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

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

Mid Atlantic Pemanente Medical Group (NPI 1811062763)

Key Findings

Field	Value
Entity Type	Organization
Organization	Mid Atlantic Pemanente Medical Group
Address	2101 East Jefferson Street
City	Rockville
State	MD
ZIP	20852
Taxonomy	Health Maintenance Organization
NPI Enumerated	November 22, 2006

Payer Source	Total Paid
Medicaid	$317.3M
Medicare	$0

MID ATLANTIC PEMANENTE MEDICAL GROUP is effectively a Medicaid-centric provider: there is no Medicare billing on file while reported Medicaid revenue totals $317.3M, indicating its patient and payer mix is heavily weighted toward state Medicaid programs rather than Medicare beneficiaries. This concentration makes Medicaid reimbursement trends the primary driver of the organization’s financial performance.

Revenue concentration is high within a small set of services: the top 3 Medicaid codes by revenue account for 40.5% of total Medicaid revenue, signaling that a few outpatient E/M visits and vaccine-related services dominate their Medicaid receipts. That level of concentration suggests business focus and operational scale around primary care, preventive visits, and immunization/vaccine administration.

The code mix strongly indicates a high-volume ambulatory primary care and preventive services operation. The largest single Medicaid revenue line is 99213 ($50.7M, 24.3% of Medicaid revenue) with very large claim volume (575.7K claims), supported by 99214 ($22.6M, 10.8%) and preventive visit codes 99392/99391; together these codes reflect sustained throughput of established and well-patient office visits and routine preventive care.

Immunizations and population health services are major service lines: high revenues for vaccine codes 90670 ($11.2M) and 90471/90472 (combined significant volume and $8.9M/$4.7M respectively), plus influenza codes 90686 and pneumococcal 90677, indicate a sizeable vaccination program and likely substantial pediatric and adult preventive care activity tied to Medicaid. These immunization lines also reinforce the preventive-care emphasis implied by the preventive medicine E/M codes.

The provider is a dominant in-state Medicaid participant for many services: multiple codes rank #1 in Maryland (including 99213, 90670, 99392, 87636, 90471, 99391, 87635, 99212, 87637, 92004 and others), and many entries are labeled “extreme outlier” at the 100th percentile. That statewide dominance for high-volume ambulatory and lab/vaccine codes positions the group as a major statewide player for routine outpatient and public-health–oriented services.

High-volume lab and testing lines accompany the primary-care footprint: multiplex respiratory tests (87636, 87635, 87637), STI NAATs (87491, 87591), HIV screening (87389), and routine lab draws (36415) all appear in the top codes, often with extreme outlier or very high percentile ranks. This pattern points to in-house or closely integrated laboratory/testing throughput supporting clinical visits and public-health screening programs under Medicaid.

Service-level scale is reinforced by procedural specialty services that still tie into ambulatory care: ophthalmology E/M codes 92014 and 92004 and imaging/mammography 77067 appear among top revenue lines, each at high state percentile ranks. These entries suggest the group either includes multi-specialty clinics or coordinates volume referrals that expand its ambulatory scope beyond basic primary care.

The organization shows long tenure in administrative records: the NPI was enumerated on 2006-11-22 (about 20 years ago), indicating an established presence in the market and sufficient time to build the high-volume Medicaid networks and service lines reflected in the data. That longevity helps explain the scale and the repeated #1 statewide rankings across many codes.

