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

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

Summit Medical Group, Inc (NPI 1750343216)

Key Findings

Field	Value
Entity Type	Organization
Organization	Summit Medical Group, Inc
Address	1360 Dolwick Drive
City	Erlanger
State	KY
ZIP	41018
Taxonomy	Family Medicine Physician
NPI Enumerated	April 3, 2006

Payer Source	Total Paid
Medicaid	$95.1M
Medicare	$0

SUMMIT MEDICAL GROUP, INC reports no Medicare billing on file and $95.1M in lifetime Medicaid revenue, making its public billing footprint effectively single‑payer (Medicaid) at scale. The provider's NPI was enumerated on 2006-04-03 (~20 years ago), indicating a long-tenured presence in the market that aligns with the large lifetime Medicaid totals.

Medicaid revenue is highly concentrated in a small set of evaluation & management codes: the precomputed top three Medicaid codes by revenue account for 66.7% of the provider's total Medicaid revenue, driven by 99213 ($27.7M, 32.5%), 99214 ($22.3M, 26.1%), and 99232 ($6.9M, 8.1%). This concentration implies that routine established‑patient office visits and subsequent inpatient E/M visits are the core revenue drivers for the organization.

The mix of high‑revenue codes points to a broad primary care and hospital follow‑up operation: 99213 and 99214 are both high‑volume established outpatient E/M services, while 99232 (and the related inpatient E/M codes 99233, 99223, 99222) indicate substantial subsequent and initial inpatient care activity. Together these codes suggest the group delivers longitudinal family medicine across ambulatory and inpatient settings rather than a narrow specialty focus.

SUMMIT commands an outsized position in Kentucky Medicaid for many of its top codes: 99213 ranks #3 of 3339 providers (100th percentile, described as an extreme outlier), 99214 ranks #4 of 2462 (100th percentile, extreme outlier), and 99232 ranks #1 of 474 (100th percentile, extreme outlier). Multiple additional codes (for example 99233, 99223, 99254, 93010, 90833) are annotated as extreme outliers or notably above typical state volume, indicating the provider is a dominant statewide billing entity for core primary care, inpatient E/M, and several diagnostic services.

Beyond basic E/M, the provider bills materially for preventive and pediatric services and vaccinations (99392, 99391, 99393, 90460, 90471, 90461), implying a full-spectrum family medicine practice that includes routine well visits and childhood immunizations. High volumes in these preventive codes (each in high percentiles statewide) reinforce that the practice mix includes pediatric and preventive care alongside adult family medicine.

The code list shows substantial ancillary and specialty services co-located with primary care: diagnostic testing and cardiology-related procedures such as 93010 and 93306 appear in the top codes, and laboratory/testing entries like 87880 and 87426 are notably above typical state volume. This combination of outpatient E/M, diagnostics, and imaging/testing suggests operational capacity to deliver on‑site diagnostics rather than relying solely on external referrals.

Behavioral health and higher‑acuity care are also present in the billing profile: 90833 (psychotherapy add‑on) and 90792 (psychiatric evaluation) together with critical care code 99291 and consultation/inpatient consultation codes (e.g., 99254, 99244) indicate the organization bills for integrated behavioral health services and higher‑complexity inpatient/consultative encounters. These items are reported at high state percentiles, signaling notable scale across multiple service lines.

Operational scale is evident from individual claim counts reported for top codes (for example 748.4K claims for 99213 and 445.1K claims for 99214), which is consistent with a multi‑site group or system‑level operation rather than a small practice. Given the combination of single‑payer dependency (no Medicare activity) and revenue concentration in a few E/M codes, the provider appears financially sensitive to Medicaid policy or reimbursement changes that affect outpatient and inpatient E/M volumes.

Medicaid: Complete Services Breakdown

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

281 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…	748,400	$40	$27.7M
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…	445,120	$50	$22.3M
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…	248,210	$30	$6.9M
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…	104,490	$40	$4.2M
99223	The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	41,510	$80	$3.5M
99239	The provider sees a patient for hospital inpatient or observation discharge day management, involving evaluation and management (E/M). The provider spends more than 30 minutes on the service on the…	45,030	$50	$2.3M
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.	40,720	$40	$1.6M
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…	20,570	$80	$1.6M
90833	In this add–on service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient, in addition to an evaluation and management service in the…	45,450	$30	$1.5M
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…	21,980	$70	$1.5M

Showing 1–10 of 281

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Kentucky Distribution

Summit Medical Group, Inc — 24 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Kentucky

Full comparison — all codes billed, vs. Kentucky median

281 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T2023	Targeted case management; per month	486	530	530	$300	$1.1M
96413	Chemotherapy is a therapeutic procedure used for the treatment of cancer via the use of chemical agents. These chemical agents (drugs) work on the cancerous cells of the body to destroy them. These…	44	50	2,340	$200	$829.7K
H0015	Alcohol and/or drug services; intensive outpatient (treatment program that operates at least 3 hours/day and at least 3 days/week and is based on an individualized treatment plan), including…	159	230	1,750	$110	$793.5K
J0585	Injection, onabotulinumtoxina, 1 unit	6	20	460	$540	$739.9K
93306	The provider uses transducers to obtain two–dimensional (2D) images of the heart structures through the chest wall. He evaluates the anatomy and function of all four heart chambers, valves, adjacent…	10	210	1,340	$160	$568K
93458	In this procedure, the provider performs imaging supervision and interpretation for a coronary angiography with left heart catheterization and intraprocedural injections for left ventriculography. He…	49	60	170	$780	$500.2K
47562	The provider removes the gallbladder through a laparoscope, a tubular instrument with a light source and camera inserted through the abdominal wall, to treat gallbladder disease.	20	40	120	$1,340	$494.5K
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…	234	1,270	760	$80	$447.2K
43239	The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum where he removes one or more tissue biopsy specimens for diagnostic analysis.	67	170	1,300	$230	$441K
87637	The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, influenza B, and respiratory syncytial virus (RSV)…	27	50	570	$110	$393.6K

Showing 1–10 of 281

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
City Medical Of Upper East Side, PLLC	NY	Urgent Care Clinic/Center	$0	$641.6M
Glen Gejerman	NJ	Radiation Oncology Physician	$6.5M	$0
Summit Medical Group, Inc.	KY	Urgent Care Clinic/Center	$0	$4.7M
Summit Medical Group, Inc	KY	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$4.2M
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
Angelia Thompson	KY	Ophthalmology Physician	$1.8M	$381.3K
Elan Diamond	NJ	Hematology & Oncology Physician	$1.9M	$0
William Ding	NJ	Radiation Oncology Physician	$1.7M	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
St Elizabeth Medical Center, Inc	KY	Physician Assistant	$0	$3.8M
Rural Metro Of Southern Ohio Inc	KY	Land Ambulance	$910.6K	$1.8M
City Of Erlanger	KY	Ambulance	$188.4K	$469.1K
Stephen Hamilton	KY	Sports Medicine (Orthopaedic Surgery) Physician	$235.9K	$0
Justin Kruer	KY	Interventional Pain Medicine Physician	$202.2K	$0
Tyler Ryan	KY	Clinical Psychologist	$152K	$0
David Sower	KY	Sports Medicine (Emergency Medicine) Physician	$115.6K	$0
James Flanagan	KY	Emergency Medicine Physician	$80.6K	$0
Michelle Howell	KY	Optometrist	$32.1K	$0
Richard Ohmer	KY	Family Medicine Physician	$28.9K	$0

Summit Medical Group, 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