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.

Plessen Medical Group, LLC (NPI 1821331133)

Key Findings

Field	Value
Entity Type	Organization
Organization	Plessen Medical Group, LLC
Address	5 Orange Grove
City	Christiansted
State	VI
ZIP	00820
Taxonomy	Multi-Specialty Clinic/Center
NPI Enumerated	April 4, 2013

Payer Source	Total Paid
Medicaid	$671K
Medicare	$0

This provider is effectively single‑payer in the available data: Total Medicare revenue is none (no Medicare billing on file) while Total Medicaid revenue is $671K, indicating Medicaid is the operational revenue stream on file and there is no Medicare billing activity to compare. The NPI was enumerated 2013-04-04 (~13 years ago), so this is an established practice with more than a decade of presence in the market despite limited payer breadth in the claims record.

Revenue is highly concentrated in a very small set of Medicaid codes: the precomputed top 3 Medicaid codes account for 58.1% of this provider’s total Medicaid revenue. Those top drivers are 87811 (24.0% of Medicaid revenue), 99211 (22.0% of Medicaid revenue), and 99215 (12.1% of Medicaid revenue), indicating a narrow set of services generate the bulk of reported Medicaid payments.

The code mix points to a combined clinic model that handles both high-volume, low-acuity outpatient encounters and laboratory-based infectious disease testing. High volume on 99211 (6.4K claims, $147.8K revenue) alongside substantial lab testing for SARS–CoV–2 such as 87811 (4.1K claims, $160.8K revenue) and 87635 (1K claims, $49K revenue) suggests front‑line outpatient access plus on‑site or affiliated testing operations rather than a procedure-heavy specialty practice.

For statewide competitive standing, the provider is dominant on at least one front: 99211 ranks #1 of 11 providers in-state (100th percentile; notably above typical state volume), which signals the practice is a major source of low-acuity established‑patient visits in the state Medicaid market. In contrast, 87811 ranks #2 of 3 (50th percentile; typical, unremarkable volume) and 99215 ranks #6 of 17 (69th percentile; typical, unremarkable volume), so the provider is a leading low‑level E/M participant but only a modest or typical participant for COVID testing and high‑complexity E/M relative to state peers.

The presence and reported volumes of remote monitoring and care-management codes indicate an operational focus on longitudinal chronic care and telemonitoring that may be unique in-state. Codes 99457 (1.1K claims, $19.1K revenue), 99454 (877 claims, $16.7K revenue), and 99458 (487 claims, $15.1K revenue) each rank #1 of 1 providers in-state (0th percentile; no state peer volume comparison available), suggesting the provider offers RPM and related services where few or no state peers bill these lines.

Multiple distinct SARS–CoV‑2 testing codes appear across the top billings, showing a sustained testing role rather than a single-code spike: 87811 (4.1K claims, $160.8K revenue; 24.0% of Medicaid revenue), 87635 (1K claims, $49K revenue; 7.3%), 87426 (780 claims, $26.5K revenue; 4.0%), 86769 (302 claims, $11.8K revenue; 1.8%), and specimen-collection G2023 (341 claims, $7.2K revenue; 1.1%). This distribution implies testing throughput is a meaningful, diversified revenue stream within the Medicaid record.

Operational risk and growth considerations are apparent from the concentration and scale: with $671K in total Medicaid revenue and the top 3 codes making up 58.1% of that total, the provider’s financial performance in the Medicaid dataset is tied closely to continued volume in a few services—chiefly 87811 and 99211. Given the absence of Medicare billing on file, strategic shifts in Medicaid reimbursement or changes in COVID testing demand could materially affect reported revenue for this entity.

Medicaid: Complete Services Breakdown

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

29 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
87811	The lab analyst performs the technical lab test to analyze for the presence of severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2) (Coronavirus disease [COVID–19]) in a specimen by…	4,120	$40	$160.8K
99211	An established patient presents for an office or other outpatient visit that may not require the presence of a physician or other qualified healthcare professional.	6,430	$20	$147.8K
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…	980	$80	$81.3K
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…	1,000	$60	$59.7K
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…	1,020	$50	$49K
87426	The lab analyst performs an immunoassay to qualitatively or semiquantitatively evaluate the patient blood specimen for antigens of severe acute respiratory syndrome coronavirus such as SARS–CoV–2,…	780	$30	$26.5K
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…	240	$90	$22.7K
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…	210	$100	$19.9K
99457	The provider manages treatment using data from remote physiologic monitoring. The service requires at least one real–time interactive communication with the patient or caregiver during the month and…	1,130	$20	$19.1K
99454	The provider supplies one or more devices for remote physiologic monitoring that occurs for 16 to 30 days in a 30–day period.	880	$20	$16.7K

Showing 1–10 of 29

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

Plessen Medical Group, LLC — 6 of 25 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

29 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
36415	In this procedure, the provider inserts a needle into a vein to collect a blood sample.	13	20	1,920	$110	$858.9K
99000	Use this code for the in office preparation of a specimen for lab analysis and or its transport from the office to the outside testing laboratory.	2	10	14,730	$30	$417.2K
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…	31	40	560	$140	$322K
97110	Therapeutic exercise is a form of physical therapy that utilizes specially designed exercises and activities to help patients gain better mobility and fitness levels. Normally used on patients with…	9	10	2,030	$50	$281.5K
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…	12	40	430	$110	$260.9K
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…	5	10	1,020	$110	$229.8K
87811	The lab analyst performs the technical lab test to analyze for the presence of severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2) (Coronavirus disease [COVID–19]) in a specimen by…	2	10	4,120	$40	$121.6K
87426	The lab analyst performs an immunoassay to qualitatively or semiquantitatively evaluate the patient blood specimen for antigens of severe acute respiratory syndrome coronavirus such as SARS–CoV–2,…	2	10	260	$120	$95.3K
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…	6	20	200	$150	$93.5K
99211	An established patient presents for an office or other outpatient visit that may not require the presence of a physician or other qualified healthcare professional.	1	10	470	$40	$51.6K

Showing 1–10 of 29

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Jan Tawakol	VI	Nephrology Physician	$212.1K	$0
Tasnim Khan	VI	Nephrology Physician	$140.4K	$0
John Cook	VI	Foot & Ankle Surgery Podiatrist	$78.7K	$0
Malgorzata Dawiskiba	MA	Rheumatology Physician	$51.3K	$0
Lindsay Ray	VI	Family Nurse Practitioner	$15.6K	$0
Jamie Schmidt	VI	Physician Assistant	$7.7K	$0
Lisa Gay	VI	Family Nurse Practitioner	$2.2K	$0
Edward Gonzalez	WA	Family Nurse Practitioner	$1.7K	$0
Madel Villegas	VI	Family Medicine Physician	$1.2K	$0

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
Governor Juan F. Luis Hospital & Medical Center	VI	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$3M
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

Plessen Medical Group, LLC — Billing Profile & Reimbursement Data

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Plessen Medical Group, LLC — 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