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NPI 1043478878 · Glen Dale, WV · Emergency Medicine Physician
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Joseph Palumbo is a emergency medicine physician provider located in Glen Dale, West Virginia. This profile covers 15 Medicare and 4 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.
Provider details (source: NPPES NPI Registry)
| Field | Value |
|---|---|
| Entity Type | Individual |
| Organization | Joseph Palumbo |
| Address | 800 Wheeling Ave |
| City | Glen Dale |
| State | WV |
| ZIP | 26038 |
| Taxonomy | Emergency Medicine Physician |
| NPI Enumerated | May 29, 2008 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $7.9M |
| Medicaid | $44.3K |
This provider’s business is heavily Medicare‑driven: Total Medicare revenue: $7.9M versus Total Medicaid revenue: $44.3K, making Medicare the dominant payer by a wide margin and effectively single‑payer in scale for material revenue. Medicaid activity exists but is small relative to Medicare, accounting for only a sliver of overall reported lifetime revenue.
Medicare revenue is highly concentrated in a small set of product/implant codes: the top 3 Medicare codes by revenue account for 92.5% of this provider's total Medicare revenue, driven by Q4253 (39.9%), Q4188 (37.6%), and Q4262 (15.0%). That concentration indicates the provider’s Medicare business is largely dependent on a narrow set of high‑value amniotic membrane/skin substitute products.
Code mix and descriptions indicate a wound‑care and procedural supply–driven operation: Q4253, Q4188, and Q4262 are all amniotic membrane/skin substitute add‑on codes, and the presence of 11042 (surgical debridement) and other skin substitute codes (15271, 15275, 15272) reinforces that much of the clinical activity and reimbursed value comes from wound management, grafting, and operative debridement services. Those product and procedure codes suggest revenue flows from both device/supply billing and hands‑on wound procedures rather than routine office‑based primary care.
Competitive standing is mixed across top Medicare codes: Q4188 ranks #2 of 47 providers nationally and is described as notably above typical national volume (98th percentile), indicating a rare, high national standing for that specific product. By contrast Q4253 ranks #16 of 73 (79th percentile) and Q4262 ranks #84 of 141 (41th percentile), both characterized as typical or unremarkable volume relative to peers, so the provider is a pronounced national outlier for Q4188 but more typical for the other amniotic membrane codes.
Several Medicare codes are labeled extreme outliers in national comparisons, signaling unusual volume patterns for certain service lines: 11042 ranks #10 of 10712 and is called an extreme outlier (100th percentile) for debridement, and 99348 ranks #12 of 11547 and is also an extreme outlier (100th percentile) for home/residence visits. Those extreme‑outlier ranks mean this provider performs far more of these specific services than typical national peers and contributes materially to Medicare revenue beyond the three product codes.
Medicaid billing is narrowly concentrated and oriented toward low‑acuity office visits: the top 3 Medicaid codes account for 95.9% of this provider's total Medicaid revenue, driven by 99212 (52.9%) and 99203 (37.9%), with only small emergency department contributions from 99283 and 99284. In‑state ranks for the Medicaid office codes are in the 70th percentile range (99212 rank #161 of 536, 99203 rank #131 of 442), indicating typical, unremarkable Medicaid office volumes within the state rather than market dominance.
The provider’s revenue profile combines high‑value product sales with unusually large volumes of certain procedures and home visits, which creates a two‑part operational model: dependence on expensive allograft/amniotic products for the bulk of Medicare dollars alongside exceptionally high utilization of debridement and home‑visit E/M codes. This mix suggests financial exposure to changes in coverage or pricing for those products and to any modulation in procedural utilization, while Medicaid-facing activity remains routine and low‑acuity.
