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

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

Craig Carson (NPI 1043288673)

Field	Value
Entity Type	Individual
Organization	Craig Carson
Address	1701 Renaissance Blvd
City	Edmond
State	OK
ZIP	73013
Taxonomy	Rheumatology Physician
NPI Enumerated	March 9, 2006

Payer Source	Total Paid
Medicare	$9.7M
Medicaid	$0

Key Findings

CRAIG CARSON’s Medicare billing profile is dominated by high-volume biologic and infusion drug administration rather than office E/M visits. The top revenue-driving HCPCS codes are J1602 ($1.9M, 20.4%), J0129 ($1.8M, 19.1%), and J1745 ($1.5M, 16.1%), and the precomputed top-3 codes account for 55.6% of this provider’s total Medicare revenue. This mix is consistent with an outpatient infusion/injectable-focused rheumatology practice that bills both specialty biologic drugs and infusion administration codes on-site.

The provider’s total Medicare revenue is $9.7M while there is no Medicaid billing on file, making the practice effectively single-payer in the available data. Because Medicaid shows "none below," this entity’s revenue and utilization picture should be interpreted as Medicare-centric with no in-state Medicaid claims to contextualize payer mix or state-level market share.

CRAIG CARSON is a national outlier on multiple specific drug codes: J1745 ranks #1 of 1352 providers nationally (100th percentile; extreme outlier), J1602 ranks #2 of 1041 (100th percentile; extreme outlier), and J0129 ranks #6 of 1221 (100th percentile; extreme outlier). These rankings indicate dominant, far-above-typical national volumes for infliximab, golimumab, and abatacept infusions and position the provider as a major national participant for those biologics.

Infusion and administration procedure codes further reinforce the practice model: 96413 ($195.8K revenue) ranks #1 of 7514 providers nationally (100th percentile; extreme outlier) and 96365 ($96.2K revenue) ranks #23 of 8873 providers nationally (100th percentile; extreme outlier). High ranks on add-on and sequential infusion codes such as 96415 (rank #4 of 4959, 100th percentile; extreme outlier) and 96375 (rank #7 of 5191, 100th percentile; extreme outlier) show substantial throughput of multi-hour infusion sessions and IV-push sequencing.

Several large-volume drug lines are billed at low average paid-per-claim values but generate substantial revenue through very high claim counts — for example, J1602 has 192.6K claims at $10 avg paid/claim ($1.9M revenue) and J3262 has 194.3K claims at $4 avg paid/claim ($777.2K revenue). This pattern suggests a business model that relies on high-frequency administration of unit-priced biologic or specialty drug items to produce aggregated revenue.

Beyond biologics, the provider bills significant volumes for immune globulin and related infusions (J1459 $226.4K, J1569 $176.8K) and for therapies such as denosumab (J0897 $223.6K), rituximab (J9312 $349.3K) and belimumab (J0490 $1.1M, rank #1 of 39, 100th percentile; extreme outlier). The presence of these codes indicates a broad scope of infusible immunomodulatory treatments and suggests ancillary services for bone health and autoimmune management are part of the practice mix.

Operational longevity supports an established practice footprint: the provider’s NPI was enumerated 2006-03-09 (~20 years ago), indicating long tenure in Medicare billing which may explain the scale and specialized service lines observed. Analysts evaluating network capacity or vendor contracting should consider this seniority alongside the concentration in infusion services.

Multiple codes tied to steroid, IV hydration, or injection administration also appear as extreme outliers nationally (for example J1720 rank #1 of 154, 100th percentile; extreme outlier and J2930 rank #2 of 2459, 100th percentile; extreme outlier), reinforcing that the provider’s utilization profile is heavily weighted toward procedural drug administration rather than typical office-based rheumatology encounters. For competitive or utilization reviews, this provider should be treated as a high-volume infusion site and compared to infusion centers and large rheumatology infusion practices rather than to average office-based peers.

Medicare: Complete Services Breakdown

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

67 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J1602	Injection, golimumab, 1 mg, for intravenous use	192,640	$10	$1.9M
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)	54,750	$30	$1.8M
J1745	Injection, infliximab, excludes biosimilar, 10 mg	60,850	$30	$1.5M
J0490	Injection, belimumab, 10 mg	28,630	$40	$1.1M
J3262	Injection, tocilizumab, 1 mg	194,300	$1	$777.2K
J0491	Injection, anifrolumab-fnia, 1 mg	32,100	$10	$385.2K
J9312	Injection, rituximab, 10 mg	5,920	$60	$349.3K
J3111	Injection, romosozumab-aqqg, 1 mg	30,660	$10	$245.3K
J1459	Injection, immune globulin (privigen), intravenous, non-lyophilized (e.g., liquid), 500 mg	6,120	$40	$226.4K
J0897	Injection, denosumab, 1 mg	12,420	$20	$223.6K

Showing 1–10 of 67

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 67 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Oklahoma Distribution

Craig Carson — 17 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Oklahoma

Full comparison — all codes billed, vs. state median

67 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0129	1	10	16,680	$30	$661.9K
J0490	1	10	8,730	$40	$562.9K
J3262	1	10	82,050	$1	$432.8K
J1602	1	20	25,400	$10	$412.3K
J1745	1	10	6,400	$30	$312.2K
J0717	5	10	60,800	$1	$255.6K
J9312	1	10	3,650	$60	$246.8K
J0491	1	10	13,510	$10	$229.2K
J3111	3	20	22,470	$10	$216.7K
J1459	1	10	3,380	$40	$150.3K

Showing 1–10 of 67

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Oklahoma Arthritis Center, P.C.	OK	Rheumatology Physician	$0	$10.1M
Ana Kumar	OK	Rheumatology Physician	$4.1M	$0
Keshav Panday	OK	Specialist	$3.3M	$0
Horng-chyi Lai	WY	Rheumatology Physician	$1.4M	$0
Uma Guniganti	OK	Cardiovascular Disease Physician	$797.5K	$0
Graciela Gallardo	OK	Family Medicine Physician	$710K	$0
Montana Arthritis Center LLC	MT	Multi-Specialty Clinic/Center	$0	$484.7K
John Schrader	OK	Cardiovascular Disease Physician	$397.8K	$0
Spencer Wopart	OK	Nurse Practitioner	$379.2K	$0
Zoom Diagnostic Imaging LLC	OK	Radiology Clinic/Center	$337.5K	$30.4K

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Specialty Care Pediatrics, Inc.	OK	Home Health Agency	$0	$44.8M
Medical Resource Management, LLC	OK	Urgent Care Clinic/Center	$0	$14.9M
Sand Lily Healthcare, Inc.	OK	In Home Supportive Care Agency	$0	$8.9M
Christopher Fisher	OK	Internal Medicine Physician	$7.6M	$0
Summit Medical Center	OK	General Acute Care Hospital	$0	$7.1M
Brian Phelps	OK	Retina Specialist (Ophthalmology) Physician	$4.1M	$0
Sandeep Shah	OK	Retina Specialist (Ophthalmology) Physician	$3.9M	$0
Ryan Ridges	OK	Retina Specialist (Ophthalmology) Physician	$3.6M	$0
Michael Hood	OK	Retina Specialist (Ophthalmology) Physician	$3.5M	$0
Pathways Professional Counseling LLC	OK	Community/Behavioral Health Agency	$0	$3.4M

Craig Carson — Billing Profile & Reimbursement Data

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Craig Carson — 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