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

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

J. Duke (NPI 1134395072)

Field	Value
Entity Type	Individual
Organization	J. Duke
Address	2967 Ross Clark Cir
City	Dothan
State	AL
ZIP	36301
Taxonomy	Surgery Physician
NPI Enumerated	April 30, 2008

Payer Source	Total Paid
Medicare	$1.3M
Medicaid	$0

Key Findings

Provider tenure and payer mix: NPI enumeration date is 2008-04-30 (~18 years ago) and lifetime Medicare revenue is $1.3M while Medicaid revenue is none, indicating this provider operates effectively as a Medicare-only biller in the available data. The absence of Medicaid billing on file means any Medicaid market or policy changes are unlikely to directly affect reported activity for this NPI.

Revenue concentration is high: the precomputed top-3 Medicare codes account for 75.1% of this provider's total Medicare revenue, driven by Q4186 (54.4%), Q4278 (12.0%), and 11043 (8.7%). This concentration signals that a small set of procedure/product codes dominates the practice’s Medicare income and creates sensitivity to reimbursement or utilization changes for those codes.

Service-line profile: the top revenue codes (Q4186 and Q4278 are per-square-centimeter skin substitute products, and 11043 is surgical debridement up to 20 cm2) indicate a wound-care/surgical debridement specialty that relies heavily on advanced skin-substitute products. The mix of high-volume product billing plus debridement procedures is consistent with a practice focused on complex wound management and graft/skin-substitute applications.

Code-level competitive standing: Q4186 generates $731K (6.2K claims, $117 avg paid/claim) and ranks #9 of 122 providers nationally (93th percentile), signaling a relatively strong national presence for that product code even though the dataset labels the volume as "typical, unremarkable." By contrast, Q4278 ($161.2K, 397 claims, $406 avg paid/claim) ranks #3 of 4 (33th percentile), reflecting a small national sample and a more modest competitive footprint for that specific product.

Statistical outliers and above-typical volumes: 11042 ($84.1K, 1.2K claims, $70 avg paid/claim) ranks #110 of 10712 providers nationally (99th percentile) and is labeled an "extreme outlier, far above typical national volume for this code," indicating unusually high utilization of this debridement code relative to peers. Similarly, 15275 ($33.3K) ranks #21 of 888 (98th percentile) and is described as "notably above typical national volume," reinforcing that skin-substitute and graft-related services are concentrated and elevated versus national peers.

Care settings and encounter mix: the provider also reports significant E/M and site-of-care activity, including 99214 (629 claims, $58.5K) for office-based moderate-complexity visits and 99349 (153 claims, $14.5K) for home visits, plus nursing facility E/M codes such as 99309 ($8K). This distribution suggests the practice treats a medically complex wound population across office, home, and facility settings rather than exclusively in an outpatient procedure suite.

Unitization and product-driven revenue dynamics: Q4186’s profile of 6.2K claims with an average paid/claim of $117 and total revenue of $731K underscores a unit-priced, per-square-centimeter reimbursement model that is the single largest revenue driver. Given that Q4186 alone is 54.4% of Medicare revenue, frequent small-area product applications appear to be the primary commercial engine for this provider.

Payer-concentration risk: with $1.3M in Medicare revenue and no Medicaid billing on file, the provider’s financial exposure in the dataset is concentrated in Medicare payment policies and utilization for skin-substitute and debridement codes. Changes in Medicare coverage, pricing, or utilization audits for Q4186, Q4278, or major debridement codes could have outsized impact because the top three codes already account for 75.1% of Medicare revenue.

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
Q4186	Epifix, per square centimeter (add-on, list separately in addition to primary procedure)	6,250	$120	$731K
Q4278	Epieffect, per square centimeter (add-on, list separately in addition to primary procedure)	400	$410	$161.2K
11043	The provider uses surgical instruments to remove the dead tissue in muscle and/or fascia, including any debridement of the epidermis, dermis, and subcutaneous tissue, for the first or only 20 cm2 or…	730	$160	$117.1K
11042	The provider uses surgical instruments to remove the dead tissue in skin down to the subcutaneous layer and including the epidermis and dermis, up to the first 20 cm2.	1,200	$70	$84.1K
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…	630	$90	$58.5K
15275	The provider uses a skin substitute, such as an allograft or xenograft, to cover wounds on the face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, up to…	350	$100	$33.3K
11046	The provider uses surgical instruments to remove the dead tissue from the muscle and/or fascia, as well as the subcutaneous tissue layer, epidermis, and dermis if needed. She performs this service at…	640	$50	$31.8K
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…	440	$60	$27.9K
11045	The provider uses surgical instruments to remove dead tissue from the subcutaneous layer, as well as the epidermis and dermis if needed. She performs this service at the same session as a separately…	860	$30	$25.1K
99349	The provider sees an established patient for a home or residence visit involving evaluation and management (E/M). The visit involves moderate medical decision making or the provider spends at least…	150	$100	$14.5K

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. Alabama Distribution

J. Duke — 4 of 24 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Alabama

Full comparison — all codes billed, vs. state median

24 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
Q4186	1	10	6,250	$120	$733.3K
Q4278	1	10	400	$410	$161.2K
99309	216	350	150	$70	$22.7K
11044	8	10	30	$210	$22.3K
99214	526	7,330	120	$80	$16.8K
11043	1	30	60	$130	$16.8K
11046	2	10	130	$50	$13.1K
99349	29	110	70	$80	$12.4K
15275	2	20	50	$90	$11.6K
11042	1	140	80	$50	$7.9K

Showing 1–10 of 24

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Leflore County Hospital Authority	OK	Critical Access Hospital	$0	$5M
Leflore County Hospital Authority	OK	Rural Health Clinic/Center	$0	$3.7M
Amjad Safvi	IL	Vascular & Interventional Radiology Physician	$568.9K	$765.4K
Chika Obele	TN	Vascular & Interventional Radiology Physician	$686.6K	$0
Philip Mcdonald	FL	Diagnostic Radiology Physician	$444.3K	$42.8K
Jason Ross	TX	Diagnostic Radiology Physician	$482.4K	$0
Elliott Wagner	CA	Diagnostic Radiology Physician	$392.6K	$7.3K
Adel Abdalla	FL	Diagnostic Radiology Physician	$259.9K	$6.1K
Shujahat Shah	OK	Interventional Cardiology Physician	$231.9K	$0
Dennis Burton	FL	Diagnostic Radiology Physician	$179.1K	$2.7K

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Houston County Healthcare Authority	AL	Internal Medicine Physician	$0	$9.6M
State Of Alabama Department Of Public Health	AL	Home Health Agency	$0	$6.9M
Wiregrass Hospice, LLC	AL	Community Based Hospice Care Agency	$0	$5.8M
Dothan Ambulance Service	AL	Land Ambulance	$1.7M	$3.9M
Southeast Alabama Maternity Care Program	AL	Exclusive Provider Organization	$0	$5.1M
Houston County Healthcare Authority	AL	General Acute Care Hospital	$0	$4.9M
Houston County Health Dept Fp Clinic	AL	Public Health or Welfare Agency	$0	$4.4M
Southern Alabama Surgery Center LLC	AL	Ambulatory Surgical Clinic/Center	$3.8M	$94.3K
Edmund Lacour	AL	Rheumatology Physician	$3.7M	$0
Houston County Healthcare Authority	AL	Clinical Medical Laboratory	$591.7K	$2.1M

J. Duke — Billing Profile & Reimbursement Data

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J. Duke — 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