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NPI 1073560330 · Westerly, RI · Rheumatology Physician
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Christopher D'arcy is a rheumatology physician provider located in Westerly, Rhode Island. This profile covers 14 Medicare and 9 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 | Christopher D'arcy |
| Address | 45 Wells Street |
| City | Westerly |
| State | RI |
| ZIP | 02891 |
| Taxonomy | Rheumatology Physician |
| NPI Enumerated | May 30, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $707.7K |
| Medicaid | $58.7K |
This provider reported Total Medicare revenue of $707.7K and Total Medicaid revenue of $58.7K, indicating a practice that is materially Medicare-dominant in scale. The gap in absolute revenue suggests most clinical activity and payer-facing exposure is oriented toward the Medicare population rather than Medicaid.
Revenue concentration is high on both payers: the top 3 Medicare codes by revenue account for 84.0% of this provider's total Medicare revenue, led by J0717 (54.5%), J0897 (20.0%), and 99213 (9.5%). On the Medicaid side the top 3 codes account for 94.4% of Medicaid revenue, driven by 99214 (63.2%), 99213 (24.6%), and 82306 (6.6%), which signals heavy reliance on a very small set of services for each payer.
The code mix and descriptions point to a rheumatology practice that combines biologic/denosumab injections with high-volume office evaluation-and-management visits. J0717 (certolizumab pegol) and J0897 (denosumab) are the two largest Medicare revenue drivers, which is consistent with on-site administration of specialty injectable therapies, while 99213/99214 dominate E/M revenue across both payers.
Competitive standing is mixed by code: J0717 ranks #153 of 848 providers nationally (82th percentile) and J0897 ranks #1706 of 10057 providers nationally (83th percentile), both described as typical, unremarkable volumes relative to peers. By contrast, 99213 on Medicare is an extreme outlier — it ranks #6321 of 457151 providers nationally (99th percentile; extreme outlier, far above typical national volume) — indicating unusually high E/M volume for that specific code compared with national peers.
Several procedure and administration codes show above-typical standing for Medicare activity: 96401 (chemotherapy administration) ranks #274 of 3868 (93th percentile) and 99442 ranks #240 of 21242 (99th percentile; notably above typical national volume), suggesting the practice performs a meaningful amount of drug/infusion administration and remote/telephonic E/M services. Other administration and injection codes appear at typical volumes, supporting an operational model that includes in-office medication administration and ancillary services.
Within-state Medicaid comparisons show the provider to be a modest participant for core E/M visits: 99214 ranks #478 of 1731 in-state (72th percentile) and 99213 ranks #1011 of 2046 in-state (51th percentile), both characterized as typical, unremarkable volume. Laboratory testing billed to Medicaid (for example 82306, 86140, 85025) contributes small shares of Medicaid revenue and ranks in the mid-to-lower range among in-state peers, indicating most lab work is likely standard monitoring rather than a unique in-office lab program.
The provider’s billing profile shows operational concentration risk: with the top three Medicare codes accounting for 84.0% of Medicare revenue and the top three Medicaid codes accounting for 94.4% of Medicaid revenue, fluctuations in coverage, reimbursement, or utilization for a small number of injectable therapies or E/M visit levels could materially affect revenue. This concentration suggests negotiating leverage and care pathways will be most sensitive around biologic administration and established-patient E/M services.
