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

Why is the Medicaid comparison limited to New Mexico 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. New Mexico (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.

Hillary Norton (NPI 1093911323)

Field	Value
Entity Type	Individual
Organization	Hillary Norton
Address	404 Brunn School Rd
City	Santa Fe
State	NM
ZIP	87505
Taxonomy	Rheumatology Physician
NPI Enumerated	June 24, 2007

Payer Source	Total Paid
Medicare	$1.5M
Medicaid	$0

Key Findings

This provider’s Medicare footprint dominates its public payer activity: total Medicare revenue is $1.5M while there is no Medicaid billing on file (none below), meaning the practice operates effectively as a Medicare-focused operation for the payers represented in these records. The lack of Medicaid billing has direct implications for network contracting and patient population analyses, since analysts should not expect Medicaid encounter volume when modeling this provider’s public-payer access or revenue sensitivity to state program changes.

Revenue is highly concentrated in a small set of biologic drug codes: the precomputed top 3 Medicare codes by revenue account for 76.1% of this provider's total Medicare revenue, driven primarily by J0129, J1602, and J3262. In particular, J0129 alone accounts for $683.4K (45.6% of Medicare revenue), while J1602 contributes $247.5K (16.5%) and J3262 contributes $208.4K (13.9%), indicating that biologic infusion and drug administration are the core revenue drivers for this clinician.

The code mix indicates an on-site infusion and biologic management service line characteristic of rheumatology infusion practices: top codes J0129 (abatacept), J1602 (golimumab), J3262 (tocilizumab), and additional infliximab/biosimilar codes (Q5115 $108.5K, Q5104 $73.8K, J1745 $41.7K) point to routine administration of IV/subcutaneous disease-modifying biologics. Infusion administration and chemotherapy-related administration CPTs such as 96365 ($26.4K) and 96413 ($15.1K) further support that the practice directly administers infusions rather than only prescribing drugs for external administration.

Competitive standing across national Medicare peers is mixed: J0129 ranks #134 of 1221 providers nationally (89th percentile) but is labeled 'typical, unremarkable volume,' J1602 ranks #230 of 1041 (78th percentile, typical, unremarkable volume), and J3262 ranks #282 of 618 (54th percentile, typical, unremarkable volume). In contrast, certain administration and visit codes are statistical outliers for volume — 96365 ranks #326 of 8873 (96th percentile) and 99204 ranks #8036 of 227068 (96th percentile) and are both labeled 'notably above typical national volume' — suggesting stronger-than-average throughput for infusion sessions and new-patient clinic intake relative to national peers.

Operational and revenue risk is concentrated in drug reimbursement rather than evaluation-and-management revenue: J0129 represents $683.4K (45.6% of Medicare revenue) while combined E/M codes like 99214 ($28.6K, 1.9%) and 99213 ($4.6K, 0.3%) are a small fraction of total revenue. This implies that changes in biologic drug pricing, reimbursement policies, or utilization of biosimilars could materially affect the provider’s Medicare revenue profile.

The provider shows evidence of offering advanced infusion/administration services beyond routine injections: 96365 (initial IV infusion up to one hour) has 550 claims and $26.4K revenue and is described as 'notably above typical national volume,' and add-on infusion time 96415 appears with 207 claims and $4.3K revenue (88th percentile, typical, unremarkable volume). These patterns suggest a clinic workflow and staffing model set up to deliver multi-hour IV infusions and associated monitoring.

Practice tenure supports stability in the dataset: the NPI was enumerated on 2007-06-24 (~19 years ago), indicating long-term presence in the Medicare billing landscape. That tenure, combined with concentrated biologic administration revenue, suggests an established rheumatology infusion practice rather than a newly formed or episodic biller.

The absence of Medicaid activity (none below) combined with heavy Medicare dependence means payer-mix assumptions should treat this provider as effectively single-payer for public programs; analysts should look to commercial and Medicare Advantage data (if available) to complete a full payer-mix picture. For network adequacy or access modeling, expect the provider’s public-payer caseload to reflect Medicare beneficiaries and limited Medicaid access unless contracting or billing patterns change.

Medicare: Complete Services Breakdown

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

24 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)	20,100	$30	$683.4K
J1602	Injection, golimumab, 1 mg, for intravenous use	24,750	$10	$247.5K
J3262	Injection, tocilizumab, 1 mg	41,680	$10	$208.4K
Q5115	Injection, rituximab-abbs, biosimilar, (truxima), 10 mg	3,100	$40	$108.5K
Q5104	Injection, infliximab-abda, biosimilar, (renflexis), 10 mg	2,460	$30	$73.8K
J1745	Injection, infliximab, excludes biosimilar, 10 mg	1,670	$30	$41.6K
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…	340	$80	$28.6K
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.	550	$50	$26.4K
J0897	Injection, denosumab, 1 mg	1,440	$20	$25.9K
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…	170	$110	$17.9K

Showing 1–10 of 24

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 24 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. New Mexico Distribution

Hillary Norton — 6 of 24 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — New Mexico

Full comparison — all codes billed, vs. state median

24 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0129	1	10	9,930	$30	$358.6K
J1602	1	10	8,900	$10	$132.4K
J3262	1	10	19,800	$1	$117.2K
J0897	36	50	3,150	$20	$113.2K
Q5115	1	10	3,100	$30	$107.1K
Q5104	1	10	2,040	$30	$55.9K
J1745	3	10	1,690	$30	$44.5K
96413	25	40	170	$90	$17.7K
99214	359	2,700	90	$70	$12.9K
99213	1,133	2,440	60	$50	$7.3K

Showing 1–10 of 24

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Joseph Poole	NM	Nurse Practitioner	$554.4K	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
St Vincent Hospital	NM	General Acute Care Hospital	$0	$46.5M
New Mexico Treatment Services LLC	NM	Community/Behavioral Health Agency	$291.6K	$35.3M
Professional Home Health Care De Santa Fe Y Los Alamos	NM	Home Health Agency	$0	$32.5M
State Of New Mexico	NM	Public Health or Welfare Agency	$0	$15.9M
Whole Child Dental, LLC	NM	Pediatric Dentistry	$0	$13.6M
Presbyterian Medical Services	NM	Federally Qualified Health Center (FQHC)	$0	$13.3M
Santa Fe Indian Hospital	NM	Federal Public Health Clinic/Center	$0	$12.5M
Noesis Integrative Health Inc	NM	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$12.3M
Healthfront PC	NM	Emergency Medicine Physician	$0	$8.9M
Hero Dental Of Santa Fe PC	NM	General Practice Dentistry	$0	$8.3M

Hillary Norton — 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