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

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

Shaun Joshi (NPI 1073629150)

Field	Value
Entity Type	Individual
Organization	Shaun Joshi
Address	1986 W Hayden Ave
City	Hayden
State	ID
ZIP	83835
Taxonomy	Nephrology Physician
NPI Enumerated	August 22, 2006

Payer Source	Total Paid
Medicare	$523.4K
Medicaid	$0

Key Findings

This provider’s Medicare activity is tightly concentrated: Total Medicare revenue is $523.4K and the precomputed top 3 Medicare codes by revenue account for 66.4% of that total. The leading three codes are 99214 ($145.6K, 27.8% of Medicare revenue), 90960 ($135.8K, 25.9%), and 99232 ($66.1K, 12.6%), indicating a small set of services drives most billings.

The code mix points to a nephrology practice focused on ESRD management and intensive evaluation-and-management work. High revenue from 90960 and 90961 (monthly ESRD management codes) alongside substantial billing for hospital E/M codes like 99232 and 99233 suggests the provider delivers both outpatient dialysis-related care and inpatient/observation follow-up for complex renal patients. Transition-of-care codes such as 99496 and 99495 further imply active involvement in post-discharge management for high-acuity patients.

Despite modest absolute Medicare revenue ($523.4K), this provider is a national high-volume outlier for several key codes. 99214 ranks #2086 of 479517 providers nationally and is labeled an extreme outlier (100th percentile, far above typical national volume), while 90960 ranks #131 of 6549 providers (98th percentile, notably above typical national volume), and 99496 ranks #136 of 15461 providers (99th percentile, extreme outlier). These rankings indicate unusually high utilization of specific nephrology and E/M services compared with peers.

Operationally, the provider appears to be structured around recurring monthly ESRD encounters and high-complexity visits rather than broad primary-care office volume. The large claim counts for dialysis-management codes (90960: 543 claims; 90961: 198 claims; 90966: 73 claims) paired with frequent higher-level E/M visits (99214: 1.8K claims; 99232: 1.1K claims) point to a roster of chronically managed, high-acuity patients that require both outpatient dialysis oversight and repeated inpatient or observation care.

Payer mix is effectively single-payer from this dataset: there is no Medicaid billing on file for this provider, so Medicare accounts for the visible public-payer activity. The absence of Medicaid billing limits conclusions about dual-coverage strategies or exposure to state-managed programs, making Medicare the primary window into this provider’s public-payor business profile.

Tenure and continuity: the provider’s NPI was enumerated on 2006-08-22 (~20 years ago), indicating long-term enrollment in the Medicare program. That duration supports the interpretation that the observed high-volume patterns for ESRD and certain E/M codes are established practice behaviors rather than short-term anomalies.

Revenue concentration creates potential sensitivity to coding or utilization shifts because two codes alone—99214 and 90960—contribute over half of Medicare revenue by themselves (27.8% and 25.9%, respectively). Any changes in reimbursement, patient mix, or referral patterns affecting those services would materially change the provider’s Medicare income profile.

Competitive standing is mixed: for several high-revenue codes the provider is a top national performer, while for others volumes are typical or below peer medians. For example, 99214 and 99496 are extreme outliers nationally, 90960 and 99232 are notably above typical national volume, but codes such as 36589 and 99233 sit at much lower national percentiles (18th and 45th respectively), indicating concentrated strengths rather than broad dominance across nephrology and inpatient E/M services.

Medicare: Complete Services Breakdown

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

19 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…	1,780	$80	$145.6K
90960	The provider manages all the services associated with the monthly care of a patient who is 20 years old or older and has a condition known as end stage renal disease or ESRD. For this service, the…	540	$250	$135.8K
99232	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	1,140	$60	$66.1K
90961	The provider manages all the services associated with the monthly care of a patient who is 20 years old or older and has a condition known as end stage renal disease, or ESRD. For this service, the…	200	$210	$42K
99496	The provider manages the care of a patient during the transition to home care after discharge from a healthcare facility. The patient’s care requires high–level medical decision making, contact…	160	$200	$31.8K
99215	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the…	190	$120	$22.4K
90966	The provider manages all the physician related services for one full month for the home dialysis care of a patient who is 20 years old or older and has a condition known as end stage renal disease,…	70	$180	$13.4K
99204	The provider sees a new 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 provider…	110	$100	$11.5K
99223	The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	80	$130	$9.9K
99205	The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the provider…	70	$140	$9.3K

Showing 1–10 of 19

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 19 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Idaho Distribution

Shaun Joshi — 6 of 19 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Idaho

Full comparison — all codes billed, vs. state median

19 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
90960	1	20	190	$260	$58K
90966	13	20	100	$220	$21.3K
90961	1	30	60	$220	$17.3K
99214	2	2,690	90	$70	$10.4K
99233	189	400	60	$90	$9.4K
99232	3	680	60	$60	$7.3K
99223	96	500	30	$120	$6.6K
99215	58	810	40	$100	$6.5K
99213	1,282	2,770	70	$50	$5.7K
99239	194	310	40	$80	$5.1K

Showing 1–10 of 19

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Kootenai Health, Inc.	ID	General Acute Care Hospital	$0	$7M
Kootenai Health, Inc.	ID	Psychiatry Physician	$0	$6.7M
Kootenai Urgent Care LLC	ID	Family Medicine Physician	$0	$3.8M
Kootenai Health, Inc.	ID	Emergency Medicine Physician	$0	$2.6M
Bonner General Hospital Inc.	ID	Critical Access Hospital	$0	$1.6M
Golden Buckland	ID	Ophthalmology Physician	$1.2M	$0
Dustin Dinning	ID	Rheumatology Physician	$1.1M	$0
Alison Granier	ID	Ophthalmology Physician	$842.5K	$0
David Dance	ID	Ophthalmology Physician	$711.8K	$0
Sara Duke	ID	Ophthalmology Physician	$611.7K	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Renewed Horizons, LLC	ID	Intellectual and/or Developmental Disabilities Residential Treatment Facility	$0	$19.9M
Wellspring Meadows, Inc.	ID	Personal Care Attendant	$0	$3.9M
Dance Dentistry PLLC	ID	General Practice Dentistry	$0	$2.6M
Periwinkle Children's Therapy	ID	Contractor	$0	$1.8M
Renewed Horizons, LLC	ID	Developmentally Disabled Services Day Training Agency	$0	$1.3M
Lookout Behavioral Health LLC	ID	Adult Mental Health Clinic/Center	$0	$888.5K
Public Health District 1	ID	Public Health or Welfare Agency	$0	$843.3K
North Idaho Nephrology Associates, Inc.	ID	Medical Specialty Clinic/Center	$0	$504.4K
Robin Lindauer	ID	Optometrist	$129.3K	$330.6K
Joshua Tree Physical Therapy PLLC	ID	Specialist	$0	$373.1K

Shaun Joshi — 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