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

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

Clearchoicemd, PLLC (NPI 1851722417)

Key Findings

Field	Value
Entity Type	Organization
Organization	Clearchoicemd, PLLC
Address	798 Route 302
City	Berlin
State	VT
ZIP	05641
Taxonomy	Urgent Care Clinic/Center
NPI Enumerated	December 9, 2013

Payer Source	Total Paid
Medicaid	$10.8M
Medicare	$0

This provider is effectively single-payer in the available data: there is no Medicare billing on file while lifetime Medicaid revenue is $10.8M, indicating the practice’s measurable revenue footprint is concentrated in the Medicaid population rather than balanced across Medicare and Medicaid. The absence of Medicare claims suggests the organization’s payer mix, network participation, or patient panel is heavily skewed toward Medicaid enrollees.

Revenue concentration is highly focused: the precomputed top-3 Medicaid codes (99214, 99204, 99213) account for 72.1% of the provider’s total Medicaid revenue. Individually these codes are $4.5M (99214, 42.1%), $1.7M (99204, 15.4%), and $1.6M (99213, 14.6%), so evaluation-and-management office visits dominate the revenue profile.

The code mix points to an urgent care / high-volume ambulatory E/M model: large volumes of 99214, 99204, and 99213 indicate the practice provides both new-patient high-complexity visits and frequent established-patient outpatient care, consistent with an urgent care clinic/center taxonomy. High counts for both new- and established-patient E/M codes imply capacity for walk-in and scheduled visits and the ability to manage moderate-complexity cases on site.

CLEARCHOICEMD is a statewide volume leader for several E/M codes. 99204 ranks #1 of 52 providers in-state (100th percentile) and 99203 also ranks #1 of 72 providers (100th percentile), while 99214 ranks #5 of 323 providers (99th percentile), characterizing the provider as a dominant or extreme-volume outlier in Vermont for these office-visit services.

The practice performs very high volumes of point-of-care infectious-disease testing alongside E/M visits, supporting an acute symptomatic testing workflow. Codes such as 87426 (24.3K claims, $825.8K; ranks #1 of 5, 100th percentile, notably above typical state volume), 87428 (6.5K claims, $326.4K; ranks #1 of 11, 100th percentile), 87804 (20.5K claims, $205.2K; ranks #1 of 19, 100th percentile, extreme outlier), and 87430 (10.7K claims, $107.5K; ranks #1 of 2, 100th percentile) indicate routine on-site testing for COVID, influenza, and strep.

Several other ancillary services appear at meaningful volumes for an urgent care operator: 99215, radiology 71046, and rapid drug and pregnancy tests (80305, 81025) are present in the top-25 list, though at much smaller revenue shares. These lower-ranked but present codes suggest the clinic offers a range of basic diagnostics and episodic treatments in addition to high-volume E/M and infectious testing.

Operational tenure is established: the NPI was enumerated 2013-12-09 (~13 years ago), indicating the provider has been active for over a decade, which supports the plausibility of the high cumulative Medicaid volumes reported. That longevity combined with concentrated Medicaid revenue reinforces that CLEARCHOICEMD has built sustained access to the Medicaid patient population in its market.

From a competitive-intelligence perspective, CLEARCHOICEMD’s extreme percentile rankings on multiple E/M and rapid test codes position it as a regional focal point for acute outpatient care in Vermont. Analysts should view this entity as a major state-level provider for ambulatory urgent-care services and respiratory/acute infectious testing when modeling network capacity or Medicaid utilization patterns.

Medicaid: Complete Services Breakdown

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

60 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…	66,850	$70	$4.5M
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…	20,480	$80	$1.7M
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…	33,650	$50	$1.6M
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…	21,540	$60	$1.3M
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,…	24,290	$30	$825.8K
87428	The lab analyst performs an immunoassay to qualitatively or semiquantitatively evaluate the patient specimen for antigens of severe acute respiratory syndrome (SARS) coronavirus, such as SARS–CoV–2…	6,530	$50	$326.4K
87804	The analyst performs an immunoassay with direct optical, meaning visual, observation to detect influenza, also called flu, in a patient sample, typically a throat or nasal swab or nasal washings.	20,520	$10	$205.2K
87430	The lab analyst performs an assay to evaluate the patient’s sample for antigens to Streptococcus, group A, using an immunoassay method, such as EIA.	10,750	$10	$107.5K
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…	670	$70	$49K
87400	The lab analyst performs the technical lab test to detect antigens of influenza A or B using an immunoassay technique, such as EIA. This analysis will distinguish if a patient has influenza A or B.	4,780	$10	$38.2K

Showing 1–10 of 60

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Vermont Distribution

Clearchoicemd, PLLC — 13 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Vermont

Full comparison — all codes billed, vs. Vermont median

60 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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.	14	20	2,660	$50	$742.4K
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,…	1	10	80	$30	$164.6K
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…	5	320	680	$30	$146.1K
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…	8	320	760	$20	$88.2K
87430	The lab analyst performs an assay to evaluate the patient’s sample for antigens to Streptococcus, group A, using an immunoassay method, such as EIA.	1	10	5,470	$10	$53.5K
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…	1	50	50	$80	$50K
87428	The lab analyst performs an immunoassay to qualitatively or semiquantitatively evaluate the patient specimen for antigens of severe acute respiratory syndrome (SARS) coronavirus, such as SARS–CoV–2…	1	10	60	$40	$45.1K
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…	31	110	170	$70	$38.6K
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	70	70	$50	$36K
E0114	Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips	3	10	160	$30	$34.4K

Showing 1–10 of 60

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
James Kelsey	NH	Family Medicine Physician	$166.6K	$0
Thomas Scott	NH	Emergency Medicine Physician	$142.1K	$0
William Wilcox	NH	Acute Care Nurse Practitioner	$45.1K	$21.7K
Rachael Comeau	NH	Family Nurse Practitioner	$20.3K	$40.8K
Mark Aronson	NH	Family Medicine Physician	$56.2K	$410
Michael Smirnioudis	NH	Family Nurse Practitioner	$50.5K	$1.6K
Megan Mcgann	NH	Nurse Practitioner	$49.4K	$1.6K
Cynthia Pawlowicz	NH	Nurse Practitioner	$49K	$0
Robert Sibley	NH	Family Nurse Practitioner	$46.4K	$0
Heidi Tzizik	NH	Family Nurse Practitioner	$44.8K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Washington County Mental Health Services, Inc.	VT	Developmental Disabilities Clinic/Center	$0	$145M
Pride Support Services Inc	VT	Case Management Agency	$0	$4.4M
Town Of Barre	VT	Land Ambulance	$631.7K	$1.6M
Central Vermont Dental Center	VT	Dentist	$0	$2.2M
Gifford Health Care, Inc	VT	Federally Qualified Health Center (FQHC)	$0	$2M
City Of Barre	VT	Land Ambulance	$202.5K	$1.1M
Jennie Holden	VT	Clinical Psychologist	$0	$1.1M
Elevate Youth Services Incorporated	VT	Case Management Agency	$0	$1.1M
Jennie Holden Plc	VT	Clinical Psychologist	$0	$1M
Fischer, Ziegler And Lundberg Orthodontics	VT	Orthodontics and Dentofacial Orthopedics Dentistry	$0	$895.5K

Clearchoicemd, PLLC — Billing Profile & Reimbursement Data

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Clearchoicemd, PLLC — 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