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

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

William Shergy (NPI 1073531307)

Field	Value
Entity Type	Individual
Organization	William Shergy
Address	4606 Bellewood Dr
City	Huntsville
State	AL
ZIP	35802
Taxonomy	Rheumatology Physician
NPI Enumerated	July 17, 2006

Payer Source	Total Paid
Medicare	$2M
Medicaid	$0

Key Findings

WILLIAM SHERGY is effectively a Medicare-focused Rheumatology Physician practice with lifetime Medicare revenue of $2M and no Medicaid billing on file; the absence of any Medicaid claims makes this provider functionally single-payer from a public program perspective and concentrates revenue exposure to Medicare reimbursement patterns. The provider’s NPI was enumerated on 2006-07-17 (~20 years ago), indicating a long-tenured presence in the market that is consistent with sustained Medicare billing activity.

Revenue concentration is high: the precomputed top three Medicare codes account for 62.7% of total Medicare revenue, driven by J0897 ($565.9K, 28.4% of Medicare revenue), J0129 ($384.2K, 19.3% of Medicare revenue), and J3111 ($300.7K, 15.1% of Medicare revenue). This concentration around a few biologic drug codes suggests the practice’s economic performance is highly dependent on infusion/injection therapies reimbursed through Medicare.

The code mix indicates an infusion- and injection-centered rheumatology practice: high-revenue biologic codes J0897, J0129, J3111 and additional injectable drugs such as J1602 and J1745 appear prominently in the top 25, while infusion administration codes 96365, 96413 and 96415 are also billed. Coupled with DXA imaging (77080) and frequent lab testing (82306, 85025, 80053), the pattern is consistent with a clinic that provides on-site drug administration, monitoring, and bone health management rather than a purely consultative office.

Competitive standing varies by service line: J0897 ranks #89 of 10057 (99th percentile; extreme outlier, far above typical national volume for this code), marking the provider as a national outlier and a major participant for denosumab administration. By contrast, J0129 (rank #399 of 1221, 67th percentile) and J3111 (rank #123 of 970, 87th percentile) are within more typical national ranges for their respective code populations, meaning the provider is exceptional for some drugs but a moderate-to-strong participant for others.

Office evaluation-and-management (E/M) services are also billed at unusually high volumes for a specialist: 99214 generated 1.7K claims and $144.3K (7.2% of Medicare revenue) and ranks #2323 of 479517 (100th percentile; extreme outlier, far above typical national volume for this code), while 99213 produced 920 claims and $52.4K (2.6% of Medicare revenue) and ranks in the 98th percentile (extreme outlier). High E/M volume alongside infusion drug billing suggests the practice blends high-frequency patient management with therapy administration, supporting a stable recurring patient base.

Several lab and procedure codes are billed at above-typical national levels, reinforcing the of on-site longitudinal care model: vitamin D testing 82306 (865 claims, $25.1K; 97th percentile), CBC 85025 (2.2K claims, $17.8K; 97th percentile) and CMP 80053 (1.7K claims, $17.4K; 97th percentile) are all well above typical national volumes. These patterns indicate routine monitoring and lab management are integral to the practice’s clinical workflow, which aligns with management of biologic therapies and bone health.

Infusion- and administration-related procedural codes are present but generally show more typical national positioning: 96413 (243 claims, $21.9K; 68th percentile) and 96365 (252 claims, $11.3K; 85th percentile) indicate ongoing use of infusion services without the same extreme national outlier status as the top drug code J0897. This suggests the practice has regular infusion capacity that supports its biologic-heavy revenue mix, but the dominant revenue signal is the drugs themselves rather than unusually large volumes of infusion administration units.

From a payer/contracting viewpoint, reliance on a small number of high-value drug codes (top 3 = 62.7% of Medicare revenue) combined with no Medicaid billing creates a concentrated reimbursement profile: Medicare is the sole public payer on file and biologic injections drive most revenue. For payers and network analysts, this highlights that negotiations or utilization review focused on high-cost injectable drugs and associated monitoring could materially affect this provider’s revenue and utilization footprint.

Medicare: Complete Services Breakdown

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

37 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J0897	Injection, denosumab, 1 mg	31,440	$20	$565.9K
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)	11,300	$30	$384.2K
J3111	Injection, romosozumab-aqqg, 1 mg	37,590	$10	$300.7K
J1602	Injection, golimumab, 1 mg, for intravenous use	18,900	$10	$189K
J1745	Injection, infliximab, excludes biosimilar, 10 mg	6,530	$30	$169.8K
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…	1,720	$80	$144.3K
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…	920	$60	$52.4K
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…	870	$30	$25.1K
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…	240	$90	$21.9K
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…	2,230	$10	$17.8K

Showing 1–10 of 37

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 37 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Alabama Distribution

William Shergy — 13 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Alabama

Full comparison — all codes billed, vs. state median

37 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0129	11	30	8,530	$30	$390.9K
J1602	7	20	16,100	$10	$189.5K
J3111	3	10	18,900	$10	$177.3K
J1745	7	30	3,020	$30	$107.2K
J0897	2	200	3,120	$20	$97.7K
86235	6	20	380	$20	$37.9K
96413	53	150	150	$90	$20.2K
99214	25	7,330	120	$80	$16.8K
82306	8	340	60	$30	$16K
80053	29	670	140	$10	$13.1K

Showing 1–10 of 37

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Kun Chen	AL	Rheumatology Physician	$2M	$0
Deepak Sree	AL	Rheumatology Physician	$764.8K	$0
Elijah Mitcham	AL	Rheumatology Physician	$676.9K	$0
Christie Thomas	AL	Rheumatology Physician	$641.5K	$0
Margaret Meehan	AL	Rheumatology Physician	$641.1K	$0
Ayesha Jaleel	AL	Rheumatology Physician	$543.4K	$0
Roxanna Sabghi	AL	Rheumatology Physician	$411.5K	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Jennifer Kiessling	AL	Cardiovascular Disease Physician	$820.4K	$0
Kelley Smith	AL	Interventional Cardiology Physician	$795.2K	$0
Jitesh Kar	AL	Neurology Physician	$776.8K	$0
Sadasiva Katta	AL	Cardiovascular Disease Physician	$705.5K	$0
United Vascular Of Huntsville, LLC	AL	Ambulatory Surgical Clinic/Center	$584.4K	$0
Warren Strickland	AL	Cardiovascular Disease Physician	$543.1K	$0
James Campbell	AL	Cardiovascular Disease Physician	$484.1K	$0
William Schneider	AL	Cardiovascular Disease Physician	$469.2K	$0
Eric Janssen	AL	Sports Medicine (Orthopaedic Surgery) Physician	$396.2K	$0
James Flatt	AL	Urology Physician	$391.2K	$0

William Shergy — 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