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 U.S. Virgin Islands for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to U.S. Virgin Islands 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. U.S. Virgin Islands (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.

Walter Pedersen (NPI 1780671909)

Field	Value
Entity Type	Individual
Organization	Walter Pedersen
Address	Sunny Isle Professional Building
City	St. Croix
State	VI
ZIP	00820
Taxonomy	Specialist
NPI Enumerated	October 3, 2005

Payer Source	Total Paid
Medicaid	$99.9K
Medicare	$0

Key Findings

This provider has no Medicare billing on file and operates effectively as a Medicaid-only biller, with total Medicaid revenue of $99.9K reported. The absence of any Medicare revenue means payer-mix analysis is concentrated entirely on the Medicaid program for understanding scale and exposure.

Revenue is highly concentrated in three evaluation-and-management codes: 99214, 99213, and 99204 together account for 100.0% of this provider's total Medicaid revenue. That concentration means the provider's entire billed Medicaid footprint is driven by office/outpatient E/M encounters rather than procedures or ancillary services.

The code mix (99214: $40.2K and 376 claims; 99213: $35.8K and 504 claims; 99204: $23.9K and 152 claims) points to an outpatient, cognitive-focused practice model. The dominance of 99213 and 99214 — established-patient office visits with low-to-moderate complexity — suggests everyday operations center on follow-up and management visits, while 99204 indicates a smaller volume of longer new-patient evaluations.

Average paid amounts per claim show a typical reimbursement spread for office E/M work in Medicaid: 99214 at $107 avg paid/claim, 99213 at $71 avg paid/claim, and 99204 at $157 avg paid/claim. These per-claim rates, combined with the claim volumes listed above, create the reported revenue splits (99214 = 40.3% of Medicaid revenue; 99213 = 35.8%; 99204 = 23.9%).

Competitive standing within the state is modest across the top codes: 99214 ranks #28 of 43 providers (36th percentile) and is described as "typical, unremarkable volume for this code," 99213 ranks #19 of 41 providers (55th percentile) and is likewise "typical, unremarkable volume for this code," and 99204 ranks #9 of 25 providers (67th percentile) and is also characterized as "typical, unremarkable volume for this code." These ranks indicate the provider is not a dominant statewide player for these E/M services but occupies middle-to-lower peer positions depending on the code.

The provider is long-tenured in national enrollment, with an NPI enumerated on 2005-10-03 (~21 years ago), and is listed under the Specialist taxonomy in ST. CROIX, VI. That tenure is consistent with an established office practice that has sustained a steady Medicaid-only billing profile rather than rapid recent growth or entry.

From an operational and revenue-risk perspective, the practice’s dependence on three E/M codes (which account for 100.0% of Medicaid revenue) and a modest total Medicaid revenue base of $99.9K indicates limited scale and sensitivity to changes in Medicaid policy or reimbursement for office visits. For payers and analysts, this pattern signals a small, outpatient-focused specialist whose financial performance will track closely with Medicaid visit volume and E/M reimbursement levels.

Medicaid: Complete Services Breakdown

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

3 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…	380	$110	$40.2K
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…	500	$70	$35.8K
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…	150	$160	$23.9K

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. U.S. Virgin Islands Distribution

Walter Pedersen — 0 of 3 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — U.S. Virgin Islands

Full comparison — all codes billed, vs. U.S. Virgin Islands median

3 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average 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…	28	40	560	$140	$322K
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…	19	40	430	$110	$260.9K
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…	9	30	80	$150	$27K

Related Providers

Other providers that share a Tax Identification Number (TIN) with Walter Pedersen, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Governor Juan F. Luis Hospital & Medical Center	VI	General Acute Care Hospital	$0	$15.4M
Governor Juan F. Luis Hospital & Medical Center	VI	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$3M
Sherman Washington	CA	Emergency Medicine Physician	$1.7M	$0
Jennifer Roberts	IL	Emergency Medicine Physician	$52.2K	$692.5K
Kevin Stewart	VI	Ophthalmology Physician	$469.5K	$0
Angel Lake	VI	Internal Medicine Physician	$78.2K	$249.8K
Emmanuel Graham	VI	Urology Physician	$318.4K	$0
Ian Manuel Corpus	MN	Family Medicine Physician	$314.8K	$0
Eugene Kim	MN	Diagnostic Radiology Physician	$248.2K	$16.1K
Elizabeth Delgiacco	VI	Hematology & Oncology Physician	$261.5K	$0

Nearby Providers

Other providers in the same ZIP code as Walter Pedersen, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
St Croix Vision Center Inc	VI	Optometrist	$0	$3.6M
One Dental Practice LLC	VI	Dentist	$0	$3.2M
Js Therapies, LLC	VI	Occupational Therapist	$0	$2.9M
Healthquest, LLC.	VI	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$2.4M
Department Of Health, Ems Stx	VI	Land Ambulance	$0	$2.2M
Lindsy Wagner LLC	VI	Clinical Social Worker	$0	$2.2M
Ophthalmology Consultants, PC	VI	Ophthalmology Physician	$0	$2.1M
Acute Alternative Medical Group	VI	Emergency Medical Services (Emergency Medicine) Physician	$0	$1.9M
Pediatric Care Center LLC	VI	Pediatrics Physician	$0	$1.7M
Island Dental Specialties Dba Toothworks	VI	Endodontics	$0	$1.5M

Walter Pedersen — Billing Profile & Reimbursement Data

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Walter Pedersen — 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