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.

Tommie Simon (NPI 1043653264)

Field	Value
Entity Type	Individual
Organization	Tommie Simon
Address	6401 Sw Lee Blvd
City	Lawton
State	OK
ZIP	73505
Taxonomy	Rheumatology Physician
NPI Enumerated	April 8, 2013

Payer Source	Total Paid
Medicare	$2.5M
Medicaid	$0

Key Findings

This provider’s payer mix is effectively single‑payer: Total Medicare revenue is $2.5M while Total Medicaid revenue is none (no Medicaid billing on file), indicating the practice’s Medicare business drives the entirety of reported public-payer income. Analyses and payer negotiations should therefore focus on Medicare utilization and pricing rather than Medicaid contracting.

Revenue is highly concentrated in a few biologic drug codes: the precomputed top 3 Medicare codes by revenue account for 54.5% of this provider's total Medicare revenue, anchored by J0129 ($857.2K, 34.6% of total), followed by J1602 ($277.2K, 11.2% of total) and J1745 ($217.4K, 8.8% of total). This concentration signals that a small set of high-cost injectable biologics drives most Medicare receipts.

The mix of top codes indicates an infusion- and biologic-focused rheumatology practice: J0129 (abatacept), J1602 (golimumab IV), and J1745 (infliximab) are administration of physician‑supervised biologic agents, and the presence of infusion administration codes such as 96365 (506 claims, $21.3K, 0.9%) and infusion/chemotherapy codes like 96413 (365 claims, $31K, 1.3%) further supports on-site infusion services rather than solely office-based management. Together these entries suggest the practice operates infusion capacity and derives meaningful revenue from drug administration services in addition to drug reimbursement.

Competitive standing varies by drug: the provider is a clearly above‑typical national participant for J0129 (26K claims, $33 avg paid/claim, $857.2K; ranks #70 of 1221 providers nationally, 94th percentile; notably above typical national volume) and shows high activity for J1745 (8.4K claims, $26 avg paid/claim, $217.4K; ranks #137 of 1352, 90th percentile), while J1602 (25.2K claims, $11 avg paid/claim, $277.2K) sits at a solid but more typical volume (rank #220 of 1041, 79th percentile). These rank percentiles indicate the provider is a major national player for abatacept administration and a strong regional/national participant for other infused biologics.

Non-drug professional services are a notable secondary revenue stream: 99214 generates $92K (3.7% of Medicare revenue) with rank #10833 of 479517 providers nationally (98th percentile; notably above typical national volume), showing above-typical office visit volume per Medicare billing. Lower-level and new-patient E&M codes (for example 99213 at $14.6K and 99204 at $15.9K) are present but contribute smaller shares, indicating the practice combines high-volume drug administration with steady office-based follow-up.

Operational evidence of frequent infusion activity appears in administration and add-on codes: 96372 (547 claims, $10 avg paid/claim, $5.5K; ranks #1371 of 58224, 98th percentile; notably above typical national volume), 96415 (273 claims, $19 avg paid/claim, $5.2K; ranks #327 of 4959, 93th percentile), and 96365 (506 claims, $42 avg paid/claim, $21.3K, 0.9%; ranks #396 of 8873, 96th percentile) together point to routine administration of injectable therapies and extended infusion sessions, supporting the inference of dedicated infusion nursing and throughput.

Ancillary diagnostic testing appears consistent with rheumatology management rather than a separate lab business: 80053 (476 claims, $10 avg paid/claim, $4.8K, 0.2%) and 85025 (452 claims, $7 avg paid/claim, $3.2K, 0.1%) appear at moderate national percentiles (80053 rank #3948 of 26416, 85th percentile; 85025 rank #5526 of 32833, 83th percentile), indicating routine ordering of CMPs and CBCs for medication monitoring and disease management. The presence of autoimmune serology 86235 (122 claims, $2.1K, 0.1%) and vitamin D testing 82306 (91 claims, $2.5K, 0.1%) further supports standard rheumatologic workup ancillary to infusion services.

The provider has an established Medicare enrollment history (NPI enumerated 2013-04-08 (~13 years ago)), which, combined with high-volume biologic administration and above-typical E&M ranking, suggests a mature practice model that has built infusion throughput over time rather than a newly launched infusion service. For payer strategy, this tenure and the concentrated biologic revenue profile argue for focused Medicare contracting, utilization review, and benchmarking against high-volume national peers for the listed infusion drugs.

Medicare: Complete Services Breakdown

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

44 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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)	25,980	$30	$857.2K
J1602	Injection, golimumab, 1 mg, for intravenous use	25,200	$10	$277.2K
J1745	Injection, infliximab, excludes biosimilar, 10 mg	8,360	$30	$217.4K
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)	50,800	$1	$203.2K
J9312	Injection, rituximab, 10 mg	3,200	$60	$201.6K
J3262	Injection, tocilizumab, 1 mg	39,860	$10	$199.3K
J0897	Injection, denosumab, 1 mg	8,640	$20	$155.5K
J3111	Injection, romosozumab-aqqg, 1 mg	17,850	$10	$142.8K
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…	1,020	$90	$92K
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…	370	$90	$31K

Showing 1–10 of 44

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 44 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Oklahoma Distribution

Tommie Simon — 2 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

44 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0129	4	10	16,680	$30	$661.9K
J3262	7	10	82,050	$1	$432.8K
J1602	10	20	25,400	$10	$412.3K
J1745	5	10	6,400	$30	$312.2K
J0717	4	10	60,800	$1	$255.6K
J9312	4	10	3,650	$60	$246.8K
J3111	12	20	22,470	$10	$216.7K
J0897	10	70	2,130	$20	$91.2K
96413	15	60	210	$90	$26.4K
99214	186	5,560	130	$70	$18.4K

Showing 1–10 of 44

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Williams Medical Group Practice, LLC	OK	Family Medicine Physician	$0	$27.6M
Comanche County Hospital Authority	OK	Federally Qualified Health Center (FQHC)	$0	$18.3M
Chris Larrow PLLC	OK	General Practice Dentistry	$0	$16.6M
State Of Oklahoma	OK	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$10.1M
Southwestern Medical Center, LLC	OK	General Acute Care Hospital	$0	$9.4M
Health Watch Health Care Of Sw Oklahoma, LLC	OK	Home Health Agency	$0	$9.1M
Comanche County Hospital Authority	OK	Federally Qualified Health Center (FQHC)	$0	$7.1M
Ocean Dental, PC	OK	General Practice Dentistry	$0	$5.5M
Our House Mhsa Inc	OK	Mental Health Counselor	$0	$5.1M
Wavel L. Wells, Dds, Inc	OK	General Practice Dentistry	$0	$4.5M

Tommie Simon — 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

Nearby Providers

Frequently Asked Questions

References