COVID–19]) in a specimen by…	2	70	380	$30	$65.4K
87631	The lab analyst performs the technical steps to detect three to five types or subtypes of pathogens, such as adenovirus, influenza virus, coronavirus, metapneumovirus, parainfluenza virus,…	2	30	440	$30	$44.9K

Showing 1–10 of 36

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Shahin Gharib	NY	Emergency Medicine Physician	$291.6K	$7.5K
David Peregrim	CT	Medical Physician Assistant	$87.5K	$0
Lynn Baylis	CT	Physician Assistant	$85.3K	$0
Christine Cannata	CT	Physician Assistant	$65.8K	$0
Waseem Shahid	CT	Family Medicine Physician	$63K	$0
Christie Roberts	CT	Emergency Medicine Physician	$61.9K	$0
Stephen Pollani	CT	Medical Physician Assistant	$59.9K	$0
Sedhene Robinson	CT	Physician Assistant	$50.7K	$0
Bernd Woerner	CT	Emergency Medicine Physician	$47.4K	$0
Andrew Baginski	CT	Medical Physician Assistant	$47.3K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Scott A. Bialik, Dds LLC	CT	Pediatric Dentistry	$0	$1.5M
The Child & Family Institute Of Fairfield County	CT	Mental Health Counselor	$0	$1.1M
Larry Wasser	CT	Pulmonary Disease Physician	$322.4K	$335.3K
The Brookfield Volunteer Fire Company Inc	CT	Land Ambulance	$284.8K	$364K
Antonio Paz	CT	Anesthesiology Physician	$543K	$0
Sanjay Gupta	CT	Orthopaedic Surgery Physician	$397.9K	$0
Ganesh Natarajan	CT	Pulmonary Disease Physician	$137.8K	$185.8K
Daniel Fish	CT	Orthopaedic Surgery Physician	$178.6K	$0
Valdet Nikci	CT	Orthopaedic Surgery Physician	$176.1K	$0
Irene Moreira	CT	Internal Medicine Physician	$26.6K	$136.3K

Urgent Care Medical Associates, LLC — Billing Profile & Reimbursement Data

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Urgent Care Medical Associates, LLC — 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