This NPI has longstanding tenure: NPI enumerated (registered) 2008-05-29 (~18 years ago), indicating nearly two decades of enrollment and consistent billing history. The longevity supports that the observed concentration and outlier patterns are persistent features of the provider’s practice rather than a brief anomaly, and should be treated as stable inputs when evaluating network impact or payer negotiations.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
15 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| Q4253 | Zenith amniotic membrane, per square centimeter (add-on, list separately in addition to primary procedure) | 4,230 | $750 | $3.1M |
| Q4188 | Amnioarmor, per square centimeter (add-on, list separately in addition to primary procedure) | 3,980 | $750 | $3M |
| Q4262 | Dual layer impax membrane, per square centimeter (add-on, list separately in addition to primary procedure) | 1,120 | $1,060 | $1.2M |
| 11042 | The provider uses surgical instruments to remove the dead tissue in skin down to the subcutaneous layer and including the epidermis and dermis, up to the first 20 cm2. | 2,610 | $120 | $302.5K |
| 99348 | The provider sees an established patient for a home or residence visit involving evaluation and management (E/M). The visit involves low medical decision making or the provider spends at least 30… | 2,670 | $70 | $173.7K |
| 15271 | The provider uses a skin substitute, such as an allograft or xenograft, to cover wounds on the patient’s trunk, arms, and/or legs up to an area of 100 cm2. This code covers up to the first 25 cm2. | 420 | $140 | $56.4K |
| 99342 | The provider sees a new patient for a home or residence visit involving evaluation and management (E/M). The visit involves a low level of medical decision making or the provider spends at least 30… | 330 | $60 | $21.3K |
| 15275 | The provider uses a skin substitute, such as an allograft or xenograft, to cover wounds on the face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, up to… | 80 | $140 | $10.9K |
| 11000 | The provider uses surgical instruments to debride the dead tissue in skin for up to 10 percent of the body surface. | 250 | $40 | $10.2K |
| 93922 | Noninvasive physiologic studies of upper or lower extremity arteries, single level, bilateral | 90 | $80 | $7K |
Showing 1–10 of 15
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 15 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
15 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| Q4188 | 1 | 10 | 3,980 | $740 | $3M |
| Q4253 | 1 | 10 | 3,970 | $620 | $2.5M |
| Q4262 | 1 | 10 | 1,120 | $1,060 | $1.2M |
| 15275 | 6 | 10 | 90 | $110 | $20.3K |
| 15271 | 1 | 10 | 90 | $120 | $19.1K |
| 11042 | 1 | 60 | 90 | $70 | $13.6K |
| 99308 | 132 | 150 | 110 | $50 | $10.7K |
| 11000 | 1 | 10 | 250 | $40 | $10.3K |
| 99348 | 1 | 30 | 40 | $60 | $9.2K |
| 99213 | 2,559 | 2,860 | 80 | $50 | $7.5K |
Showing 1–10 of 15
Medicaid revenue breakdown by year and by CPT/HCPCS procedure code, including monthly billing trends and the top codes driving revenue.
View: By Year1 / 3
Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.
4 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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,… | 1,070 | $20 | $23.6K |
| 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… | 370 | $50 | $16.9K |
| 99283 | The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a low level of medical decision making. | 30 | $80 | $2.3K |
| 99284 | The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making. | 20 | $90 | $1.8K |
How this provider's Medicaid billing volume and revenue compare to other West Virginia providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. West Virginia median
4 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 99284 | The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making. | 154 | 170 | 3,350 | $120 | $1.1M |
| 99283 | The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a low level of medical decision making. | 154 | 160 | 3,690 | $80 | $714.8K |
| 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… | 131 | 440 | 110 | $60 | $57.2K |
| 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,… | 161 | 540 | 320 | $20 | $43.2K |
Other providers in the same ZIP code as Joseph Palumbo, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Reynolds Memorial Hospital, Inc | WV | General Acute Care Hospital | $0 | $14.9M |
| Reynolds Memorial Hospital, Inc | WV | Emergency Medical Services (Emergency Medicine) Physician | $0 | $11.4M |
| Michael Wayt | WV | Family Medicine Physician | $350.9K | $0 |
| Zaveen Kureishy | WV | Internal Medicine Physician | $295.1K | $0 |
| Melvin Saludes | WV | Pulmonary Disease Physician | $155.3K | $0 |
| David Romano | WV | Foot Surgery Podiatrist | $89.9K | $0 |
| Cody Larsen | WV | Emergency Medicine Physician | $80.9K | $0 |
| Brandon Wilson | WV | General Practice Physician | $62.3K | $6.4K |
| Reima El Naili | WV | Anatomic Pathology & Clinical Pathology Physician | $59.7K | $0 |
| Dakota Brooker | WV | Physician Assistant | $53.9K | $0 |
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