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

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

City Medical Of Upper East Side, PLLC (NPI 1730491945)

Key Findings

Field	Value
Entity Type	Organization
Organization	City Medical Of Upper East Side, PLLC
Address	336 E 86th St
City	New York
State	NY
ZIP	10028
Taxonomy	Urgent Care Clinic/Center
NPI Enumerated	July 6, 2010

Payer Source	Total Paid
Medicaid	$641.6M
Medicare	$0

CITY MEDICAL OF UPPER EAST SIDE, PLLC is effectively a Medicaid-focused provider: there is no Medicare billing on file and lifetime Medicaid revenue is $641.6M, indicating the practice operates at scale within the Medicaid program rather than serving Medicare populations. The NPI was enumerated 2010-07-06 (~16 years ago), so this revenue base has been built over a multi-year tenure.

Revenue concentration is heavily skewed to a small set of codes: the precomputed top three Medicaid codes account for 73.6% of the provider's total Medicaid revenue, with 99213 ($225.5M, 35.3%), S9083 ($135.5M, 21.2%), and 99214 ($108.9M, 17.1%) together dominating the revenue mix. This concentration implies that ambulatory evaluation-and-management visits and the global urgent-care center fee are the primary revenue drivers.

The code mix (high volumes of 99213, 99214, 99203, 99202 and other E/M codes) and the provider taxonomy of Urgent Care Clinic/Center signal an operational model built around high-throughput ambulatory care and urgent visits. Large counts for acute-care procedures and supplies—such as 10060/10061 (incision and drainage), 29515 (short leg splint), and multiple radiology codes (71046, 73610, 73630)—support that minor procedures and on-site imaging are material service lines.

S9083 (868.5K claims, $156 avg paid/claim, $135.5M revenue) is reported as an "extreme outlier" and ranks #1 in-state; together with 99213 and 99214 also ranking as extreme outliers at #1, these standings indicate the provider is a dominant state-level participant for urgent care and high-volume E/M services. The repeated 100th percentile / extreme outlier labels across core codes point to unusually large market share or throughput in New York Medicaid for this practice.

Testing and episodic diagnostic services are also visible in the profile: 87426 (1M claims, $18 avg paid/claim, $18M revenue) and 87880/87804 entries appear with extremely high claim volumes and are flagged as extreme outliers for the state. While testing codes contribute a smaller share of total Medicaid revenue relative to E/M and S9083, the sheer claim counts imply a high-throughput testing capability embedded within the clinic’s operations.

Several procedure and ancillary service codes—vaccines 90471 (63K claims), 90686 (32.5K claims), chest x-ray 71046 (48.2K claims), and ECG 93000 (34.2K claims)—are reported at very high in-state percentiles (many at or near the 100th percentile). This breadth of high-volume ancillary coding reinforces that the site provides comprehensive urgent-care services beyond basic office visits, including immunizations, radiology, ECG, and wound management.

Not all codes show exceptional standing: codes such as 99211 and 99215 are described as typical or unremarkable in percentile (e.g., 99211 ranks #94 of 1655 providers, 94th percentile; 99215 ranks #82 of 2046, 96th percentile), indicating that while the provider is an extreme outlier on the core high-volume codes, some lower-revenue or higher-acuity visit codes are within a more typical statewide range. This mixed pattern suggests a focus on high-volume, lower- to moderate-complexity visits rather than predominance of high-complexity E/M encounters.

From a payer and competitive-intelligence perspective, the combination of no Medicare billing and $641.6M in Medicaid revenue — heavily concentrated in a few E/M and urgent-care global fee codes that rank as extreme outliers — positions this clinic as a specialized, high-volume Medicaid urgent-care operator in New York. Analysts evaluating network adequacy, reimbursement risk, or competitive displacement in-state should treat CITY MEDICAL as a major Medicaid player for ambulatory urgent-care and related testing services.

Medicaid: Complete Services Breakdown

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

162 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…	2,049,980	$110	$225.5M
S9083	Global fee urgent care centers	868,500	$160	$135.5M
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…	900,090	$120	$108.9M
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…	651,220	$100	$66.4M
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,…	324,550	$100	$33.1M
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…	262,870	$110	$29.2M
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,…	1,002,030	$20	$18M
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…	144,510	$90	$13.3M
87804	The analyst performs an immunoassay with direct optical, meaning visual, observation to detect influenza, also called flu, in a patient sample, typically a throat or nasal swab or nasal washings.	336,250	$10	$1.7M
87428	The lab analyst performs an immunoassay to qualitatively or semiquantitatively evaluate the patient specimen for antigens of severe acute respiratory syndrome (SARS) coronavirus, such as SARS–CoV–2…	67,970	$20	$1.2M

Showing 1–10 of 162

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. New York Distribution

City Medical Of Upper East Side, PLLC — 22 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — New York

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

162 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
S9083	Global fee urgent care centers	1	200	340	$120	$1.7M
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…	304	340	1,090	$70	$1.4M
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,…	270	300	1,710	$20	$458.6K
95165	In this procedure, the provider mixes and prepares the antigens for allergen immunotherapy. Use this code when the provider prepares one or more antigens.	154	200	470	$150	$336.9K
31231	In this procedure, the provider inserts an endoscope into the nasal cavity to examine the structures of the nasal cavity on one or both sides.	139	260	300	$170	$325.9K
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	19,110	360	$70	$321K
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	16,550	220	$90	$186.8K
99499	Use 99499 to report evaluation and management services for which there is no specific code available.	26	180	120	$90	$179K
99201	Deleted code, effective Jan. 1, 2021	10	190	90	$70	$167.3K
12011	This CPT code is used for the simple repair of superficial wounds to the face, ears, eyelids, nose, lips, and/or mucous membranes, that are 2.5 cm or less in size.	8	80	210	$320	$162.5K

Showing 1–10 of 162

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Summit Medical Group, Inc	KY	Family Medicine Physician	$0	$95.1M
Glen Gejerman	NJ	Radiation Oncology Physician	$6.5M	$0
Bader Pedemonte	NJ	Hematology (Pathology) Physician	$4.2M	$1.5K
Elizabeth Fleming	NJ	Adult Health Nurse Practitioner	$2.9M	$0
John Sylvester	FL	Radiation Oncology Physician	$2.5M	$0
Edward Rutkovsky	NY	Internal Medicine Physician	$2.1M	$10.3K
Elan Diamond	NJ	Hematology & Oncology Physician	$1.9M	$0
Matthew Weissler	NY	Hematology & Oncology Physician	$1.7M	$90
William Ding	NJ	Radiation Oncology Physician	$1.7M	$0
John Mccormick	NJ	Diagnostic Radiology Physician	$1.5M	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Omar Ahmed	NY	Neurology Physician	$1M	$1.8M
Talha Shaikh	NY	Radiation Oncology Physician	$667.1K	$659.7K
Steven Gruenstein	NY	Hematology & Oncology Physician	$1.2M	$11.4K
Andrew Rosen	NY	Adult Reconstructive Orthopaedic Surgery Physician	$1M	$0
Brenda Panzera	NY	Hematology & Oncology Physician	$922.4K	$21.8K
Amory Novoselac	NY	Hematology & Oncology Physician	$835.7K	$63.6K
Waseem Mir	NY	Specialist	$845.2K	$610
Adam Deutsch	NY	Cardiovascular Disease Physician	$771.5K	$32K
Joseph Maklansky	NY	Diagnostic Radiology Physician	$774.9K	$0
Gary Starkman	NY	Neurology Physician	$695.8K	$19.8K

City Medical Of Upper East Side, PLLC — 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