Medicaid: Complete Services Breakdown

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

656 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…	575,660	$90	$50.7M
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…	179,560	$130	$22.6M
90670	This code represents a pneumococcal vaccine product administered into the muscle to protect against 13 types of pneumococcal bacteria that can cause serious infections like pneumonia, meningitis, and…	50,510	$220	$11.2M
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…	90,300	$110	$10.1M
87636	The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, and influenza B using a multiplex amplified nucleic…	106,590	$90	$10M
81420	The lab analyst performs a genomic sequence analysis panel to evaluate circulating cell free fetal DNA in maternal blood for genetic sequences of at least the genes on chromosomes 13, 18, and 21,…	13,250	$730	$9.6M
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	386,580	$20	$8.9M
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…	85,270	$100	$8.5M
87635	Using an amplified nucleic acid probe technique, the lab analyst performs the necessary steps to identify the nucleic acids from the severe acute respiratory syndrome coronavirus 2 (SARS–COV–2) virus…	122,340	$60	$6.9M
92014	An ophthalmologist sees an established patient for a comprehensive level eye examination. Generally, a patient is considered to be "established" if the same physician, or any physician in the group…	50,300	$120	$6.2M

Showing 1–10 of 656

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Maryland Distribution

Mid Atlantic Pemanente Medical Group — 25 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Maryland

Full comparison — all codes billed, vs. Maryland median

656 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
81229	The lab analyst performs the technical lab test using comparative genomic hybridization (CGH) microarray, also referred to as chromosomal microarray (CMA) or molecular karyotype performed by…	2	10	29,570	$280	$8.2M
81420	The lab analyst performs a genomic sequence analysis panel to evaluate circulating cell free fetal DNA in maternal blood for genetic sequences of at least the genes on chromosomes 13, 18, and 21,…	1	10	8,770	$640	$5.6M
87536	A lab tests a patient’s specimen to measure the amount of HIV–1 present. This may be referred to as viral load.	3	10	5,010	$80	$668.2K
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…	152	220	2,530	$60	$618.3K
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…	617	2,200	890	$110	$596.1K
86008	The lab analyst performs the technical lab test to analyze a specimen for an allergen specific immunoglobulin E (IgE), using a recombinant or purified allergen component; the result is quantitative…	1	10	5,870	$100	$589.7K
77067	The provider takes two X–ray views of each breast for routine screening and may use specially designed computer software to help identify any potential abnormalities within the images; the software…	3	50	590	$90	$493.6K
81220	The lab analyst performs the technical lab test to detect the presence of changes in the gene for cystic fibrosis transmembrane conductance regulator, also known as CFTR. The test evaluates the CFTR…	2	10	180	$230	$388.6K
80307	The lab analyst performs presumptive drug test(s) via instrumented chemistry analyzers to screen for any number of drug classes on a single date.	12	160	980	$50	$387.6K
93303	The provider performs a complete transthoracic echocardiography to obtain images of the heart structures through the chest wall in patients born with heart defects. This study includes visualization…	7	10	2,880	$100	$358.7K

Showing 1–10 of 656

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Joshua Black	SC	Dermatology Physician	$126.5K	$0
Mohammad Waris	DC	Hospitalist Physician	$17.8K	$30.8K
John Swift	DC	Diagnostic Radiology Physician	$43.3K	$200

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Adult Day Health, Inc.	MD	Adult Day Care Clinic/Center	$0	$17.5M
Montgomery County Maryland Government	MD	Local Education Agency (LEA)	$0	$12.6M
Reginald S Lourie Center For Infants & Young Children	MD	Clinic/Center	$0	$6.5M
Harcart Health Holdings, LLC	MD	Emergency Medicine Physician	$0	$5.5M
Visionary Ophthalmology LLC	MD	Ophthalmology Physician	$0	$5.2M
Jewish Social Service Agency	MD	Community Based Hospice Care Agency	$0	$4.5M
Rockville Pediatric Dental LLC	MD	Pediatric Dentistry	$0	$4.4M
Behavioral Framework, LLC	MD	Community/Behavioral Health Agency	$0	$4.3M
Vinay Desai	MD	Retina Specialist (Ophthalmology) Physician	$2.5M	$0
James Xu	MD	Hematology & Oncology Physician	$1.6M	$0

Mid Atlantic Pemanente Medical Group — Billing Profile & Reimbursement Data

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Mid Atlantic Pemanente Medical Group — 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