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

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

Umass Memorial Medical Group Inc (NPI 1760445373)

Key Findings

Field	Value
Entity Type	Organization
Organization	Umass Memorial Medical Group Inc
Address	55 Lake Ave N
City	Worcester
State	MA
ZIP	01655
Taxonomy	Internal Medicine Physician
NPI Enumerated	April 7, 2006

Payer Source	Total Paid
Medicaid	$98.5M
Medicare	$0

This provider has no Medicare billing on file and reports $98.5M in lifetime Medicaid revenue, making it effectively single‑payer (Medicaid) in the available claims data; that concentration means Medicaid policy and rate changes would directly affect the majority of its recorded revenue. The absence of Medicare activity distinguishes its payer mix from typical multisource health systems and signals Medicaid as the primary revenue channel in the dataset.

Revenue is highly concentrated in a small set of outpatient evaluation-and-management codes: the top three Medicaid codes (99214, 99284, 99213) together account for 51.4% of the provider’s total Medicaid revenue. Individually those codes generated $17.1M (99214, 21.3%), $13.6M (99284, 16.9%), and $10.5M (99213, 13.1%), indicating that a majority of Medicaid dollars flow through routine office visits and emergency department E/M services.

The code mix shows a large, integrated acute-care footprint: extremely high volumes of ED E/M codes (99284: 188.6K claims; 99285: 82.4K claims; 99283: 37.3K claims) alongside substantial inpatient visit codes (99233: 150.8K claims; 99232: 105.6K claims; 99223: 17.8K claims). Combined with outpatient office visits (99214: 356K claims; 99213: 292.4K claims) this pattern is consistent with an organization that operates emergency, inpatient, and ambulatory services at scale rather than a narrowly focused clinic.

The provider is a dominant statewide performer for many high-revenue codes, frequently ranking in the top percentiles: examples include 99233 (rank #1 of 261, 100th percentile, extreme outlier), 99469 (rank #1 of 8, 100th percentile, notably above typical state volume), 99284 (rank #2 of 827, 100th percentile, extreme outlier), and 99214 (rank #6 of 5039, 100th percentile, extreme outlier). These rank and percentile signals indicate market leadership across multiple service lines within Massachusetts Medicaid.

Several codes point to specialty and high-acuity services beyond routine visits: critical care 99291 produced $2.4M (28.9K claims) and ranks #2 of 153 providers (99th percentile, extreme outlier), while neonatal codes 99469 ($2.4M, 8.5K claims, rank #1 of 8) and 99479 ($718.9K, 8K claims, rank #1 of 14) show significant NICU/newborn care volume. These line items suggest the provider treats medically complex patients and delivers time-intensive, high-acuity care.

The dataset also shows substantial ancillary and diagnostic service volumes that support an acute-care platform: high counts and revenue for CT abdomen/pelvis 74177 (33.8K claims, $1.5M), surgical pathology 88305 (38.3K claims, $1.2M), transthoracic echo 93306 (30.8K claims, $863.1K), and ECG interpretation 93010 (232.2K claims, $928.9K). This profile is consistent with on-site imaging, lab, and cardiology support for inpatient and ED workflows.

Operational scale is evident in claim volumes and average payments: for example, 99214 has 356K claims at $48 avg paid/claim and 99213 has 292.4K claims at $36 avg paid/claim, demonstrating large patient throughput in ambulatory settings. These volumes imply significant visit-level capacity and likely complex billing operations to support high-frequency E/M services.

The provider’s NPI was enumerated on 2006-04-07 (~20 years ago), indicating long tenure in the market; combined with the code-level dominance and breadth of services, this tenure supports the interpretation of an established, large-scale regional care provider. At the same time, the reliance on Medicaid revenue and on a concentrated set of high-volume codes (top three = 51.4% of Medicaid revenue) represents both a competitive strength in the Medicaid market and a financial concentration risk if payer dynamics change.

