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

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

Catalyst Medical Group, PLLC (NPI 1912458787)

Key Findings

Field	Value
Entity Type	Organization
Organization	Catalyst Medical Group, PLLC
Address	2315 8th St
City	Lewiston
State	ID
ZIP	83501
Taxonomy	Multi-Specialty Clinic/Center
NPI Enumerated	October 17, 2016

Payer Source	Total Paid
Medicaid	$11.4M
Medicare	$0

CATALYST MEDICAL GROUP, PLLC is effectively a single‑payer Medicaid operator: there is no Medicare billing on file while total Medicaid revenue is $11.4M. The practice is listed as a Multi‑Specialty Clinic/Center and its financial footprint is built almost entirely on Medicaid volume, so payer strategy and rate negotiations should be evaluated in that context.

Revenue is highly concentrated in a few evaluation & management and preventive codes: the top three Medicaid codes (99214, 99213, 99391) account for 82.8% of the provider’s Medicaid revenue. Specifically, 99214 represents $5.2M (46.6%), 99213 $3.2M (28.2%), and 99391 $893.1K (8.0%), indicating dependence on face‑to‑face outpatient visits and well‑visit services for most revenue.

The code mix signals a high‑volume ambulatory primary care and pediatric preventive operation. Large claim counts for visit codes (72.7K claims for 99214 and 52.9K claims for 99213) together with substantial preventive medicine billing (99391, 99392, 99393) and pediatric vaccine administration (90460, 90698) indicate the practice delivers routine primary care, well‑child/adolescent visits, and immunizations at scale.

CATALYST is a statewide volume leader for core E/M codes: 99214 ranks #5 of 618 providers in‑state (99th percentile; labeled an "extreme outlier") and 99213 ranks #13 of 669 (98th percentile; "notably above typical"). These ranks position the clinic as a dominant in‑state provider of established patient outpatient visits, which is important when evaluating competitive standing and capacity.

The practice also shows concentrated strength in pediatric vaccination and preventive services: 90698 ranks #1 of 23 providers in‑state (100th percentile; "extreme outlier") and 90460 ranks #3 of 78 (97th percentile; "notably above typical"). High ranks for 99188 (fluoride application) and pediatric vision screening (99173) further underscore a substantial pediatric/preventive services footprint.

Beyond visits and vaccines, the clinic provides routine ancillary services that complement high outpatient throughput. Examples include 36415 blood draws (15.1K claims, $45.4K revenue), STD NAAT testing (87491/87591, each $39.7K), and minor procedures such as 20552 trigger point injections (616 claims, $11.7K; rank #1 of 5, 100th percentile), indicating on‑site capability for common diagnostics and minor interventions.

The provider has been enumerated since 2016‑10‑17 (~10 years ago), so this Medicaid volume has been developed over multiple years of operation. The combination of long tenure and very large claim counts for core visit codes supports the interpretation of an established, high‑throughput ambulatory practice rather than a new entrant.

For payers and contracting teams, the concentration in E/M and preventive pediatric codes implies revenue sensitivity to changes in visit volumes or Medicaid E/M reimbursement. Given no Medicare activity, negotiations and utilization management should be prioritized within Medicaid arrangements and programs aimed at primary care access, pediatric preventive care, and vaccine delivery rather than dual‑payer strategies.

Medicaid: Complete Services Breakdown

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

132 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…	72,730	$70	$5.2M
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…	52,870	$60	$3.2M
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…	9,920	$90	$893.1K
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…	6,210	$100	$633.3K
90460	In this procedure, the provider administers a single live attenuated vaccine through a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age.	15,810	$20	$316.1K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	2,980	$100	$295.1K
90461	In this procedure, the provider administers an additional live attenuated vaccine either via a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age after the…	3,700	$40	$140.4K
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…	640	$110	$71.7K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	630	$110	$69.2K
36415	In this procedure, the provider inserts a needle into a vein to collect a blood sample.	15,140	$1	$45.4K

Showing 1–10 of 132

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Idaho Distribution

Catalyst Medical Group, PLLC — 5 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Idaho

Full comparison — all codes billed, vs. Idaho median

132 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average 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…	13	670	740	$40	$193.6K
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	620	560	$60	$191.8K
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…	9	80	450	$80	$171.3K
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…	6	80	380	$70	$151.1K
U0003	Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high…	21	20	270	$60	$101K
D9999	N/A	6	10	230	$330	$92.8K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	11	80	130	$80	$91.4K
G0480	Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but…	21	20	1,060	$70	$84.3K
90460	In this procedure, the provider administers a single live attenuated vaccine through a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age.	3	80	460	$30	$77.7K
59400	In this global service, the provider and nonphysician healthcare providers in the practice provide all of the antepartum care, admission to the hospital for delivery, labor management, including…	4	10	30	$1,500	$57.2K

Showing 1–10 of 132

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Gritman Medical Center Inc	ID	Critical Access Hospital	$0	$3.7M
Gritman Medical Center, Inc.	ID	Family Medicine Physician	$0	$1.4M
John Jelinek	ID	Sports Medicine (Orthopaedic Surgery) Physician	$236.3K	$0
Melanie Eggleston	ID	Internal Medicine Physician	$234.5K	$0
Regan Hansen	ID	Orthopaedic Surgery Physician	$227.7K	$0
James Maguire	ID	Family Medicine Physician	$175.4K	$0
Gregory Dietrich	ID	Orthopaedic Surgery of the Spine Physician	$158K	$0
Bryan Beardsley	WA	Orthopaedic Surgery Physician	$157.1K	$0
Charla Willis	ID	Internal Medicine Physician	$137.6K	$0
Steven Boyea	ID	Orthopaedic Hand Surgery Physician	$136K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Alternative Nursing Services, Inc.	ID	Adult Day Care Clinic/Center	$0	$29.3M
Opportunities Unlimited, Inc.	ID	Specialist	$0	$9.1M
St. Joseph Hospital LLC	ID	General Acute Care Hospital	$0	$4.7M
County Of Nez Perce Independent School District No 1	ID	Local Education Agency (LEA)	$0	$3.5M
Community Health Association Of Spokane	ID	Federally Qualified Health Center (FQHC)	$0	$3.2M
City Of Lewiston	ID	Land Ambulance	$697.3K	$1.9M
Riverside Recovery LLC	ID	Addiction (Substance Use Disorder) Counselor	$0	$2.1M
Addus Healthcare (idaho), Inc	ID	In Home Supportive Care Agency	$0	$2M
Emeritus Properties Ii, Inc.	ID	Assisted Living Facility	$0	$1.9M
Hospitalist Medicine Physicians Of Idaho- Nampa PLLC	ID	Emergency Medicine Physician	$0	$1.7M

Catalyst Medical Group, 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