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

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

Physicians Clinic Inc (NPI 1821049156)

Key Findings

Field	Value
Entity Type	Organization
Organization	Physicians Clinic Inc
Address	10060 Regency Cir
City	Omaha
State	NE
ZIP	68114
Taxonomy	Family Medicine Physician
NPI Enumerated	May 12, 2006

Payer Source	Total Paid
Medicaid	$20.5M
Medicare	$0

This provider is effectively single‑payer in scope: there is no Medicare billing on file and Medicaid accounts for all reported lifetime revenue at $20.5M. The absence of Medicare activity means analyses of Medicare risk, rehospitalization exposure, or dual‑eligible mix cannot be performed from these files; operational conclusions should focus on Medicaid contracting and utilization dynamics.

Revenue concentration is high: the precomputed top‑3 Medicaid codes account for 66.3% of this provider's total Medicaid revenue, indicating that a small set of office and preventive visit codes drive the bulk of income. That concentration suggests financial sensitivity to changes in outpatient E/M and preventive visit reimbursement or utilization patterns.

The code mix (99213, 99214, 99391 as the three largest contributors) aligns with a high‑volume primary care/family medicine practice model: 99213 reports 168.8K claims, $44 avg paid/claim, $7.4M revenue (38.2% of Medicaid revenue); 99214 reports 81.2K claims, $53 avg paid/claim, $4.3M revenue (22.1%); and 99391 reports 14.8K claims, $79 avg paid/claim, $1.2M revenue (6.0%). This pattern points to a heavy emphasis on established‑patient management and routine preventive care rather than specialty procedural services.

Competitive standing in Nebraska is dominant for core outpatient work: 99213 ranks #3 of 696 providers in‑state (100th percentile; extreme outlier) and 99214 ranks #4 of 596 (99th percentile; extreme outlier), meaning PHYSICIANS CLINIC INC operates at volumes far above typical state peers for basic E/M services. Preventive visits like 99391 also rank highly (#2 of 69, 99th percentile; notably above typical), reinforcing the provider's role as a leading source of primary and preventive care for Medicaid enrollees.

There are multiple marked outliers in ancillary services that support a broad outpatient practice footprint: 90471 (vaccination administration) is #1 of 118 providers in‑state (100th percentile; extreme outlier) with 28.5K claims, $11 avg paid/claim, $313.9K revenue, and 87502 (multiplex influenza testing) is #1 of 65 (100th percentile; extreme outlier) with 3.9K claims, $88 avg paid/claim, $340.2K revenue. High volumes in immunization and point‑of‑care testing suggest on‑site preventive and respiratory‑illness workflows that drive visit volumes and downstream testing revenue.

The practice also bills a mix of non‑visit services consistent with an integrated outpatient clinic: J0585 (onabotulinumtoxina) appears with 763 claims and $582.2K revenue (3.0% of Medicaid revenue) and 36415 (phlebotomy) shows 51.9K claims and $155.8K revenue (0.8%); several diagnostic codes (93306 echocardiography, 87651 Strep A testing, 87635 SARS‑CoV‑2 testing) appear at notable volumes. These codes indicate capability to deliver minor procedures, injections, labs, and basic imaging/diagnostics in the outpatient setting, broadening the service mix beyond E/M.

Hospital and acute care E/M are present but less central: 99232 (subsequent inpatient care) reports 18.8K claims, $28 avg paid/claim, $525.4K revenue and ranks #7 of 50 (88th percentile; typical), while 99291 (critical care) shows 1K claims, $87 avg paid/claim, $91.1K revenue and ranks #3 of 15 (86th percentile; typical). These entries imply the group occasionally provides inpatient/critical care services, but inpatient work is not the primary revenue engine compared with high outpatient E/M volumes.

Tenure and stability: the NPI was enumerated on 2006-05-12 (~20 years ago), indicating long‑standing presence in the market. Combined with sustained, high Medicaid volumes and top‑percentile ranks on multiple codes, this tenure supports characterization of PHYSICIANS CLINIC INC as an established, high‑volume Medicaid primary care provider in Nebraska with concentrated revenue exposure to outpatient E/M and preventive services.

Medicaid: Complete Services Breakdown

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

143 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…	168,790	$40	$7.4M
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…	81,240	$50	$4.3M
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…	14,750	$80	$1.2M
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…	13,120	$80	$1.1M
J0585	Injection, onabotulinumtoxina, 1 unit	760	$760	$582.2K
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…	8,460	$60	$533.2K
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…	18,770	$30	$525.4K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	6,360	$80	$508.8K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	4,630	$90	$412.2K
87502	The lab analyst performs a test to determine the presence of multiple types or subtypes of influenza virus through nucleic acid detection using multiplex amplified probe technique and possibly…	3,870	$90	$340.2K

Showing 1–10 of 143

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Nebraska Distribution

Physicians Clinic Inc — 16 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Nebraska

Full comparison — all codes billed, vs. Nebraska median

143 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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…	5	40	350	$170	$366.6K
99490	The clinical staff provides services directed by the provider to support and coordinate a patient’s care across multiple disciplines. The patient has two or more chronic conditions that place the…	7	10	210	$80	$358.8K
J0585	Injection, onabotulinumtoxina, 1 unit	3	10	630	$380	$355.1K
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…	3	700	660	$70	$305.1K
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…	4	600	610	$70	$251.4K
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…	19	30	630	$50	$250.1K
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…	2	70	360	$80	$234.7K
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…	3	70	230	$90	$222.7K
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…	7	50	670	$30	$186.5K
93010	The provider interprets and reports on the results of a routine 12–lead (or more) electrocardiogram.	5	30	1,720	$10	$158.7K

Showing 1–10 of 143

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Matthew Appenzeller	NE	Ophthalmology Physician	$2.5M	$0
Mark Emig	NE	Ophthalmology Physician	$2.2M	$0
David Ingvoldstad	NE	Ophthalmology Physician	$1.8M	$0
Montgomery County Memorial Hospital	IA	Critical Access Hospital	$0	$1.7M
Bliss O'bryhim	MO	Retina Specialist (Ophthalmology) Physician	$1.5M	$0
Edward Taylor	NE	Internal Medicine Physician	$658.9K	$0
Thomas Franco	NE	Physical Medicine & Rehabilitation Physician	$526.6K	$0
Scott Debates	NE	Dermatology Physician	$393.1K	$0
Monty Sellon	NE	Family Medicine Physician	$366K	$0
Joseph Ayoub	IA	Cardiovascular Disease Physician	$361.2K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Children's Hospital & Medical Center	NE	Children's Hospital	$0	$89.8M
Children's Physicians	NE	Pediatrics Physician	$0	$39.4M
Nebraska Pediatric Practice, Inc	NE	Pediatrics Physician	$0	$29M
Nebraska Methodist Hospital	NE	General Acute Care Hospital	$0	$14.5M
Smiles 4 Kids PC	NE	General Practice Dentistry	$0	$11.5M
Children's Hospital	NE	Pediatric Emergency Medicine (Pediatrics) Physician	$0	$8.4M
Nebraska Methodist Hospital	NE	Emergency Medicine Physician	$0	$5.3M
Unmc College Of Dentistry	NE	Dentist	$0	$4.8M
Stones Worth Stepping, P.C.	NE	Occupational Therapist	$0	$4.7M
Pacific Surgery Center, LLC	NE	Ambulatory Surgical Clinic/Center	$3.4M	$3.2K

Physicians Clinic 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