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.

Upper Valley Family Practice, PLLC (NPI 1922237874)

Field	Value
Entity Type	Organization
Organization	Upper Valley Family Practice, PLLC
Address	32 W 1st S
City	Rexburg
State	ID
ZIP	83440
Taxonomy	Family Medicine Physician
NPI Enumerated	July 13, 2009

Payer Source	Total Paid
Medicaid	$365.4K
Medicare	$0

Medicaid: Complete Services Breakdown

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

7 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…	3,510	$60	$207K
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…	1,930	$80	$148.8K
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…	50	$140	$6.5K
36415	In this procedure, the provider inserts a needle into a vein to collect a blood sample.	460	$1	$1.4K
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…	10	$100	$1.3K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	10	$20	$210
90688	This code represents a vaccine product administered into the muscle to protect against four strains of influenza (flu). It uses split virus technology and is given as a 0.5 mL dose.	20	$10	$200

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

Upper Valley Family Practice, PLLC — 0 of 7 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

7 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…	158	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…	181	620	560	$60	$191.8K
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…	92	140	100	$90	$54.4K
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…	199	220	90	$80	$51.4K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	168	180	140	$10	$28.4K
36415	In this procedure, the provider inserts a needle into a vein to collect a blood sample.	108	210	510	$1	$7K
90688	This code represents a vaccine product administered into the muscle to protect against four strains of influenza (flu). It uses split virus technology and is given as a 0.5 mL dose.	32	50	30	$1	$210

Related Providers

Other providers that share a Tax Identification Number (TIN) with Upper Valley Family Practice, PLLC, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Brett Zundel	ID	Medical Physician Assistant	$158K	$0
Sheri Smith	ID	Physician Assistant	$82.1K	$0

Nearby Providers

Other providers in the same ZIP code as Upper Valley Family Practice, PLLC, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
County Of Madison School District 321	ID	Local Education Agency (LEA)	$0	$17.1M
Valley Help At Home Senior Care LLC	ID	In Home Supportive Care Agency	$0	$7.9M
Upper Valley Community Health Services Inc	ID	Federally Qualified Health Center (FQHC)	$0	$7.6M
Mhd Therapies, PLLC	ID	Physical Therapist	$0	$7.4M
Upper Valley Options, Inc.	ID	Developmentally Disabled Services Day Training Agency	$0	$3.7M
Madison Co Memorial Hospital	ID	Obstetrics & Gynecology Physician	$0	$2.6M
Teton Medical Group PLLC	ID	Family Medicine Physician	$0	$2.1M
Clubhouse Pediatric Dentistry Of Madison	ID	Pediatric Dentistry	$0	$1.9M
Seasons Medical, PLLC	ID	Obstetrics & Gynecology Physician	$0	$1.8M
Fall River Medical, PLLC	ID	Primary Care Clinic/Center	$0	$1.7M

Upper Valley Family Practice, PLLC — Billing Profile & Reimbursement Data

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Upper Valley Family Practice, PLLC — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References