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NPI 1073538047 · Salt Lake City, UT · Neurology Physician
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John Foley is a neurology physician provider located in Salt Lake City, Utah. This profile covers 12 Medicare and 2 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 | John Foley |
| Address | 370 9th Ave |
| City | Salt Lake City |
| State | UT |
| ZIP | 84103 |
| Taxonomy | Neurology Physician |
| NPI Enumerated | July 12, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $789.8K |
| Medicaid | $608K |
This provider’s billing mix is highly focused on infusion-based neurology therapies: the top Medicare codes are J2323 and J2350, both monoclonal antibody infusions commonly used in multiple sclerosis care, while typical office visit codes such as 99213 appear but contribute only a small share of revenue. The predominance of infusion drug codes suggests the practice operates primarily as an infusion/infusion-adjacent specialty rather than a general outpatient clinic.
Medicare revenue is heavily concentrated in a very small set of drugs: the precomputed top-3 Medicare codes account for 98.4% of this provider’s total Medicare revenue, with J2323 alone representing $578.3K (72.1% of Medicare revenue) and J2350 representing $201.7K (25.1%). This concentration indicates operational and financial dependence on a narrow set of high-cost infused therapies for the Medicare population.
Medicaid revenue is effectively single-product: the precomputed top-3 Medicaid codes account for 100.0% of Medicaid revenue, with J2323 alone reported as $607.8K (100.0% of Medicaid revenue) across 160 claims at an avg paid/claim of $3799. This means Medicaid activity and revenue for this provider are nearly entirely driven by natalizumab administration.
The provider has a meaningful dual-payer footprint in scale: total Medicare revenue is $789.8K while total Medicaid revenue is $608K, so both payers are material to the practice’s revenue base. This is not a single-payer operation; payerside exposure is split across Medicare and Medicaid, with Medicare somewhat larger in absolute dollars.
Competitive standing is mixed across payers and drugs. For J2323 on Medicare the provider ranks #14 of 40 nationally (67th percentile) and is described as typical, unremarkable volume, indicating it is a modest but not dominant national participant for that drug; by contrast, for J2350 the provider ranks #102 of 105 nationally (3th percentile) and is at the low end of national participation for that code. In-state for Medicaid, J2323 ranks #2 of 2 providers (0th percentile) which positions the provider as the second of two billers for this drug in the state rather than a statewide leader.
There is a stark payer-level difference in reported avg paid/claim for the same drug: J2323 shows an avg paid/claim of $18 on Medicare versus $3799 on Medicaid in these data. This large discrepancy likely reflects differences in how units or billing episodes are reported and paid across Medicare and Medicaid rather than reflecting a difference in clinical use; it is an important operational and reconciliation signal for payer analysts.
Routine evaluation-and-management activity is minimal compared with infusion work: 99213 generates only $9.5K (1.2% of Medicare revenue) across 159 Medicare claims, and other E/M codes (99214, 99212) contribute even smaller shares. That pattern reinforces the interpretation that the practice’s revenue model centers on infusion drug administration rather than traditional office-based cognitive visits.
The provider has long-tenure in the Medicare/Medicaid system, with the NPI enumerated on 2006-07-12 (~20 years ago). That extended active period, combined with the concentrated drug-focused revenue mix, suggests an established specialty infusion practice rather than a newly entered market participant.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
12 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J2323 | Injection, natalizumab, 1 mg | 32,130 | $20 | $578.3K |
| J2350 | Injection, ocrelizumab, 1 mg | 4,800 | $40 | $201.7K |
| 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… | 160 | $60 | $9.5K |
| 96365 | The provider administers the initial intravenous infusion of a medication or other substance for a period up to one hour to prevent, treat, or diagnose a condition or disease. | 120 | $50 | $5.7K |
| 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… | 50 | $80 | $3.6K |
| 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… | 30 | $70 | $1.9K |
| 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,… | 20 | $30 | $540 |
| 96415 | In this add on procedure, the provider continues administration of a chemotherapy drug into a vein using an infusion technique. He uses this code to report each additional hour of infusion beyond the… | 30 | $20 | $520 |
| 96375 | Following the administration of a drug or other substance via intravenous, or IV, push, the provider sequentially infuses a different medication or medications, also via IV push. He administers the… | 40 | $10 | $390 |
| J2930 | Injection, methylprednisolone sodium succinate, up to 125 mg | 20 | $1 | $90 |
Showing 1–10 of 12
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 12 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
12 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J2323 | 3 | 10 | 32,130 | $20 | $741.7K |
| J2350 | 3 | 10 | 5,100 | $40 | $221.6K |
| 96413 | 46 | 50 | 100 | $90 | $13.8K |
| 99214 | 2,711 | 4,080 | 80 | $80 | $11.6K |
| 99213 | 780 | 3,680 | 60 | $50 | $6.4K |
| 96365 | 28 | 80 | 90 | $40 | $5.2K |
| 96415 | 36 | 40 | 60 | $20 | $2K |
| 99212 | 512 | 680 | 30 | $40 | $1.9K |
| 96375 | 27 | 30 | 50 | $10 | $990 |
| J2930 | 6 | 10 | 30 | $1 | $140 |
Showing 1–10 of 12
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.
2 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J2323 | Injection, natalizumab, 1 mg | 160 | $3,800 | $607.8K |
| 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… | 80 | $1 | $160 |
How this provider's Medicaid billing volume and revenue compare to other Utah providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Utah median
2 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| J2323 | Injection, natalizumab, 1 mg | 2 | 10 | 680 | $3,240 | $2.2M |
| 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… | 14 | 20 | 750 | $50 | $74.4K |
Other providers in the same ZIP code as John Foley, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Dr John Foley LLC | UT | Neurology Physician | $0 | $3.9M |
| Ihc Health Services Inc | UT | Rehabilitation Clinic/Center | $0 | $2.5M |
| Diana Banks | UT | Neurology Physician | $1.6M | $0 |
| April Erwin | UT | Neurology Physician | $1.2M | $0 |
| Ihc Health Services Inc | UT | Psychiatry Physician | $0 | $830.1K |
| Timothy West | UT | Neurology Physician | $664.5K | $0 |
| Shriners Hospitals For Children | UT | Children's Hospital | $0 | $605.5K |
| Viktoria Kaplan | UT | Neurology Physician | $517.8K | $0 |
| Daniel Preece | UT | Foot & Ankle Surgery Podiatrist | $267.1K | $0 |
| Avenues Surgery Center, LLC | UT | Ambulatory Surgical Clinic/Center | $236K | $0 |
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