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 U.S. Virgin Islands for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to U.S. Virgin Islands 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. U.S. Virgin Islands (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.

Prohealth Urgent Care LLC (NPI 1952936635)

Field	Value
Entity Type	Organization
Organization	Prohealth Urgent Care LLC
Address	6040 Castle Coakley
City	Christiansted
State	VI
ZIP	00820
Taxonomy	Urgent Care Clinic/Center
NPI Enumerated	March 3, 2020

Payer Source	Total Paid
Medicaid	$53.2K
Medicare	$0

Key Findings

PROHEALTH URGENT CARE LLC’s Medicaid billing is concentrated in evaluation-and-management office/outpatient visits: the top three Medicaid codes are 99214, 99203, and 99205, which reflect a mix of established-patient and new-patient E/M visits at moderate-to-high complexity levels consistent with urgent care operations. Ancillary point-of-care lab codes (36415, 82962, 81003) and the annual wellness code G0439 appear on the file but contribute only marginal revenue relative to the E/M activity.

The provider’s Medicaid revenue is highly concentrated in a small number of codes: the precomputed top 3 Medicaid codes account for 82.5% of total Medicaid revenue, with 99214 alone representing $30.4K (57.1% of Medicaid revenue). This concentration indicates that a majority of revenue derives from routine to moderately complex outpatient visits rather than a broad array of procedures or high-volume ancillary services.

This entity is effectively single-payer in the available data: Total Medicare revenue is none (no Medicare billing on file), while Total Medicaid revenue is $53.2K. The absence of Medicare billing on file makes Medicaid the primary and essentially sole recorded payer in this dataset, limiting insights into cross-payer mix or diversification.

On competitive standing for its largest code, 99214, the provider ranks #24 of 43 in-state (45th percentile) with 467 claims and an average paid/claim of $65; this is described in the source as "typical, unremarkable volume for this code." That positioning suggests the practice is a modest, middle-tier participant for established-patient visits statewide rather than a dominant provider.

For new-patient visits, patterns diverge: 99203 shows 77 claims, $89 avg paid/claim and $6.9K revenue (12.9% of Medicaid revenue), ranking #11 of 20 in-state (47th percentile), while 99205 shows 39 claims, $170 avg paid/claim and $6.6K revenue (12.5% of Medicaid revenue), ranking #6 of 7 in-state (17th percentile). The relative rank and count for 99205 indicate it is offered at a low volume compared with a small set of peers, and its higher average payment per claim helps it capture a material share of revenue despite fewer encounters.

The provider’s tenure in the NPI registry is relatively recent: NPI enumerated 2020-03-03 (~6 years ago). This limited time on file may help explain the modest overall Medicaid scale ($53.2K) and the lack of Medicare billing observed in the dataset.

Ancillary and preventive codes are minimal contributors: G0439 (19 claims, $22 avg paid/claim, $418 revenue, 0.8% of Medicaid revenue) and common point-of-care labs such as 36415 (129 claims, $1 avg, $129 revenue, 0.2%) are present but account for only a sliver of revenue. These patterns reinforce that the practice’s economic activity is driven by E/M visits rather than high-volume lab or preventive-service billing.

Medicaid: Complete Services Breakdown

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

9 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…	470	$70	$30.4K
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…	80	$90	$6.9K
99205	The provider sees a new 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 provider…	40	$170	$6.6K
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…	70	$70	$5K
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…	50	$80	$3.7K
G0439	Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	20	$20	$420
36415	In this procedure, the provider inserts a needle into a vein to collect a blood sample.	130	$1	$130
82962	Blood glucose monitoring at home with small electronic devices is an easy method to check blood sugar level on a daily basis. The patient himself can perform the procedure and the result is obtained…	40	$1	$40
81003	The lab analyst inserts a dip stick into a freshly collected urine specimen, removes the dipstick, and shakes off the excess urine. She places the stick onto a mechanical dip stick reader that will…	30	$1	$30

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. U.S. Virgin Islands Distribution

Prohealth Urgent Care LLC — 0 of 9 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — U.S. Virgin Islands

Full comparison — all codes billed, vs. U.S. Virgin Islands median

9 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
36415	In this procedure, the provider inserts a needle into a vein to collect a blood sample.	14	20	1,920	$110	$858.9K
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…	24	40	560	$140	$322K
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…	34	40	430	$110	$260.9K
81003	The lab analyst inserts a dip stick into a freshly collected urine specimen, removes the dipstick, and shakes off the excess urine. She places the stick onto a mechanical dip stick reader that will…	7	10	210	$40	$123K
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…	14	20	200	$150	$93.5K
82962	Blood glucose monitoring at home with small electronic devices is an easy method to check blood sugar level on a daily basis. The patient himself can perform the procedure and the result is obtained…	4	10	2,890	$20	$66K
99205	The provider sees a new 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 provider…	6	10	140	$240	$42.7K
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…	11	20	80	$90	$27K
G0439	Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	4	10	30	$20	$820

Related Providers

Other providers that share a Tax Identification Number (TIN) with Prohealth Urgent Care LLC, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
John Perez	VI	Specialist	$121.5K	$0
Josephine Kozloff	VI	Physician Assistant	$30.3K	$0
Carmine Hendricks	VI	Family Medicine Physician	$25.3K	$0
Lindsay Ray	VI	Family Nurse Practitioner	$15.6K	$0
Mayya Kawar	VI	Emergency Medicine Physician	$15.4K	$0
Jozette Matthews	VI	Family Nurse Practitioner	$13.9K	$0
Robert Martin	VI	Family Medicine Physician	$2K	$0

Nearby Providers

Other providers in the same ZIP code as Prohealth Urgent Care LLC, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
St Croix Vision Center Inc	VI	Optometrist	$0	$3.6M
One Dental Practice LLC	VI	Dentist	$0	$3.2M
Governor Juan F. Luis Hospital & Medical Center	VI	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$3M
Js Therapies, LLC	VI	Occupational Therapist	$0	$2.9M
Healthquest, LLC.	VI	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$2.4M
Department Of Health, Ems Stx	VI	Land Ambulance	$0	$2.2M
Lindsy Wagner LLC	VI	Clinical Social Worker	$0	$2.2M
Ophthalmology Consultants, PC	VI	Ophthalmology Physician	$0	$2.1M
Acute Alternative Medical Group	VI	Emergency Medical Services (Emergency Medicine) Physician	$0	$1.9M
Pediatric Care Center LLC	VI	Pediatrics Physician	$0	$1.7M

Prohealth Urgent Care LLC — Billing Profile & Reimbursement Data

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Prohealth Urgent Care 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

Related Providers

Nearby Providers

Frequently Asked Questions

References