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

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

Procare Medical Group Sc (NPI 1922164656)

Key Findings

Field	Value
Entity Type	Organization
Organization	Procare Medical Group Sc
Address	3727 W Wisconsin Ave
City	Milwaukee
State	WI
ZIP	53208
Taxonomy	Multi-Specialty Clinic/Center
NPI Enumerated	December 28, 2006

Payer Source	Total Paid
Medicaid	$25.1M
Medicare	$0

PROCARE MEDICAL GROUP SC is effectively a Medicaid-focused ambulatory provider with no Medicare revenue on file and $25.1M in lifetime Medicaid revenue; its NPI was enumerated on 2006-12-28 (≈20 years ago), indicating long tenure in the market. The absence of Medicare billing makes the organization's commercial positioning and Medicaid relationships the primary drivers of observable revenue and utilization patterns.

Revenue is highly concentrated in evaluation-and-management services: the top three Medicaid codes account for 70.6% of total Medicaid revenue, led by 99214 ($10M, 42.0%) and 99213 ($6M, 25.3%), with 99204 contributing $768.2K (3.2%). This concentration indicates the bulk of Medicaid payments flow from routine/new patient outpatient visits rather than procedural or facility-based services.

The code mix points to a large-volume primary care and general ambulatory practice with a strong preventive and pediatric footprint. High volumes of established visit codes (99214 and 99213) combined with substantial claims and revenue for well-patient visit codes—99393 (9.8K claims, $579.7K; 2.4%) and 99392/99394/99395 series—signal regular preventive care delivery across childhood and adult age bands.

PROCARE shows significant on-site or closely affiliated diagnostic service activity supporting ambulatory care: MRI brain 70551 (2K claims, $635.8K; 2.7%), MRI lumbar 72148 (1.8K claims, $570.1K; 2.4%), lower-extremity MRI 73721 (1.4K claims, $393.1K; 1.7%), echocardiography 93306 (3K claims, $483.7K; 2.0%), and multiple ultrasound codes (76700, 76830, 76856) are present at meaningful volumes. These diagnostics appear integrated with the clinic’s high outpatient visit load rather than representing a standalone imaging center.

State-level ranking shows PROCARE is a dominant Medicaid performer for many visit and screening codes: 99214 ranks #8 of 1628 (100th percentile; extreme outlier, far above typical state volume), 99213 ranks #9 of 1755 (100th percentile; extreme outlier), and 99204 ranks #5 of 334 (99th percentile; extreme outlier). Additional leadership positions include 92552 (hearing assessment) at rank #1 of 18 (100th percentile; extreme outlier) and 3008F (no summary) at rank #1 of 237 (100th percentile; extreme outlier), indicating the provider is among the top statewide billers for several high-volume codes.

Preventive and pediatric services are an identifiable specialization: 99393 (established well–patient 5–11) ranks #5 of 204 (98th percentile; extreme outlier), 99395 (18–39) ranks #2 of 66 (98th percentile; extreme outlier), and 99394 (12–17) ranks #4 of 151 (98th percentile; extreme outlier). These rankings, together with very large claim counts for pediatric screening codes such as 99173 (20.1K claims, $361.6K; 1.5%) and high-frequency lab/point-of-care codes (81025, 87880), underscore a broad primary care panel that includes high pediatric throughput.

Several codes are labeled as typical or unremarkable in statewide volume despite contributing non-trivial revenue (for example, MRI and many ultrasound codes are in the mid-to-high percentiles but described as typical/unremarkable). This suggests the provider’s dominance is most pronounced in ambulatory visit and preventive/screening categories, while imaging and technical diagnostics align more closely with peers.

Operational risk should be monitored given the heavy dependence on two E/M codes for the majority of Medicaid dollars; 99214 and 99213 alone drive the single largest shares of reported Medicaid revenue. Any policy, coverage, or reimbursement changes affecting outpatient evaluation-and-management payment could materially affect the provider’s revenue profile, so analysts should treat Medicaid reimbursement trends and visit-level utilization as leading indicators for financial impact.

Medicaid: Complete Services Breakdown

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

172 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…	191,430	$50	$10M
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…	171,240	$40	$6M
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…	7,050	$110	$768.2K
70551	The provider uses magnetic resonance imaging, or MRI, to examine the brain and brain stem. The provider does not administer contrast for this exam.	1,990	$320	$635.8K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	9,830	$60	$579.7K
72148	In this diagnostic procedure, the provider performs magnetic resonance imaging (MRI) of the lumbar spinal canal and contents without using contrast.	1,750	$330	$570K
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…	9,330	$60	$550.6K
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…	3,020	$160	$483.7K
99395	The provider performs an established well–patient visit for a patient who is between the ages of 18 and 39.	7,240	$60	$412.6K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	6,860	$60	$411.3K

Showing 1–10 of 172

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Wisconsin Distribution

Procare Medical Group Sc — 15 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Wisconsin

Full comparison — all codes billed, vs. Wisconsin median

172 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average 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…	8	1,630	270	$40	$205.3K
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…	9	1,760	250	$40	$173.2K
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…	25	150	440	$70	$131.9K
94640	The provider administers oxygen under pressure or not under pressure to open obstructed air passages. He uses any of the listed devices to treat a patient with an acute obstruction of the airway that…	104	120	1,090	$40	$124.7K
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…	16	190	370	$60	$107.4K
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	70	$1,270	$99.2K
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…	7	210	340	$60	$98.9K
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…	161	350	210	$60	$95.8K
70551	The provider uses magnetic resonance imaging, or MRI, to examine the brain and brain stem. The provider does not administer contrast for this exam.	9	60	170	$90	$90.7K
59025	In this procedure, the provider measures the fetal heart rate of the fetus in response to its own movements.	56	70	300	$60	$90.5K

Showing 1–10 of 172

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Amjad Safvi	IL	Vascular & Interventional Radiology Physician	$568.9K	$765.4K
Brett Rhode	WI	Ophthalmology Physician	$796.4K	$0
Courtney Lamm	WI	Primary Care Nurse Practitioner	$144K	$0
Dean Moesch	SC	Diagnostic Radiology Physician	$70.4K	$0
Shakaib Razzaq	WI	General Practice Physician	$24.4K	$0
Natalie Kerber	WI	Family Nurse Practitioner	$17.4K	$0
Annika Collins	WI	Adult Health Nurse Practitioner	$16.2K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Progressive Community Health Centers, Inc.	WI	Federally Qualified Health Center (FQHC)	$0	$7.7M
Dva Renal Healthcare Inc	WI	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$6.3M
Milwaukee Public Schools	WI	Speech-Language Pathologist	$0	$4.5M
Wisconsin Community Services Inc.	WI	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$4.1M
Baby And Me Prenatal Care Coordination LLC	WI	Case Management Agency	$0	$3.8M
True Dental LLC	WI	Dentist	$0	$1.8M
Baylon Family Physicians, Ltd.	WI	Pediatrics Physician	$0	$1.8M
Helen Jurgensen	WI	Clinical Social Worker	$45.5K	$105.2K
Ramneet Bhathal	WI	Family Medicine Physician	$106K	$0
Krista D'amore	WI	Anatomic Pathology & Clinical Pathology Physician	$32.2K	$0

Procare Medical Group Sc — Billing Profile & Reimbursement Data

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Procare Medical Group Sc — 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