Medicaid: Complete Services Breakdown

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

400 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…	356,010	$50	$17.1M
99284	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making.	188,570	$70	$13.6M
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…	292,410	$40	$10.5M
99285	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a high level of medical decision making.	82,400	$80	$6.7M
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…	150,840	$40	$5.7M
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…	105,620	$30	$2.6M
99291	Critical care services include the treatment of vital organ failure or prevention of further life–threatening conditions. Delivering medical care in a moment of crisis and in time of emergency is…	28,890	$80	$2.4M
99469	The provider evaluates and manages the subsequent care of a newborn or infant less than 28 days of age in a neonatal critical care setting, after the first day.	8,490	$280	$2.4M
99215	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the…	31,150	$60	$1.9M
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…	33,430	$50	$1.7M

Showing 1–10 of 400

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Massachusetts Distribution

Umass Memorial Medical Group Inc — 23 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Massachusetts

Full comparison — all codes billed, vs. Massachusetts median

400 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99285	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a high level of medical decision making.	11	520	120	$130	$1M
99283	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a low level of medical decision making.	39	550	110	$120	$865.5K
42820	The provider removes the tonsils and adenoids in a patient younger than 12 years old.	5	20	130	$1,630	$701.7K
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.	68	120	530	$450	$681.5K
99284	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making.	2	830	130	$120	$671K
J9035	Injection, bevacizumab, 10 mg	20	30	210	$690	$668.3K
90834	In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere…	90	1,620	580	$80	$599.6K
45380	The provider examines the rectum and colon using a flexible colonoscope, a tubular instrument with a light source and camera, to look for the cause of a patient's symptoms, which may include…	66	100	260	$550	$524.4K
45385	The provider examines the colon and rectum using a colonoscope, a long, thin flexible tubular instrument with a light source and camera. He removes one or more tumors, polyps, or other lesions with a…	62	100	230	$600	$511.3K
74177	The provider performs computed tomography of the abdomen and pelvis with contrast material to diagnose the cause of abdominal or pelvic pain or other abnormalities of the internal organs.	7	220	280	$100	$491.2K

Showing 1–10 of 400

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Umass Memorial Mri & Imaging Center, LLC	MA	Magnetic Resonance Imaging (MRI) Clinic/Center	$3.8M	$8.1M
Stephen Lyle	MA	Anatomic Pathology Physician	$852.2K	$40.3K
Srini Vasan	OH	Radiation Oncology Physician	$807K	$0
Karen Jeng-miller	MA	Ophthalmology Physician	$698.7K	$0
Seema Sahib	MA	Internal Medicine Physician	$635.4K	$7.5K
Andrew Bouley	MA	Neurology Physician	$602.8K	$0
Jeffrey Potter	MA	Diagnostic Radiology Physician	$355.4K	$201.1K
Vivek Sehgal	NJ	Diagnostic Radiology Physician	$281.4K	$265.1K
David Geist	MA	MOHS-Micrographic Surgery Physician	$516.3K	$0
Yasir Al-azzawi	FL	Gastroenterology Physician	$488.9K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Umass Memorial Medical Center, Inc.	MA	General Acute Care Hospital	$0	$490.8M
Hesham Malik	MA	Diagnostic Radiology Physician	$3.9M	$0
Bradley Switzer	MA	Internal Medicine Physician	$524.2K	$0
Ilsa Grunder	MA	Nurse Practitioner	$419.2K	$0
Erica Ghosh	MA	Diagnostic Radiology Physician	$286.3K	$110K
Matthew Peckham	MA	Diagnostic Radiology Physician	$348.3K	$1.1K
Umass Memorial Mri & Imaging Center, LLC	MA	Magnetic Resonance Imaging (MRI) Clinic/Center	$102.9K	$216.4K
Thomas Fitzgerald	MA	Radiation Oncology Physician	$293.9K	$0
Ryan Holstead	MA	Hematology & Oncology Physician	$270.2K	$7.6K
Robert Lee	MA	Diagnostic Radiology Physician	$269.3K	$0

Umass Memorial 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