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

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

App Of New Mexico Ed PLLC (NPI 1891169942)

Field	Value
Entity Type	Organization
Organization	App Of New Mexico Ed PLLC
Address	601 Dr Martin Luther King Jr Ave Ne
City	Albuquerque
State	NM
ZIP	87102
Taxonomy	Emergency Medicine Physician
NPI Enumerated	November 30, 2015

Payer Source	Total Paid
Medicaid	$42M
Medicare	$0

Key Findings

This entity is effectively a Medicaid-focused emergency medicine practice: there is no Medicare billing on file and the provider reports $42M in lifetime Medicaid revenue, indicating a single‑payer footprint dominated by state Medicaid. The NPI was enumerated 2015-11-30 (~11 years ago), so observed patterns reflect roughly a decade of enrollment activity concentrated in Medicaid billing.

Revenue concentration is extreme and narrowly focused: the precomputed top 3 Medicaid codes by revenue account for 99.3% of this provider's total Medicaid revenue, signaling that nearly all topline Medicaid receipts derive from a small set of ED evaluation-and-management services. Those three codes are 99285 ($17.2M revenue, 40.9%), 99284 ($15.9M revenue, 37.9%), and 99283 ($8.6M revenue, 20.4%).

The code mix confirms an emergency department service-line with a high volume of moderate-to-high acuity visits: 99285 (130K claims, $132 avg paid/claim, $17.2M revenue) and 99284 (171.3K claims, $93 avg paid/claim, $15.9M revenue) together represent the majority of revenue and reflect frequent moderate-to-high complexity ED evaluations. The large claim counts for these E/M codes imply the operation is organized to deliver high-throughput emergency care rather than a broader outpatient or procedural portfolio.

Competitive standing within New Mexico is dominant for core ED codes: 99283 ranks #1 of 84 providers in-state (100th percentile; extreme outlier) and both 99285 and 99284 rank #2 in their peer groups (each 99th percentile; extreme outlier). These percentile and rank positions indicate this provider bills far above typical state volumes for the same ED E/M services and is a major in-state player for emergency department visit billing.

While ED E/M services dominate revenue, documented critical care and ancillary billing are small by comparison: 99291 shows 1.3K claims and $158.1K revenue (0.4% of Medicaid revenue) and 99292 has only 16 claims and $624 revenue, both described as typical or unremarkable volumes for the state. This suggests the practice provides some critical care resources but does not derive material revenue from prolonged critical care encounters.

Ancillary services generate negligible Medicaid revenue relative to ED E/M volume: ECG interpretation 93010 produced $106.8K (0.3% of Medicaid revenue) on 17.8K claims and the FOBT 82272 produced $49 on 49 claims, indicating limited ancillary-service monetization within the billing profile. The dominance of E/M codes and the small share from diagnostics point to an ED-focused workflow with minimal ancillary billing impact.

The provider’s operational scale is evident in raw claim volumes: hundreds of thousands of E/M claims (130K for 99285, 171.3K for 99284, 158.8K for 99283) underpin the $42M Medicaid total, which emphasizes throughput-centric emergency care rather than elective or longitudinal services. This pattern should be interpreted as a high-volume ED billing model rather than a diversified clinical revenue mix.

From a payer and network strategy perspective, the combination of no Medicare billing on file and concentrated Medicaid revenue suggests this entity is strategically—or practically—positioned within Medicaid networks and may be an important Medicaid ED access point in Albuquerque. Analysts evaluating network adequacy, contracting leverage, or utilization should treat the provider as a Medicaid-dominant ED operator with unusually large state-level volumes for core ED E/M codes.

Medicaid: Complete Services Breakdown

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

9 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	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.	130,020	$130	$17.2M
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.	171,290	$90	$15.9M
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.	158,770	$50	$8.6M
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…	1,290	$120	$158.1K
93010	The provider interprets and reports on the results of a routine 12–lead (or more) electrocardiogram.	17,800	$10	$106.8K
99282	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a straightforward level of medical decision making.	1,400	$40	$48.9K
99292	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…	20	$40	$620
99281	The provider sees a patient for the lowest level emergency department visit.	10	$20	$260
82272	The lab analyst uses a peroxidase activity method to perform a test for the presence of hidden blood in a fecal specimen that the patient collects from three consecutive bowel movements, or that the…	50	$1	$50

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. New Mexico Distribution

App Of New Mexico Ed PLLC — 3 of 9 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — New Mexico

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

9 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average 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.	2	80	12,050	$160	$3.9M
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.	2	70	6,920	$210	$3.5M
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.	1	80	10,650	$130	$2.4M
99282	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a straightforward level of medical decision making.	32	60	1,990	$90	$406.6K
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…	12	50	210	$150	$326.4K
99281	The provider sees a patient for the lowest level emergency department visit.	42	40	740	$60	$120.1K
93010	The provider interprets and reports on the results of a routine 12–lead (or more) electrocardiogram.	9	70	1,940	$10	$68.7K
99292	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…	5	10	30	$90	$5.1K
82272	The lab analyst uses a peroxidase activity method to perform a test for the presence of hidden blood in a fecal specimen that the patient collects from three consecutive bowel movements, or that the…	5	10	50	$1	$330

Related Providers

Other providers that share a Tax Identification Number (TIN) with App Of New Mexico Ed PLLC, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Patrick Connor	NM	Emergency Medicine Physician	$48.3K	$765.9K
Thomas Wulf	NM	Family Medicine Physician	$196.4K	$0
Alisha Lowden	NM	Nurse Practitioner	$150.5K	$0
Bassam Al Homsi	NM	Internal Medicine Physician	$139.2K	$0
Brian Cashin	WA	Emergency Medicine Physician	$107.6K	$0
Michael Hamrick	NM	Nurse Practitioner	$106.5K	$50
Carlos Echevarria	AZ	Phlebology Physician	$101.5K	$0
Carol Marquez	NM	Emergency Medicine Physician	$80.6K	$0
Emmanuel Gallegos	NM	Emergency Medicine Physician	$73.5K	$0
Jorge Partida	NM	Emergency Medicine Physician	$65.7K	$0

Nearby Providers

Other providers in the same ZIP code as App Of New Mexico Ed PLLC, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Tricore Reference Laboratories	NM	Clinical Medical Laboratory	$0	$64.8M
Bright Horizons, Inc.	NM	Intellectual and/or Developmental Disabilities Residential Treatment Facility	$0	$46.9M
Lovelace Health System LLC	NM	General Acute Care Hospital	$0	$45.2M
Tricore Inc.	NM	Clinical Medical Laboratory	$7M	$35.8M
Duke City Recovery Toolbox LLC	NM	Community/Behavioral Health Agency	$108.4K	$28M
Metro Treatment Of New Mexico LP	NM	Methadone Clinic	$220.4K	$27.9M
Enchanted Care Solutions, LLC	NM	Home Health Agency	$0	$25.8M
Open Skies Healthcare	NM	Community/Behavioral Health Agency	$0	$23.8M
Krossroads Integrative Health And Recovery Solutions Inc	NM	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$16.7M
Behavioral Healthcare Services, Inc.	NM	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$14.8M

App Of New Mexico Ed 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