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

Why is the Medicaid comparison limited to Unspecified Location 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. Unspecified Location (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.

Maxwell Simard (NPI 1871975441)

Field	Value
Entity Type	Individual
Organization	Maxwell Simard
Address	Unit 2022
City	Kunsan
State	XX (Unspecified Location)
ZIP	96264
Taxonomy	Family Medicine Physician
NPI Enumerated	June 19, 2015

Payer Source	Total Paid
Medicare	$13.2K
Medicaid	$0

Key Findings

This provider’s Medicare billing footprint is very small in absolute terms: total Medicare revenue is $13.2K and there is no Medicaid billing on file, so the provider is effectively single-payer (Medicare-only) in the available dataset. Absence of Medicaid activity means there is no in-state Medicaid profile to analyze or compare.

Revenue concentration is extremely high: the precomputed top 3 Medicare codes account for 100.0% of this provider’s total Medicare revenue, with 99284 representing 57.8% of Medicare revenue, 99285 representing 26.7%, and 99283 representing 15.5%. This indicates nearly all Medicare dollars are tied to a very small set of E/M codes.

The top codes (99284, 99285, 99283) are all emergency department E/M codes, so the code mix is dominated by ED visit billing rather than office-based family medicine CPTs. That pattern suggests the provider bills primarily for emergency department evaluation-and-management services rather than routine outpatient primary-care visits in the Medicare record.

Average payments by code show an acuity-weighted mix: 99285 pays $140 avg per claim, 99284 pays $87 avg per claim, and 99283 pays $44 avg per claim, indicating the presence of higher-acuity ED visits but with much lower revenue contribution from the highest-acuity code than from 99284. Claim counts (25 for 99285, 87 for 99284, 46 for 99283) confirm that moderate-acuity 99284 visits drive the largest share of revenue by volume.

Competitive standing across peers is mixed: 99284 ranks #20150 of 64306 (68th percentile) and is characterized as "typical, unremarkable volume," indicating modestly above-median participation for that ED code. By contrast, 99283 ranks #4556 of 31069 (85th percentile) and is also labelled "typical, unremarkable volume," so this provider bills relatively more 99283 visits than many peers; 99285 ranks #53224 of 61347 (12th percentile) and is likewise called "typical, unremarkable volume," indicating relatively low volume on the highest-acuity ED code.

The provider’s NPI has been enumerated since 2015-06-19 (~11 years ago), providing a multi-year enrollment window in which the reported Medicare activity appears concentrated and limited in scale. With that tenure, the small lifetime Medicare revenue ($13.2K) suggests either a limited scope of Medicare-facing practice or partial/irregular Medicare billing.

From a business risk and opportunity perspective, concentration of 100.0% of Medicare revenue in three ED E/M codes exposes the provider to reimbursement or coding changes that affect ED visit valuation; the absence of Medicaid billing means there is no offset from that payer class. Given the low absolute revenue, growth opportunities would likely require either diversification of billed services beyond ED E/M codes or development of payer relationships beyond Medicare.

Medicare: Complete Services Breakdown

The CPT/HCPCS codes generating the most Medicare revenue for this provider.

3 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
99284	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making.	90	$90	$7.6K
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.	30	$140	$3.5K
99283	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a low level of medical decision making.	50	$40	$2K

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 3 CPT/HCPCS codes. Note: this provider's state, "XX," is a placeholder CMS uses when a provider's practice-location state wasn't reported — not a traditional US state; the State panel below benchmarks against other providers coded under the same designation.

View: State1 / 2

Claims Volume vs. Unspecified Location Distribution

Maxwell Simard — 0 of 0 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Unspecified Location

Full comparison — all codes billed, vs. state median

3 rows

CPT/HCPCS Code	Rank	Median Claims	Avg Paid	Average Revenue
99283	1	N/A	$N/A	$N/A
99284	3	N/A	$N/A	$N/A
99285	5	N/A	$N/A	$N/A

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Nicolette Ingel	AP (Armed Forces Pacific)	Physical Therapist	$2.1K	$4.9K
Lance Mcadams	AP (Armed Forces Pacific)	Family Medicine Physician	$3K	$0

Maxwell Simard — Billing Profile & Reimbursement Data

Sign up for Maxwell Simard — Billing Profile & Reimbursement Data policy alerts

Maxwell Simard — Billing Profile & Reimbursement Data

Sign up for Maxwell Simard — Billing Profile & Reimbursement Data policy alerts

Key Findings

Medicare: Total Revenue Breakdown by CPT/HCPCS Code

Medicare: Complete Services Breakdown

Medicare: Competitive Analysis & Benchmarks

Nearby Providers

Frequently Asked Questions

References