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

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

Elizabeth Clayton (NPI 1104051945)

Field	Value
Entity Type	Individual
Organization	Elizabeth Clayton
Address	505 Dutchmans Ln
City	Easton
State	MD
ZIP	21601
Taxonomy	Rheumatology Physician
NPI Enumerated	May 22, 2009

Payer Source	Total Paid
Medicare	$7.1M
Medicaid	$0

Key Findings

This provider’s Medicare business is concentrated in high-cost biologic and infusion drugs and related administration services, with J0897, J3111, and J3245 together accounting for 51.4% of total Medicare revenue. The top codes are injections for agents like denosumab, romosozumab, and tildrakizumab, indicating a service-line focused on specialty drug administration rather than predominantly office-based E/M care.

Medicare revenue totals $7.1M while there is no Medicaid billing on file, so this provider functions effectively as a single-payer (Medicare) earner in the available data. The absence of Medicaid suggests limited participation in state Medicaid programs or that their patient mix among publicly insured populations is minimal or routed through other providers.

Several individual codes show extreme national concentration: J0897 ranks #7 of 10057 providers (100th percentile) and J3111 ranks #6 of 970 providers (99th percentile), both described as extreme outliers. These rankings imply this provider is a major national outlier in volume for these specific biologic injections, far above typical national activity for those codes.

Administration and infusion/oncology-adjacent services also appear material to the practice: code 96401 ranks #3 of 3868 providers (100th percentile) and 96413 ranks #83 of 7514 providers (99th percentile), both flagged as extreme outliers. High relative volume on chemotherapy administration add-on and infusion codes supports the interpretation that the practice operates infusion suites or regularly provides supervised parenteral specialty therapies.

While several infusion drug codes are extreme outliers, many commonly billed rheumatology drugs and related injectables show high-but-not-extreme positioning: J0717 (certolizumab) ranks in the 96th percentile, J1745 (infliximab) ranks in the 98th percentile, and J3262 (tocilizumab) is at the 79th percentile. This mix suggests the provider has unusually high throughput for multiple biologic therapies compared with peers, consistent with a high-volume specialty infusion practice rather than a typical office-only rheumatology clinic.

Traditional evaluation-and-management volume is modest relative to drug administration revenue: 99214 accounts for $71.7K (1.0% of Medicare revenue) and 99213 only $1.7K (0.0% of Medicare revenue). These E/M figures reinforce that professional revenue is dominated by drug and infusion billing rather than by routine outpatient visits.

Several codes that are typically less common for rheumatology are present at notable percentiles, such as J1306 (inclisiran) at the 93rd percentile and J9312 (rituximab) at the 89th percentile. The provider’s portfolio spans both musculoskeletal/autoimmune biologics and newer lipid-lowering injectable agents, indicating breadth in administered specialty injectables beyond classic rheumatologic therapies.

Provider tenure shows an NPI enumerated date of 2009-05-22 (~17 years ago), indicating long-standing Medicare enrollment and the opportunity to develop the established high-volume infusion services reflected in the billing mix. This longevity supports that the observed high volumes are the result of sustained practice patterns rather than a short-term anomaly.

Medicare: Complete Services Breakdown

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

29 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J0897	Injection, denosumab, 1 mg	75,780	$20	$1.4M
J3111	Injection, romosozumab-aqqg, 1 mg	166,110	$10	$1.3M
J3245	Injection, tildrakizumab, 1 mg	8,400	$110	$915.6K
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)	183,600	$1	$734.4K
J3380	Injection, vedolizumab, intravenous, 1 mg	24,600	$20	$418.2K
J9312	Injection, rituximab, 10 mg	6,450	$60	$399.9K
J1745	Injection, infliximab, excludes biosimilar, 10 mg	15,270	$30	$397K
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)	11,200	$30	$380.8K
J1306	Injection, inclisiran, 1 mg	32,090	$10	$288.8K
J3262	Injection, tocilizumab, 1 mg	70,040	$1	$280.2K

Showing 1–10 of 29

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 29 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Maryland Distribution

Elizabeth Clayton — 11 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Maryland

Full comparison — all codes billed, vs. state median

29 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J3245	1	10	7,100	$110	$775.4K
J0129	13	40	6,060	$30	$290.2K
J9312	2	10	2,900	$60	$261.2K
J0717	2	30	41,000	$1	$225.7K
J3380	1	20	10,650	$20	$213.3K
J3111	1	30	17,430	$10	$192.3K
J3262	1	20	28,780	$1	$159K
J0897	1	340	3,600	$20	$114.4K
J1306	2	20	8,800	$10	$113.3K
J1745	2	40	2,810	$30	$109K

Showing 1–10 of 29

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Naila Ahmad	MD	Rheumatology Physician	$1.1M	$0
Curtis Foy	MD	Family Medicine Physician	$440.6K	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
For All Seasons, Inc	MD	Clinical Social Worker	$0	$11.4M
Bay Pediatric Center	MD	Pediatrics Physician	$0	$10.8M
Ydiprmc LLC	MD	Urgent Care Clinic/Center	$0	$8.7M
Bnj Health Services LLC Easton	MD	Substance Use Disorder Rehabilitation Clinic/Center	$0	$6.7M
David Smith	MD	Hematology & Oncology Physician	$6.4M	$0
Eastern Shore Psychological Services LLC	MD	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$5.3M
Shore Health System, Inc	MD	General Acute Care Hospital	$0	$5.3M
Chesapeake Treatment Services LLC	MD	Methadone Clinic	$0	$5.2M
Building Bridges Therapy Services	MD	Occupational Therapist	$0	$4.9M
Channel Marker, Inc.	MD	Rehabilitation Clinic/Center	$0	$4.3M

Elizabeth Clayton — Billing Profile & Reimbursement Data

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Elizabeth Clayton — 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