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

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

Pinelake Physician Practice, LLC (NPI 1861563439)

Pinelake Physician Practice, LLC is a internal medicine physician provider located in Mayfield, Kentucky. This profile covers 0 Medicare and 124 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.

Medicaid: Complete Services Breakdown

Field	Value
Entity Type	Organization
Organization	Pinelake Physician Practice, LLC
Address	1029 Medical Center Cir
City	Mayfield
State	KY
ZIP	42066
Taxonomy	Internal Medicine Physician
NPI Enumerated	November 13, 2006

Payer Source	Total Paid
Medicaid	$4.6M
Medicare	$0

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

124 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…	40,910	$20	$981.7K
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…	21,500	$30	$687.8K
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…	8,690	$50	$434.3K
43239	The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum where he removes one or more tissue biopsy specimens for diagnostic analysis.	4,320	$80	$324.1K
95165	In this procedure, the provider mixes and prepares the antigens for allergen immunotherapy. Use this code when the provider prepares one or more antigens.	2,880	$90	$253.3K
99291	Critical care services include the treatment of vital organ failure or prevention of further life–threatening conditions. Delivering medical care in a moment of crisis and in time of emergency is…	4,440	$50	$239.5K
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…	3,800	$50	$201.1K
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…	12,980	$10	$142.7K
99243	The provider sees a patient for an office or other outpatient consultation involving evaluation and management (E/M). The E/M involves a low level of medical decision making or the provider spends at…	1,150	$80	$89.9K
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…	3,060	$30	$85.7K

Showing 1–10 of 124

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Kentucky Distribution

Pinelake Physician Practice, LLC — 6 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Kentucky

Full comparison — all codes billed, vs. Kentucky median

124 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99285	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a high level of medical decision making.	223	240	4,710	$150	$2.6M
70450	The provider performed computed tomography, or CT scanning, of the head or brain, without contrast. He performs the procedure to diagnose any brain or intracranial abnormalities.	153	180	2,960	$110	$672.4K
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…	57	210	1,340	$160	$568K
93458	In this procedure, the provider performs imaging supervision and interpretation for a coronary angiography with left heart catheterization and intraprocedural injections for left ventriculography. He…	44	60	170	$780	$500.2K
95165	In this procedure, the provider mixes and prepares the antigens for allergen immunotherapy. Use this code when the provider prepares one or more antigens.	10	60	820	$110	$467.9K
43239	The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum where he removes one or more tissue biopsy specimens for diagnostic analysis.	22	170	1,300	$230	$441K
L4361	Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf	20	20	90	$190	$410.9K
78452	In this procedure, the provider performs multiple SPECT studies of the heart to determine the areas of deficient blood flow. The goal of the procedure is to determine areas that have deficient blood…	75	130	420	$270	$375.3K
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…	153	3,340	1,020	$30	$296K
99291	Critical care services include the treatment of vital organ failure or prevention of further life–threatening conditions. Delivering medical care in a moment of crisis and in time of emergency is…	19	160	420	$140	$270.5K

Showing 1–10 of 124

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Louis Caruso	TN	Cardiovascular Disease Physician	$373.1K	$0
Spencer Romine	KY	Orthopaedic Surgery Physician	$183.1K	$0
Elias Pitaras	KY	Nephrology Physician	$145.1K	$0
Jessica Little	KY	Foot & Ankle Surgery Podiatrist	$90.1K	$0
John Vansavage	KY	Urology Physician	$79K	$0
Daniel Howard	KY	Surgery Physician	$75.7K	$0
Bethanie Apperson	KY	Nurse Practitioner	$69.2K	$0
Philip Hunt	KY	Orthopaedic Surgery Physician	$48.2K	$0
Anita Torok	KY	Gastroenterology Physician	$42.7K	$0
David Koury	KY	Neurology Physician	$42.4K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Pinelake Regional Hospital LLC	KY	Rural Acute Care Hospital	$0	$43.3M
Purchase Area Agency On Aging	KY	Supports Brokerage Agency	$0	$30M
Pinnacle Treatment Centers, LLC D/b/a Recovery Works Paducah	KY	Substance Abuse Rehabilitation Facility	$0	$17.7M
Purchase Area Agency On Aging	KY	Supports Brokerage Agency	$0	$12.5M
City Of Mayfield Office Of City Clerk	KY	Land Ambulance	$545.1K	$2M
Air Evac Ems Inc	KY	Air Ambulance	$772K	$828.9K
Tony Smith	KY	Optometrist	$32K	$273.2K
Richard Stone	KY	Family Medicine Physician	$240.7K	$1.6K
Roberto Dos Remedios	KY	Pulmonary Disease Physician	$220.5K	$0
Myra Irvin	KY	Internal Medicine Physician	$181K	$0

Pinelake Physician Practice, LLC — Billing Profile & Reimbursement Data

Sign up for Pinelake Physician Practice, LLC — Billing Profile & Reimbursement Data policy alerts

Pinelake Physician Practice, LLC — Billing Profile & Reimbursement Data

Sign up for Pinelake Physician Practice, LLC — Billing Profile & Reimbursement Data policy alerts

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References