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

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

James Lipstate (NPI 1043260607)

Field	Value
Entity Type	Individual
Organization	James Lipstate
Address	4212 W Congress St Ste 2300a
City	Lafayette
State	LA
ZIP	70506
Taxonomy	Rheumatology Physician
NPI Enumerated	May 12, 2006

Payer Source	Total Paid
Medicare	$1.2M
Medicaid	$0

Key Findings

JAMES LIPSTATE is a Rheumatology Physician in LAFAYETTE, LA with an NPI enumerated 2006-05-12 (~20 years ago). His lifetime Medicare revenue is $1.2M and he has no Medicaid billing on file (none (no Medicaid billing on file)), which makes his operation effectively single‑payer Medicare in scale based on the available claims data.

Revenue is highly concentrated in injectable biologic drugs: the precomputed top 3 Medicare codes by revenue account for 76.9% of this provider's total Medicare revenue. Those top drivers are J0717 ($468.8K revenue (37.8% of this provider's total Medicare revenue)), J0129 ($322.5K revenue (26.0% of this provider's total Medicare revenue)), and J0897 ($163.1K revenue (13.1% of this provider's total Medicare revenue)).

The code mix implies an in‑office biologic/infusion and monitoring practice: high revenue from J0717, J0129, and J0897 paired with administration codes 96401 ($38K revenue (3.1% of this provider's total Medicare revenue)) and 96413 ($23.1K revenue (1.9% of this provider's total Medicare revenue)) indicates the provider administers injectable therapies on site and bills for drug administration and supportive chemotherapy administration services. Numerous lab and monitoring codes (for example 80053 $12.5K revenue (1.0%), 36415 $11.3K revenue (0.9%), and 85025 $9.7K revenue (0.8%)) support ongoing laboratory surveillance consistent with chronic biologic therapy management.

Competitive standing on the national stage is mixed: J0717 ranks #109 of 848 providers nationally (87th percentile; typical, unremarkable volume for this code) and J0897 ranks #1335 of 10057 providers nationally (87th percentile; typical, unremarkable volume), showing above‑median presence for certain biologics, while J0129 ranks #515 of 1221 providers nationally (58th percentile; typical, unremarkable volume), indicating more modest participation for that specific agent. Overall these ranks suggest the provider is not a dominant national infusion center but maintains meaningful, specialty‑level volume for selected biologics.

There are salient statistical outliers in the service mix that signal practice focus: 99214 is an extreme outlier, far above typical national volume (1.5K claims, $127.6K revenue (10.3% of this provider's total Medicare revenue); rank #3474 of 479517 providers nationally (99th percentile; extreme outlier, far above typical national volume)), indicating unusually high moderate‑complexity E/M office visit volume. Similarly, 96401 is notably above typical national volume (745 claims, $38K revenue (3.1%); rank #135 of 3868 providers nationally (97th percentile; notably above typical national volume)), reinforcing that on‑site drug administration is a material part of the business model.

Ancillary service lines are consistent with comprehensive rheumatology care: the provider bills a range of high‑percentile laboratory panels and monitoring tests (for example 80053 rank #1106 of 26416 providers nationally (96th percentile) and 82550 rank #119 of 2749 providers nationally (96th percentile)), and performs DXA scans (77080, 86 claims, $2.9K revenue (0.2%)). This pattern supports a practice that combines biologic/injectable therapy administration with routine lab surveillance and bone density assessment, typical for long‑term management of rheumatologic disease.

The payer mix concentration (Medicare $1.2M vs. Medicaid none) creates single‑payer exposure and suggests limited Medicaid referral or credentialing activity; strategic growth or risk mitigation would likely require development of non‑Medicare payer relationships or Medicaid engagement if broader payer diversification is a goal. Given the long tenure since NPI enumeration (2006-05-12 (~20 years ago)) and the concentrated biologic revenue, the practice appears to be an established local rheumatology infusion/office care provider rather than a multi‑site or Medicaid‑focused operation.

Medicare: Complete Services Breakdown

The CPT/HCPCS codes generating the most Medicare revenue for this provider.

38 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J0717	Injection, certolizumab pegol, 1 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)	117,200	$1	$468.8K
J0129	Injection, abatacept, 10 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)	9,490	$30	$322.5K
J0897	Injection, denosumab, 1 mg	9,060	$20	$163.1K
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…	1,520	$80	$127.6K
96401	The provider administers nonhormonal, antineoplastic chemotherapy drugs subcutaneously or intramuscularly to the patient.	750	$50	$38K
96413	Chemotherapy is a therapeutic procedure used for the treatment of cancer via the use of chemical agents. These chemical agents (drugs) work on the cancerous cells of the body to destroy them. These…	250	$90	$23.1K
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…	230	$60	$12.8K
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.	1,250	$10	$12.5K
36415	In this procedure, the provider inserts a needle into a vein to collect a blood sample.	1,420	$10	$11.3K
85025	A complete blood count (better known as a CBC) is a blood test request by a doctor that provides detailed information about various types of cells in a patient's blood. Usually a pathologist or a…	1,210	$10	$9.7K

Showing 1–10 of 38

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 38 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Louisiana Distribution

James Lipstate — 8 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Louisiana

Full comparison — all codes billed, vs. state median

38 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0129	7	10	9,490	$30	$506.1K
J0717	3	10	55,200	$1	$263K
J0897	13	70	3,120	$20	$105.6K
96413	22	70	140	$90	$22.8K
99214	44	6,670	110	$80	$16.5K
96401	5	50	130	$50	$12.9K
99213	1,084	6,060	70	$50	$8.1K
84443	220	300	120	$20	$5.1K
82306	94	200	60	$30	$5.1K
99204	805	3,190	30	$110	$4.8K

Showing 1–10 of 38

Related Providers

Other providers that share a Tax Identification Number (TIN) with James Lipstate, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Jennifer Malin	LA	Rheumatology Physician	$1.7M	$0
Bennett Baquet	LA	Endocrinology, Diabetes & Metabolism Physician	$604.8K	$0
Justin Fontenot	LA	Endocrinology, Diabetes & Metabolism Physician	$501.5K	$0
Erron Pujol	LA	Family Nurse Practitioner	$33.7K	$0

Nearby Providers

Other providers in the same ZIP code as James Lipstate, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
University Hospital & Clinics, Inc.	LA	General Acute Care Hospital	$0	$60.9M
Complete Home Health, Inc.	LA	Home Health Agency	$0	$57.4M
Lsuhn Billing LLC	LA	Multi-Specialty Clinic/Center	$0	$45.7M
Share Care Usa	LA	Developmentally Disabled Services Day Training Agency	$0	$27.4M
Alternative Home Care Specialists, Inc.	LA	Personal Care Attendant	$0	$21.9M
Eckerd Youth Alternatives , Inc. Dba Eckerd Connects	LA	Case Management Agency	$0	$17.7M
Cadence Of Acadiana, Inc.	LA	Case Management Agency	$0	$14.1M
Lafayette Association For Retarded Citizens, Inc.	LA	Respite Care	$0	$12.4M
University Hospital & Clinics, Inc.	LA	Anesthesiology Physician	$0	$12.1M
Aa Angel Care Inc	LA	Early Intervention Provider Agency	$0	$11.8M

James Lipstate — Billing Profile & Reimbursement Data

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Key Findings

Medicare: Total Revenue Breakdown by CPT/HCPCS Code

Medicare: Complete Services Breakdown

Medicare: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References