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.

Delaware Medical Care Associates LLC (NPI 1740230309)

Delaware Medical Care Associates LLC is a pulmonary disease physician provider located in Newark, Delaware. This profile covers 0 Medicare and 16 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.

Medicaid: Complete Services Breakdown

Field	Value
Entity Type	Organization
Organization	Delaware Medical Care Associates LLC
Address	537 Stanton Christiana Rd
City	Newark
State	DE
ZIP	19713
Taxonomy	Pulmonary Disease Physician
NPI Enumerated	May 12, 2006

Payer Source	Total Paid
Medicaid	$479.8K
Medicare	$0

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

16 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…	7,030	$50	$344.3K
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…	760	$50	$35K
99454	The provider supplies one or more devices for remote physiologic monitoring that occurs for 16 to 30 days in a 30–day period.	350	$40	$12.7K
99457	The provider manages treatment using data from remote physiologic monitoring. The service requires at least one real–time interactive communication with the patient or caregiver during the month and…	440	$30	$12.2K
95806	A technologist is not in attendance during this sleep study, which involves measuring several parameters while the patient sleeps in a clinic or sleep lab to help diagnose sleep disorders.	220	$50	$12.1K
99233	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	220	$50	$11.2K
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…	220	$50	$10K
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…	350	$30	$9.2K
94726	The provider performs a pulmonary function test, or PFT, to determine the patient’s lung volumes, such as total lung capacity, residual volume, and functional residual capacity. The testing also may…	350	$30	$8.8K
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…	520	$20	$8.3K

Showing 1–10 of 16

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

Delaware Medical Care Associates LLC — 0 of 16 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

16 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99233	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	34	50	1,030	$60	$292.3K
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…	46	80	940	$30	$277.8K
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,…	10	10	410	$480	$250.4K
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…	91	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…	386	540	1,100	$40	$185.3K
99222	The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	52	70	260	$60	$96.7K
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…	51	190	240	$60	$90.8K
99211	An established patient presents for an office or other outpatient visit that may not require the presence of a physician or other qualified healthcare professional.	46	70	180	$20	$66.8K
99454	The provider supplies one or more devices for remote physiologic monitoring that occurs for 16 to 30 days in a 30–day period.	5	10	300	$50	$51.2K
99457	The provider manages treatment using data from remote physiologic monitoring. The service requires at least one real–time interactive communication with the patient or caregiver during the month and…	6	10	220	$40	$49.9K

Showing 1–10 of 16

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Associated Retinal Consultants LLC	DE	Ophthalmology Physician	$0	$25.2M
Columbus Medical Services, LLC	DE	Case Management Agency	$0	$18.7M
Christiana Care Health Services Inc	DE	Hospitalist Physician	$0	$13.6M
Caritas Home Health Services, Inc	DE	Home Health Agency	$0	$11.2M
Delaware Center For Maternal Fetal Medicine Of Christiana Care	DE	Maternal & Fetal Medicine Physician	$0	$9.8M
Christiana Care Health Services Inc	DE	Neonatal-Perinatal Medicine Physician	$0	$8.9M
Medical Oncology Hematology Consultants PA	DE	Hematology & Oncology Physician	$0	$7.7M
Christiana Care Quality Partners	DE	Urgent Care Clinic/Center	$0	$7M
Jamal Misleh	DE	Hematology & Oncology Physician	$6.8M	$0
Mid-atlantic Behavioral Health, LLC	DE	Intellectual & Developmental Disabilities Psychologist	$0	$6.5M

Delaware Medical Care Associates LLC — Billing Profile & Reimbursement Data

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Delaware Medical Care Associates LLC — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

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