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NPI 1831592211 · Hollywood, MD · Internal Medicine Physician
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Medstar Medical Group - Southern Maryland LLC is a internal medicine physician provider located in Hollywood, Maryland. This profile covers 0 Medicare and 190 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.
Provider details (source: NPPES NPI Registry)
| Field | Value |
|---|---|
| Entity Type | Organization |
| Organization | Medstar Medical Group - Southern Maryland LLC |
| Address | 24035 Three Notch Road |
| City | Hollywood |
| State | MD |
| ZIP | 20636 |
| Taxonomy | Internal Medicine Physician |
| NPI Enumerated | September 30, 2014 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $27.7M |
| Medicare | $0 |
This provider is essentially single‑payer in the available claims data: there is no Medicare billing on file while total Medicaid revenue is $27.7M, indicating Medicaid is the de facto primary payer for this entity. Analysts should treat any Medicare comparisons as inapplicable for this NPI.
Revenue is heavily concentrated in a small set of ambulatory evaluation-and-management codes: the precomputed top three Medicaid codes account for 76.5% of the provider's Medicaid revenue, driven by 99214 ($12.6M, 49.9%), 99213 ($5.7M, 22.5%), and 99244 ($1M, 4.1%). This concentration signals that a few visit types produce the vast majority of billed dollars.
The code mix and taxonomy (Internal Medicine Physician) point to a high-volume outpatient primary care/internal medicine operation: 99214 and 99213 are the two largest revenue drivers and together account for the majority of clinical revenue, consistent with frequent established-patient office visits. The presence of 99244 (outpatient consultation) further indicates the practice also performs moderate-complexity consultative encounters.
Claim volumes demonstrate substantial throughput: 99214 appears on 150.2K claims with an average paid per claim of $84, and 99213 appears on 87.7K claims at $65 average paid — these volumes are characteristic of a large clinic network or group practice managing sustained ambulatory demand. High claim counts for sample ancillary entries such as 36415 (52.3K claims, $522.6K revenue) also support a high-volume, fast-turn procedural environment.
On statewide competitive standing, the provider ranks as an outlier for its top E/M codes: 99214 ranks #7 of 3673 providers in-state (100th percentile; extreme outlier), 99213 ranks #17 of 3275 (100th percentile; extreme outlier), and 99244 ranks #1 of 118 (100th percentile; extreme outlier). These rankings indicate the provider is a dominant participant in Maryland Medicaid for core ambulatory E/M and consultation codes.
Beyond E/M, the provider bills a range of diagnostic and preventive services indicating broader ambulatory capabilities: 93306 (9.1K claims, $803.5K revenue; ranks #9 of 157, 95th percentile, notably above typical), 88305 (5.1K claims, $591.7K revenue; ranks #20 of 123, 84th percentile), and multiple preventive visit codes (99392, 99393, 99394, 99391) contribute additional revenue and suggest integrated screening and pathology workflows. These line items point to on-site or closely affiliated imaging, lab, and preventive services supporting the primary care base.
The provider’s mix includes higher-complexity and inpatient-related E/M activity alongside ambulatory care: codes such as 99215 ($294.9K, 1.2%), 99223 ($194.2K, 0.8%), and 99233 ($226.8K, 0.9%) indicate a nontrivial volume of high-complexity follow-ups and initial inpatient/observation care, implying the practice manages a spectrum of patient acuity beyond routine office visits. This breadth signals capacity to handle more complex clinical needs within the same billing entity.
The NPI was enumerated on 2014-09-30 (~12 years ago), which, combined with sustained Medicaid revenue of $27.7M and the extreme statewide rankings on key codes, suggests an established presence and long-term operational footprint in Southern Maryland’s Medicaid market. For payers and competitors, this profile is consistent with a large, entrenched Medicaid-facing internal medicine group rather than a small solo practice.
Medicaid revenue breakdown by year and by CPT/HCPCS procedure code, including monthly billing trends and the top codes driving revenue.
View: By Year1 / 3
Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.
190 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… | 150,220 | $80 | $12.6M |
| 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… | 87,690 | $70 | $5.7M |
| 99244 | The provider sees a patient for an office or other outpatient consultation involving evaluation and management (E/M). The E/M involves a moderate level of medical decision making or the provider… | 6,190 | $170 | $1M |
| 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… | 9,130 | $90 | $803.5K |
| 88305 | The physician, typically a pathologist, performs a level IV examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally… | 5,150 | $120 | $591.7K |
| 36415 | In this procedure, the provider inserts a needle into a vein to collect a blood sample. | 52,260 | $10 | $522.6K |
| 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… | 3,890 | $100 | $377.6K |
| 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… | 6,250 | $60 | $350.1K |
| 99393 | The provider performs an established well–patient visit for a child who is between the ages of 5 and 11. | 3,110 | $100 | $310.6K |
| 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… | 3,440 | $90 | $298.8K |
Showing 1–10 of 190
How this provider's Medicaid billing volume and revenue compare to other Maryland providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Maryland median
190 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 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… | 16 | 50 | 590 | $90 | $493.6K |
| J0585 | Injection, onabotulinumtoxina, 1 unit | 4 | 10 | 70 | $1,120 | $385.4K |
| 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… | 7 | 3,670 | 680 | $90 | $310K |
| 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… | 17 | 3,280 | 610 | $80 | $296.1K |
| 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… | 41 | 330 | 800 | $110 | $228.7K |
| 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… | 40 | 300 | 420 | $50 | $213.2K |
| 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… | 36 | 290 | 730 | $100 | $212.2K |
| 88305 | The physician, typically a pathologist, performs a level IV examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally… | 20 | 120 | 850 | $60 | $186.4K |
| 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… | 73 | 420 | 600 | $40 | $182.1K |
| 90960 | The provider manages all the services associated with the monthly care of a patient who is 20 years old or older and has a condition known as end stage renal disease or ESRD. For this service, the… | 9 | 40 | 1,260 | $60 | $177.7K |
Showing 1–10 of 190
Other providers in the same ZIP code as Medstar Medical Group - Southern Maryland LLC, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Pathways Inc | MD | Community/Behavioral Health Agency | $0 | $14.2M |
| Pathways Inc | MD | Adult Mental Health Clinic/Center | $0 | $6.1M |
| Amish Shah | MD | Cardiovascular Disease Physician | $461.2K | $0 |
| Rajbinderpal Gill | MD | Internal Medicine Physician | $401.6K | $0 |
| Kiran Mehta | MD | Pulmonary Disease Physician | $202.7K | $0 |
| Vinod Abraham | MD | Psychiatry Physician | $195.5K | $0 |
| John Harvey | MD | Vascular Surgery Physician | $186.2K | $0 |
| Adinath Patil | MD | Cardiovascular Disease Physician | $183.7K | $0 |
| Kundan Karkhanis | MD | Rheumatology Physician | $153.7K | $0 |
| Anil Kankaria | MD | Gastroenterology Physician | $130.3K | $0 |
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