NPI tenure supports a mature practice footprint: the provider enumerated on 2006-05-30 (~20 years ago), which indicates long-standing participation in Medicare/Medicaid and potentially stable referral patterns. That tenure, combined with the code mix, is consistent with an established rheumatology clinician whose core revenue derives from biologic injections and frequent established-patient office visits.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
14 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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) | 98,000 | $1 | $392K |
| J0897 | Injection, denosumab, 1 mg | 7,560 | $20 | $143.6K |
| 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… | 1,010 | $70 | $68.5K |
| 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… | 450 | $90 | $39.6K |
| 96401 | The provider administers nonhormonal, antineoplastic chemotherapy drugs subcutaneously or intramuscularly to the patient. | 490 | $60 | $28.4K |
| 99442 | N/A | 390 | $60 | $25K |
| 99443 | N/A | 80 | $100 | $7.8K |
| 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. | 90 | $50 | $4.6K |
| 99441 | N/A | 100 | $40 | $4.4K |
| 96372 | A therapeutic, prophylactic, or diagnostic substance (a fluid, a drug, etc.) is injected via intramuscular or subcutaneous route into the patient's body. The procedure is performed by the physician… | 180 | $10 | $2K |
Showing 1–10 of 14
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 14 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
14 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J0717 | 1 | 10 | 66,600 | $1 | $261.1K |
| J0897 | 2 | 10 | 3,000 | $20 | $67.3K |
| 96401 | 1 | 10 | 360 | $60 | $21.1K |
| 99214 | 98 | 1,950 | 100 | $80 | $11.7K |
| 99213 | 8 | 1,950 | 70 | $60 | $7.4K |
| 20610 | 85 | 110 | 60 | $50 | $4.6K |
| 99204 | 575 | 740 | 30 | $110 | $4.6K |
| 96365 | 4 | 10 | 70 | $50 | $4.2K |
| 99443 | 12 | 110 | 30 | $80 | $3.5K |
| 99442 | 3 | 220 | 20 | $60 | $2.6K |
Showing 1–10 of 14
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.
9 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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… | 670 | $60 | $37.2K |
| 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… | 310 | $50 | $14.5K |
| 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… | 80 | $50 | $3.9K |
| 86140 | The lab analyst performs the technical lab test to analyze a specimen, typically serum, for the presence of C reactive protein. | 80 | $10 | $1K |
| 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… | 40 | $20 | $720 |
| 82565 | The lab analyst measures the amount of creatinine in a patient specimen, typically of blood. Creatinine is the waste material generated by the muscle tissue produced from the breakdown of creatine… | 40 | $10 | $480 |
| 85652 | The lab analyst performs a test on patient blood to evaluate the rate of sedimentation of red blood cells using an automated test platform. | 30 | $20 | $410 |
| 84450 | The lab analyst performs the technical lab test, typically using serum or plasma, to quantitate the enzyme aspartate amino transferase, or AST, also called SGOT, serum glutamic oxaloacetic… | 30 | $10 | $350 |
| 84460 | The lab analyst performs the technical lab test, typically using serum or plasma, to quantitate the enzyme alanine amino transferase, or ALT, also called SGPT, serum glutamate pyruvate transaminase.… | 30 | $10 | $350 |
How this provider's Medicaid billing volume and revenue compare to other Rhode Island providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Rhode Island median
9 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 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… | 55 | 100 | 120 | $40 | $93K |
| 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… | 188 | 290 | 100 | $30 | $88K |
| 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… | 478 | 1,730 | 220 | $70 | $75.2K |
| 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… | 1,011 | 2,050 | 300 | $50 | $72.3K |
| 82565 | The lab analyst measures the amount of creatinine in a patient specimen, typically of blood. Creatinine is the waste material generated by the muscle tissue produced from the breakdown of creatine… | 30 | 40 | 260 | $20 | $45.7K |
| 86140 | The lab analyst performs the technical lab test to analyze a specimen, typically serum, for the presence of C reactive protein. | 21 | 30 | 110 | $20 | $40K |
| 84460 | The lab analyst performs the technical lab test, typically using serum or plasma, to quantitate the enzyme alanine amino transferase, or ALT, also called SGPT, serum glutamate pyruvate transaminase.… | 35 | 40 | 220 | $10 | $31.4K |
| 84450 | The lab analyst performs the technical lab test, typically using serum or plasma, to quantitate the enzyme aspartate amino transferase, or AST, also called SGOT, serum glutamic oxaloacetic… | 35 | 40 | 230 | $10 | $31.2K |
| 85652 | The lab analyst performs a test on patient blood to evaluate the rate of sedimentation of red blood cells using an automated test platform. | 18 | 20 | 760 | $10 | $26.8K |
Other providers in the same ZIP code as Christopher D'arcy, ranked by combined Medicare and Medicaid revenue.
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