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

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

Ashley Nelson (NPI 1154938736)

Field	Value
Entity Type	Individual
Organization	Ashley Nelson
Address	388 Ypao Rd
City	Tamuning
State	GU
ZIP	96913
Taxonomy	Physical Therapist
NPI Enumerated	September 28, 2020

Payer Source	Total Paid
Medicare	$33.6K
Medicaid	$0

Key Findings

This clinician is effectively a single‑payer Medicare practice: total Medicare revenue is $33.6K and there is no Medicaid billing on file, indicating no Medicaid-facing activity in the available claims dataset. The provider’s NPI was enumerated on 2020-09-28 (~6 years ago), so this revenue profile reflects activity since becoming registered.

Revenue is highly concentrated in a narrow PT service mix: the precomputed top three Medicare codes account for 97.9% of this provider’s Medicare revenue, dominated by 97110 (82.0%), followed by 97161 (12.8%) and 97162 (3.0%). That concentration implies the business relies heavily on a small set of evaluation and therapeutic exercise services for its Medicare income.

Operationally the code mix points to a hands-on outpatient physical therapy model focused on therapeutic exercise and standard PT evaluations. 97110 shows very high utilization (1.4K claims, $19 avg paid/claim, $27.2K revenue) while 97161 and 97162 reflect routine evaluation services (56 claims/$4.3K and 13 claims/$988 respectively), consistent with short, repeated treatment sessions and periodic PT assessment.

Clinical adjuncts like unattended electrical stimulation (G0283) are present but represent a small share of revenue: 101 claims produced $707 (2.1% of Medicare revenue) with an average paid/claim of $7. This suggests modality use is supplemental rather than a primary revenue driver.

Competitive standing by code is mixed when measured against national peers: 97110 ranks #12004 of 79999 (85th percentile) and is labeled in the source as "typical, unremarkable volume for this code," indicating relatively strong national placement for that treatment line. By contrast, 97162 ranks #31560 of 35551 (7th percentile) and 97161 ranks #8118 of 35745 (77th percentile); the dataset’s plain‑English labels for these codes remain "typical, unremarkable volume," so while 97110 shows comparatively higher footprint, the provider is not a dominant national player across the full evaluation mix.

There is a clear revenue concentration risk: with 97110 comprising $27.2K (82.0% of Medicare revenue) a meaningful reimbursement or utilization change to that single procedure would materially affect total Medicare income. The precomputed top‑3 concentration (97.9%) underscores dependence on a narrow set of services rather than a diversified procedure portfolio.

Claim-level economics show many low‑unit payments for the high‑volume service and higher per‑claim payments for evaluations: 97110 averaged $19 paid/claim while 97161 and 97162 averaged $76 per claim. This pattern is consistent with a care model delivering frequent low‑priced therapeutic sessions supplemented by less frequent, higher‑payment evaluations.

From a payer/contracting perspective, the provider’s lack of Medicaid claims means analysts should treat this profile as Medicare‑centric for negotiations or network planning. Absent Medicaid activity, comparisons to in‑state Medicaid peers are not available and any Medicaid market positioning would need to be assessed through non‑claims data or credentialing records.

Medicare: Complete Services Breakdown

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

4 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
97110	Therapeutic exercise is a form of physical therapy that utilizes specially designed exercises and activities to help patients gain better mobility and fitness levels. Normally used on patients with…	1,430	$20	$27.2K
97161	The provider, typically a physical therapist, conducts a physical therapy evaluation that includes history to rule out any adverse factors that will affect care; observes whether the patient's…	60	$80	$4.3K
97162	The provider, typically a physical therapist, conducts a physical therapy evaluation that includes history to rule out any adverse factors that will affect care; observes whether the patient's…	10	$80	$990
G0283	Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care	100	$10	$710

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 4 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Guam Distribution

Ashley Nelson — 1 of 4 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Guam

Full comparison — all codes billed, vs. state median

4 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
97110	2	10	720	$20	$20.5K
97162	4	10	20	$80	$3K
97161	1	10	20	$80	$2.3K
G0283	3	10	170	$10	$1.7K

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Thomas Lee	GU	Dentist	$0	$10.9M
Guam Memorial Hospital	GU	General Acute Care Hospital	$0	$3.5M
Rsa - Tumon, LLC	GU	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$2.9M
Robert Yang	GU	Dentist	$0	$2.4M
Antonio Garcia	GU	Pediatrics Physician	$0	$2.2M
Ma Gladys Linsangan	GU	Pediatrics Physician	$0	$2.2M
Ari Katerelos	GU	Radiation Oncology Physician	$2.1M	$0
Guam X-ray	GU	Vascular & Interventional Radiology Physician	$0	$2.1M
Sarah Clegg	GU	General Practice Dentistry	$0	$1.7M
Peter Kh Go	GU	Surgery Physician	$152.8K	$1.5M

Ashley Nelson — Billing Profile & Reimbursement Data

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Ashley Nelson — 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

Nearby Providers

Frequently Asked Questions

References