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

Why is the Medicaid comparison limited to North Carolina 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. North Carolina (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.

University Of North Carolina At Chapel Hill (NPI 1780669200)

Key Findings

Field	Value
Entity Type	Organization
Organization	University Of North Carolina At Chapel Hill
Address	101 Manning Dr
City	Chapel Hill
State	NC
ZIP	27514
Taxonomy	Anesthesiology Physician
NPI Enumerated	December 7, 2005

Payer Source	Total Paid
Medicaid	$87.6M
Medicare	$0

This billing profile is effectively single‑payer: there is no Medicare billing on file and all reported federal fee‑for‑service revenue comes from Medicaid, with total Medicaid revenue of $87.6M. The absence of Medicare transactions means analyses of payer mix, utilization and competitive position should be framed around Medicaid only rather than a dual‑payer comparison.

Revenue concentration is substantial: the precomputed top three Medicaid codes account for 33.6% of the provider’s total Medicaid revenue. Those top three codes are 99214 ($9.9M / 14.8% of Medicaid revenue), 99472 ($7.4M / 11.1%), and 99469 ($5.1M / 7.6%), signaling that a relatively small set of service lines drives a large share of revenue.

Clinical service‑line mix is dominated by neonatal and pediatric critical care: high volumes and revenue for 99472 (22.6K claims, $7.4M) and 99469 (16.5K claims, $5.1M), plus notable activity on 99479 (9.7K claims, $966.1K), indicate substantial NICU/newborn critical care capacity. These codes being among the top revenue drivers implies the provider operates significant inpatient neonatal services and follow‑up care pathways that are revenue‑significant under Medicaid.

The provider also shows very large E/M throughput across outpatient, ED, and inpatient settings, consistent with a multi‑setting clinical operation. High claim counts and revenue for office E/M codes 99214 (173.9K claims, $9.9M), 99215 (53.8K claims, $4.3M), and 99213 (92.8K claims, $3.8M) together with ED and inpatient codes 99285 (46.1K claims, $5M) and 99233 (70.7K claims, $4.9M) point to heavy outpatient and urgent/emergency care volume feeding both ambulatory and hospital care pathways.

Diagnostic and procedural capacity is also material: elevated volumes for echocardiography codes 93306 (29.7K claims, $2.1M) and 93303 (15K claims, $1.3M), imaging codes 70553 (14.4K claims, $1.1M) and 74177 (22.9K claims, $1.1M), and pathology 88305 (28.3K claims, $1.4M) indicate robust in‑house diagnostic services that support high acuity inpatient and outpatient care. This mix aligns with a provider that performs complex inpatient monitoring and imaging rather than only low‑acuity ambulatory visits.

Statewide competitive standing is strong and often dominant for Medicaid: multiple high‑revenue codes rank at or near the top in North Carolina, frequently in the 99th–100th percentile. Examples include 99472 (rank #1 of 12), 99214 (rank #6 of 4404, 100th percentile described as an extreme outlier), 99215 (rank #2 of 1128), 99233 (rank #4 of 342), and 99243 (rank #1 of 209), indicating this provider is a major Medicaid service provider in several specialty and high‑acuity categories.

Several individual codes are flagged as statistical outliers compared with in‑state peers, which points to concentrated referral patterns or centralized specialty services rather than routine primary care throughput. Codes explicitly described as “extreme outlier” or “notably above typical” in the file—such as 99214, 99233, 99215, 99213, 93306, 99291, 99244, 99239, and 70553—appear repeatedly across service lines, suggesting the provider captures disproportionate Medicaid volume for those services within the state.

The NPI was enumerated on 2005‑12‑07 (~21 years ago), reflecting long tenure in Medicaid billing. That longevity combined with concentrated high volumes and many top statewide ranks suggests entrenched clinical programs and payer relationships, which is an important consideration for network negotiations, capacity planning, and competitive analyses.

Medicaid: Complete Services Breakdown

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

410 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…	173,920	$60	$9.9M
99472	The provider performs follow up care of a critically ill infant or young child, 29 days through 24 months of age, in an inpatient setting.	22,610	$330	$7.4M
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.	16,470	$310	$5.1M
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.	46,060	$110	$5M
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…	70,660	$70	$4.9M
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.	51,060	$90	$4.4M
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…	53,840	$80	$4.3M
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…	92,820	$40	$3.8M
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…	29,650	$70	$2.1M
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…	14,850	$140	$2.1M

Showing 1–10 of 410

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. North Carolina Distribution

University Of North Carolina At Chapel Hill — 17 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — North Carolina

Full comparison — all codes billed, vs. North Carolina median

410 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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.	34	330	6,130	$130	$2.7M
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.	125	320	6,160	$120	$2.1M
T2016	Habilitation, residential, waiver; per diem	75	90	5,520	$190	$1.6M
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.	18	280	2,690	$130	$1.6M
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.	2	20	2,430	$300	$1.5M
99472	The provider performs follow up care of a critically ill infant or young child, 29 days through 24 months of age, in an inpatient setting.	1	10	1,880	$290	$1.4M
T1017	Targeted case management, each 15 minutes	50	220	1,700	$150	$1.3M
92507	The provider treats a patient with communication and hearing difficulties by directly interacting with the patient. He assesses the patient with impairment in his ability to make sounds, along with…	603	640	4,280	$60	$983.2K
99479	The provider directs the care of a recovering low birth weight infant, whose current weight is between 1500 and 2500 grams.	9	20	3,950	$100	$740.3K
H2023	Supported employment, per 15 minutes	46	70	1,950	$150	$679.8K

Showing 1–10 of 410

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
University Of North Carolina Hospitals At Chapel Hill	NC	General Acute Care Hospital	$0	$50.7M
Unc Physicians Network LLC	NC	General Practice Physician	$0	$47M
Caldwell Memorial Hospital, Inc.	NC	General Acute Care Hospital	$0	$28.8M
Rex Hospital Inc.	NC	General Acute Care Hospital	$0	$25.3M
Unc Rockingham Health Care, Inc.	NC	General Acute Care Hospital	$0	$10.3M
University Of North Carolina Hospitals At Chapel Hill	NC	Durable Medical Equipment & Medical Supplies	$0	$7.8M
Caldwell Memorial Hospital, Inc	NC	Pediatrics Physician	$0	$7.3M
Veronica Kon Graversen	MS	Retina Specialist (Ophthalmology) Physician	$3.1M	$0
Ari Isaacson	NC	Vascular & Interventional Radiology Physician	$2.8M	$0
John Deans	NC	Ophthalmology Physician	$2.4M	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Standards-based Solutions Behavioral Health Consulting	NC	Mental Health Counselor	$0	$8.3M
James Bates	NC	Radiation Oncology Physician	$656.1K	$0
William Delgado	NC	MOHS-Micrographic Surgery Physician	$515.5K	$0
Bradley Merritt	NC	MOHS-Micrographic Surgery Physician	$354.7K	$0
Stephen Goldner	NC	Internal Medicine Physician	$254.7K	$0
Jonathan Pack	NC	Diagnostic Radiology Physician	$235.2K	$0
John Wood	NC	Ophthalmology Physician	$231.7K	$0
North Carolina Cvs Pharmacy LLC	NC	Pharmacy	$217.7K	$0
Timothy Zagar	NC	Radiation Oncology Physician	$207.8K	$0
Joshua Wallace	NC	Diagnostic Radiology Physician	$206.4K	$0

University Of North Carolina At Chapel Hill — 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