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

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

Center For Women's Health, LLC (NPI 1922535996)

Field	Value
Entity Type	Organization
Organization	Center For Women's Health, LLC
Address	744 N Marine Corps Dr Ste A121
City	Tamuning
State	GU
ZIP	96913
Taxonomy	Obstetrics & Gynecology Physician
NPI Enumerated	May 21, 2017

Payer Source	Total Paid
Medicaid	$1.9K
Medicare	$0

Key Findings

This provider reports no Medicare billing on file (Medicare revenue: none) and a small Medicaid billing footprint with total Medicaid revenue of $1.9K. The absence of any Medicare activity indicates the practice’s public-payer billing is effectively single-payer (Medicaid) in the available data, rather than a mixed Medicare/Medicaid payer mix.

Medicaid revenue is highly concentrated: the precomputed top-3 Medicaid codes account for 100.0% of this provider’s total Medicaid revenue. Two codes dominate the mix — 99213 represents 55.3% of Medicaid revenue and 81025 represents 44.7% — leaving no material revenue outside these procedure lines.

The code mix (99213 and 81025) points to a primarily ambulatory OB/GYN operation focused on routine office evaluation/management of established patients and point-of-care pregnancy testing. 99213’s descriptor (established patient office visit with low MDM or ~20 minutes) and 81025’s descriptor (visually read urine pregnancy test) together suggest front-line outpatient prenatal or general women's health visits rather than procedure-heavy specialty services.

For the dominant evaluation/management code 99213, the provider filed 12 claims with an average paid per claim of $89 and Medicaid revenue of $1.1K; this code ranks #48 of 48 in-state (0th percentile; typical, unremarkable volume for this code). That ranking and low claim count indicate the provider is a modest participant in established-patient office visits relative to other in-state peers.

For the pregnancy test code 81025, the provider filed 108 claims with an average paid per claim of $8 and Medicaid revenue of $864; this code ranks #4 of 5 in-state (25th percentile; typical, unremarkable volume for this code). While the raw claim count for 81025 is larger than for 99213, the provider remains a modest statewide participant for this service line and the revenue contribution is still limited in absolute terms.

The provider’s NPI was enumerated on 2017-05-21 (~9 years ago), indicating multiple years of enrollment in Medicare/Medicaid systems despite the current absence of Medicare billing. The tenure suggests the Medicaid activity reported is from an established practice rather than a newly enrolled provider.

Operationally and financially, the practice’s Medicaid profile is fragile to small changes because total Medicaid revenue is only $1.9K and almost entirely tied to two codes. The concentration across 99213 and 81025, combined with low absolute revenue and modest in-state rankings, implies limited scale in Medicaid fee-for-service and that observed billing patterns could shift materially with a small change in patient volume or coding behavior.

Medicaid: Complete Services Breakdown

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

2 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…	10	$90	$1.1K
81025	The lab analyst performs the pregnancy test on a urine specimen using a methodology or kit that the analyst can read visually for a direct readout.	110	$10	$860

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Guam Distribution

Center For Women's Health, LLC — 0 of 2 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Guam

Full comparison — all codes billed, vs. Guam median

2 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…	48	50	900	$80	$201.7K
81025	The lab analyst performs the pregnancy test on a urine specimen using a methodology or kit that the analyst can read visually for a direct readout.	4	10	110	$20	$3.3K

Center For Women's Health, LLC — Billing Profile & Reimbursement Data

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Center For Women's Health, LLC — 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

Frequently Asked Questions

References