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.

Stephen Richins (NPI 1104861368)

Field	Value
Entity Type	Individual
Organization	Stephen Richins
Address	711 Rigby Lake Dr
City	Rigby
State	ID
ZIP	83442
Taxonomy	Medical Physician Assistant
NPI Enumerated	June 19, 2006

Payer Source	Total Paid
Medicare	$466.6K
Medicaid	$0

Key Findings

This provider’s lifetime Medicare revenue is $466.6K and there is no Medicaid billing on file, so the practice is effectively single‑payer (Medicare) in the claims dataset provided. Analysts should treat Medicaid as absent for payer-mix models and focus competitive and utilization comparisons against Medicare peers.

Revenue is highly concentrated in three biologic drug codes: J1602 generated $131.5K (27.5% of Medicare revenue), J3262 generated $120.2K (25.1%), and J0129 generated $85K (17.8%); these top three codes together account for 70.4% of this provider’s total Medicare revenue. This concentration signals that a small set of high-cost injectable therapies drives the majority of billed Medicare dollars.

The top codes are all injectable biologic or infusion drugs (golimumab J1602, tocilizumab J3262, abatacept J0129) with supplemental infusion and administration activity (e.g., 96365 and J1745 present on the profile). That code mix is consistent with an operation that provides recurring parenteral biologic therapy and on‑site medication administration rather than a visit-only outpatient clinic.

On competitive standing for the leading drugs, this provider ranks in the middle-to-lower national distribution: J1602 at rank #569 of 1041 (45th percentile; typical, unremarkable volume), J3262 at #458 of 618 (26th percentile; typical, unremarkable volume), and J0129 at #1111 of 1221 (9th percentile; typical, unremarkable volume). Those percentiles indicate a modest national presence for these therapies rather than a dominant market share in any one drug.

Evaluation-and-management activity also contributes materially: 99214 accounts for $43.1K (9.0% of Medicare revenue) and the provider ranks #35660 of 479517 (93th percentile; typical, unremarkable volume) on that code. The combination of relatively high E/M percentile plus biologic administration suggests the practice pairs recurrent drug administration with regular office follow-up visits.

A cluster of laboratory and procedure codes appears throughout the profile (86235 $10.6K, 80053 $5.3K, 36415 $5.2K, 86481 $4.6K), indicating on‑site or closely associated lab testing and phlebotomy supporting the infusion/biologic service line. These ancillary services are consistent with routine monitoring for patients receiving immune-modulating therapies.

Operational detail in the claims shows large claim counts with low per-claim payments for some drug codes (12K claims for J1602 at $11 avg paid/claim and 24K claims for J3262 at $5 avg paid/claim), which may reflect billing patterns for unit-based drug dosing or drug re‑shipment lines rather than high per-encounter professional fees. Analysts should be aware that high claim volumes can coexist with modest per‑claim payments when the revenue mix is driven by unit-priced injectable drugs.

The provider’s NPI was enumerated on 2006-06-19 (~20 years ago), which indicates long tenure in the Medicare program; combined with the concentrated biologic and infusion billing pattern, this profile fits an established ambulatory infusion/biologic administration practice rather than a recent high‑growth entrant. Tenure should be considered when benchmarking utilization trends over time.

Medicare: Complete Services Breakdown

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

32 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J1602	Injection, golimumab, 1 mg, for intravenous use	11,950	$10	$131.4K
J3262	Injection, tocilizumab, 1 mg	24,040	$10	$120.2K
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)	2,500	$30	$85K
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…	600	$70	$43.1K
J1745	Injection, infliximab, excludes biosimilar, 10 mg	1,160	$30	$31.3K
86235	The lab analyst performs an assay to evaluate the patient’s serum for each antibody to an extractable nuclear antigen, also called ENA. Types of ENA antibodies include anti ribonuclear protein,…	590	$20	$10.6K
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.	150	$40	$5.7K
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…	40	$130	$5.3K
80053	The lab analyst performs a comprehensive metabolic panel, or CMP test in which he measures the blood level of 14 chemicals the code descriptor lists for the panel.	530	$10	$5.3K
36415	In this procedure, the provider inserts a needle into a vein to collect a blood sample.	650	$10	$5.2K

Showing 1–10 of 32

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 32 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Idaho Distribution

Stephen Richins — 4 of 25 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

32 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0129	6	10	9,950	$30	$369.8K
J3262	4	10	27,790	$1	$340.8K
J1602	5	10	15,030	$10	$266.6K
J1745	4	10	8,420	$30	$196.9K
96413	11	20	250	$90	$26K
99214	90	2,690	90	$70	$10.4K
83970	9	20	100	$40	$9.1K
96365	8	20	80	$40	$7.4K
99215	354	810	40	$100	$6.5K
86235	2	10	310	$20	$6.2K

Showing 1–10 of 32

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Ananda Walaliyadda	ID	Specialist	$3.9M	$0
Arthritis Specialty Center,inc	ID	Specialist	$0	$1.4M
James Blaine	ID	Medical Physician Assistant	$297.2K	$0
Monika Jarzmik	ID	Family Nurse Practitioner	$119.4K	$0
Ranmali Walaliyadda	ID	Physician Assistant	$101K	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Van Wagoner Consulting, Inc.	ID	Case Management Agency	$0	$6.7M
Jefferson Joint School District 251	ID	Local Education Agency (LEA)	$0	$3.5M
Upper Valley Family Medicine PLLC	ID	Family Medicine Physician	$0	$1.9M
Robert Ellis	ID	Dentist	$0	$1.3M
West Wind Dental	ID	General Practice Dentistry	$0	$644.9K
Rigby Pediatric Dental PLLC	ID	Pediatric Dentistry	$0	$576.5K
Mobley Physical Therapy PC	ID	Physical Therapy Clinic/Center	$0	$444.8K
Rigby Physical Therapy, PLLC	ID	Physical Therapist	$0	$363.1K
Cameron French	ID	Medical Physician Assistant	$173.9K	$0
Kay Bishop	ID	Specialist	$152.2K	$0

Stephen Richins — 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