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

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

Providence Medical Group (NPI 1972533149)

Providence Medical Group is a family medicine physician provider located in Dayton, Ohio. This profile covers 0 Medicare and 120 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	Providence Medical Group
Address	2912 Springboro Rd W
City	Dayton
State	OH
ZIP	45439
Taxonomy	Family Medicine Physician
NPI Enumerated	July 4, 2006

Payer Source	Total Paid
Medicaid	$7.9M
Medicare	$0

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

120 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…	52,780	$60	$3.1M
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…	72,280	$40	$2.9M
90460	In this procedure, the provider administers a single live attenuated vaccine through a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age.	8,550	$30	$273.5K
99309	The provider sees a patient for a subsequent nursing facility care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or the provider…	6,290	$30	$182.5K
96372	A therapeutic, prophylactic, or diagnostic substance (a fluid, a drug, etc.) is injected via intramuscular or subcutaneous route into the patient's body. The procedure is performed by the physician…	6,300	$20	$100.8K
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…	1,720	$60	$97.9K
99308	The provider sees a patient for a subsequent nursing facility care visit involving evaluation and management (E/M). The visit involves a low level of medical decision making and/or the provider…	4,600	$20	$96.7K
99396	The provider performs an established well–patient visit for a patient who is between the ages of 40 and 64.	1,300	$70	$84.2K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	1,410	$60	$79.1K
99395	The provider performs an established well–patient visit for a patient who is between the ages of 18 and 39.	1,170	$60	$69K

Showing 1–10 of 120

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Ohio Distribution

Providence Medical Group — 3 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Ohio

Full comparison — all codes billed, vs. Ohio median

120 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
80307	The lab analyst performs presumptive drug test(s) via instrumented chemistry analyzers to screen for any number of drug classes on a single date.	255	340	2,260	$30	$398.2K
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…	87	4,510	500	$60	$377.8K
80053	The lab analyst performs a comprehensive metabolic panel, or CMP test in which he measures the blood level of 14 chemicals the code descriptor lists for the panel.	177	270	8,700	$10	$353.7K
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…	82	5,080	560	$40	$323.9K
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…	173	430	560	$60	$303.2K
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…	162	480	450	$70	$292.9K
84443	The lab analyst performs a test to measure the amount of thyroid–stimulating hormone (TSH), a hormone produced in the pituitary gland that helps regulate thyroid function. The typical specimen is the…	101	240	2,610	$10	$239.7K
95810	Polysomnography refers to the continuous and simultaneous monitoring and recording of various physiological and pathophysiological parameters of sleep for six or more hours with physician review,…	29	170	240	$360	$217K
82306	The lab analyst measures the vitamin D level, typically on a serum specimen. This analyte, commonly known as vitamin D, is not really a vitamin, but is an important steroid hormone that is produced…	144	260	760	$20	$187.3K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	124	480	280	$70	$181.7K

Showing 1–10 of 120

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Providence Medical Group	OH	Clinical Medical Laboratory	$213.6K	$1M
Jacinta Ford	OH	Medical Physician Assistant	$128.4K	$0
Shane Sampson	OH	Family Medicine Physician	$107K	$0
Kevin Carter	OH	Sleep Medicine (Family Medicine) Physician	$63.6K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
South Community Inc	OH	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$54.4M
Compunet Clinical Laboratories LLC	OH	Clinical Medical Laboratory	$7.7M	$34.3M
Premier Health Specialists Inc	OH	Internal Medicine Physician	$0	$31.1M
Fidelity Health Care Inc	OH	Home Health Agency	$0	$10.1M
Fidelity Health Care Inc	OH	Durable Medical Equipment & Medical Supplies	$0	$10.1M
Project Cure, Inc.	OH	Community/Behavioral Health Agency	$0	$10.1M
Cleanslate Medical Group Of Ohio LLC	OH	Addiction Medicine (Internal Medicine) Physician	$0	$9.5M
Excel Home Health Care LLC	OH	Home Health Agency	$0	$7.8M
Fresenius Vascular Care Dayton Asc LLC	OH	Ambulatory Surgical Clinic/Center	$624K	$215.1K
Stefanie Cain	OH	Family Nurse Practitioner	$79.5K	$0

Providence Medical Group — Billing Profile & Reimbursement Data

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Providence Medical Group — 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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