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

Why is the Medicaid comparison limited to New York 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. New York (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.

Vertex LLC (NPI 1831377407)

Field	Value
Entity Type	Organization
Organization	Vertex LLC
Address	1080 E Gun Hill Rd
City	Bronx
State	NY
ZIP	10469
Taxonomy	Substance Use Disorder Rehabilitation Clinic/Center
NPI Enumerated	February 6, 2008

Payer Source	Total Paid
Medicaid	$24.6M
Medicare	$0

Medicaid: Complete Services Breakdown

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

8 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
G0397	Alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., audit, dast), and intervention, greater than 30 minutes	67,540	$160	$10.5M
G0396	Alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes	60,460	$110	$6.8M
H0005	Alcohol and/or drug services; group counseling by a clinician	99,580	$60	$6.1M
H0001	Alcohol and/or drug assessment	4,670	$170	$803.2K
99202	The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves straightforward medical decision making, and/or the provider…	1,810	$150	$265.8K
99201	Deleted code, effective Jan. 1, 2021	430	$90	$39.8K
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…	230	$130	$28.6K
99406	The provider counsels the patient on how to stop tobacco use. The counseling lasts more than three minutes, up to 10 minutes.	30	$20	$660

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. New York Distribution

Vertex LLC — 3 of 8 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — New York

Full comparison — all codes billed, vs. New York median

8 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
H0005	Alcohol and/or drug services; group counseling by a clinician	6	230	3,600	$60	$805.5K
G0396	Alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes	7	250	1,290	$110	$761.7K
G0397	Alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., audit, dast), and intervention, greater than 30 minutes	2	190	1,030	$140	$613.3K
99201	Deleted code, effective Jan. 1, 2021	49	190	90	$70	$167.3K
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…	1,928	4,700	130	$100	$136.6K
99202	The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves straightforward medical decision making, and/or the provider…	129	1,260	110	$80	$100.2K
H0001	Alcohol and/or drug assessment	68	810	390	$30	$52.8K
99406	The provider counsels the patient on how to stop tobacco use. The counseling lasts more than three minutes, up to 10 minutes.	609	810	140	$10	$7.5K

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Important Steps, Inc.	NY	Early Intervention Provider Agency	$0	$22.2M
Ambulatory Surgery Center Of Greater New York, LLC	NY	Ambulatory Surgical Clinic/Center	$966.7K	$5.9M
Donald Wallerson	NY	Cardiovascular Disease Physician	$495.3K	$3.8M
Fabio Volterra	NY	Hematology & Oncology Physician	$795.3K	$256.7K
Howard Hochster	NY	Internal Medicine Physician	$380.6K	$137.4K
Sanjiv Bansal	NY	Specialist	$312.7K	$640
Prakash Patel	NY	Anesthesiology Physician	$66.1K	$8.2K

Vertex LLC — Billing Profile & Reimbursement Data

Sign up for Vertex LLC — Billing Profile & Reimbursement Data policy alerts

Vertex LLC — Billing Profile & Reimbursement Data

Sign up for Vertex LLC — Billing Profile & Reimbursement Data policy alerts

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Nearby Providers

Frequently Asked Questions

References