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

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

Pines Health Services (NPI 1942277819)

Pines Health Services is a internal medicine physician provider located in Caribou, Maine. This profile covers 0 Medicare and 92 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.

Medicaid: Complete Services Breakdown

Field	Value
Entity Type	Organization
Organization	Pines Health Services
Address	74 Access Hwy
City	Caribou
State	ME
ZIP	04736
Taxonomy	Internal Medicine Physician
NPI Enumerated	March 1, 2006

Payer Source	Total Paid
Medicaid	$7.6M
Medicare	$0

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

92 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T1015	Clinic visit/encounter, all-inclusive	35,270	$140	$4.8M
G0467	Federally qualified health center (fqhc) visit, established patient; a medically-necessary, face-to-face encounter (one-on-one) between an established patient and a fqhc practitioner during which…	11,520	$50	$518.6K
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…	21,380	$20	$470.4K
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…	16,800	$20	$285.6K
99232	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	6,660	$20	$139.9K
D1206	Topical Fluoride Treatment – Except Varnish; Therapeutic application for moderate to high caries risk patients	2,760	$50	$124K
99212	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,…	3,710	$30	$122.4K
90832	In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere…	1,790	$60	$111K
D0220	Intraoral - periapical first radiographic image	1,920	$50	$103.8K
88305	The physician, typically a pathologist, performs a level IV examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally…	3,200	$30	$92.9K

Showing 1–10 of 92

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Maine Distribution

Pines Health Services — 0 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Maine

Full comparison — all codes billed, vs. Maine median

92 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1015	Clinic visit/encounter, all-inclusive	24	180	8,540	$180	$3M
43239	The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum where he removes one or more tissue biopsy specimens for diagnostic analysis.	24	30	200	$250	$316.8K
G0467	Federally qualified health center (fqhc) visit, established patient; a medically-necessary, face-to-face encounter (one-on-one) between an established patient and a fqhc practitioner during which…	8	80	3,000	$50	$269.8K
D7140	Extraction, erupted tooth or exposed root (elevation and/or forceps removal)	33	70	630	$100	$235.5K
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…	42	460	1,240	$30	$190K
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…	42	480	1,030	$20	$128.9K
88305	The physician, typically a pathologist, performs a level IV examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally…	17	50	2,110	$20	$123K
99232	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	11	70	730	$30	$120.2K
20610	In this procedure, the provider inserts a needle through the skin of a patient and into a major joint or bursa and then uses the syringe attachment to the needle to remove fluid or he may inject a…	8	40	860	$70	$109.1K
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…	51	70	1,060	$40	$97K

Showing 1–10 of 92

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Pines Health Services	ME	Obstetrics & Gynecology Physician	$0	$7.1M
Pines Health Services	ME	Federally Qualified Health Center (FQHC)	$0	$3.7M
Pines Health Services	ME	Family Medicine Physician	$0	$3M
Allan Espinosa Morazan	AZ	Medical Oncology Physician	$2.2M	$0
Pines Health Services	ME	Federally Qualified Health Center (FQHC)	$0	$480.1K
Ninu Sharma	ME	Anatomic Pathology & Clinical Pathology Physician	$109.9K	$1.9K
Albert Whiting	ME	Ophthalmology Physician	$98.3K	$0
Irene Djuanda	ME	Internal Medicine Physician	$65.7K	$0
Jean Michaud	ME	Sports Medicine (Orthopaedic Surgery) Physician	$59.3K	$0
Jeffrey Hoeksma	ME	Hospitalist Physician	$58K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Aroostook Home Health Services	ME	Home Health Agency	$0	$15.8M
City Of Caribou	ME	General Acute Care Hospital	$0	$3M
City Of Caribou	ME	Land Ambulance	$312.2K	$1.6M
Lincare Inc.	ME	Durable Medical Equipment & Medical Supplies	$0	$1.5M
Healing Hearts LLC	ME	Mental Health Counselor	$0	$1M
County Physical Therapy, LLC	ME	Physical Therapist	$0	$802.4K
Your Journey, LLC	ME	Community/Behavioral Health Agency	$0	$676.2K
David Conner	ME	Family Medicine Physician	$45.4K	$579.4K
Craig K. Small O.d. Family Eye Care	ME	Optometrist	$0	$522.7K
New Day Counseling Services, LLC	ME	Community/Behavioral Health Agency	$0	$508.6K

Pines Health Services — Billing Profile & Reimbursement Data

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Pines Health Services — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

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