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.

Richard Jones (NPI 1174507800)

Field	Value
Entity Type	Individual
Organization	Richard Jones
Address	4280 Watermelon Rd Ste 112
City	Northport
State	AL
ZIP	35473
Taxonomy	Rheumatology Physician
NPI Enumerated	December 6, 2005

Payer Source	Total Paid
Medicare	$3.8M
Medicaid	$0

Key Findings

RICHARD JONES (Rheumatology Physician, NPI enumerated 2005-12-06 (~21 years ago)) reports Medicare as the dominant payer with Total Medicare revenue of $3.8M and no Medicaid billing on file (none). This makes the provider effectively single-payer (Medicare) for public program activity, concentrating all reported public-payor revenue into Medicare-covered services and drugs.

Revenue is highly concentrated in infused or injected biologic therapies: the precomputed top 3 Medicare codes (J0129, J9312, J3262) account for 45.6% of the provider’s total Medicare revenue. Those three codes individually show $682.6K (17.8%) for J0129, $538.7K (14.0%) for J9312, and $529.4K (13.8%) for J3262, indicating that nearly half of Medicare dollars flow through a small set of high-cost biologic agents.

The code mix and volumes point to an infusion-centric rheumatology practice: large counts for injectable biologics (e.g., J3262 with 105.9K claims) combined with elevated use of infusion/administration codes such as 96413 (810 claims, $74.5K revenue), 96415 (719 claims, $14.4K revenue) and 96365 (309 claims, $13.9K revenue) indicate on-site parenteral therapy and routine prolonged infusions. These patterns are consistent with a service-line that bills both the drug J-codes and associated administration time and add-on hours.

Competitive standing is mixed across products: the provider ranks highly for several biologics nationally — J9312 ranks #13 of 317 providers nationally (96th percentile; notably above typical national volume for this code) and J3262 ranks #45 of 618 providers nationally (93th percentile; typical, unremarkable volume for this code) — while J0129 ranks #135 of 1221 (89th percentile; typical, unremarkable volume for this code). This suggests the provider is a major national outlier for select agents (rituximab in particular) but operates at more typical volumes for other biologics.

Multiple service lines show extreme or notable outlier status versus national peers: 99214 (1.3K claims, $107.2K revenue) ranks #6203 of 479517 providers nationally (99th percentile; extreme outlier, far above typical national volume), 96415 ranks in the 99th percentile (extreme outlier, far above typical national volume), and 96372 ranks at the 100th percentile (extreme outlier, far above typical national volume). These labels indicate unusually high volumes of higher-level office visits, extended infusion add-ons, and injection procedures relative to national benchmarks and may reflect a high throughput clinic model.

There are additional notable high-volume elements tied to musculoskeletal imaging and bone-health therapeutics: 73130 (287 claims, $13.5K revenue) ranks #64 of 1287 (95th percentile; notably above typical national volume) and J0897 (denosumab) contributes $415.8K (10.8%) while ranking #200 of 10057 (98th percentile; notably above typical national volume). Together these suggest the practice also manages bone-density and fracture-risk care alongside inflammatory disease biologics.

For payers and contracting analysts, the combination of a $3.8M Medicare revenue base, a 45.6% concentration in three biologic J-codes, and frequent high-percentile administration code usage highlights two levers for utilization and cost management: site-of-care and drug mix/selection for infused biologics. Given the absence of Medicaid billing (none), negotiations or network strategies for public programs should focus on Medicare pathways, infusion rate structures, and oversight of high-volume add-on administration codes.

The provider’s long tenure (NPI enumerated 2005-12-06 (~21 years ago)) supports that these patterns reflect an established operational model rather than a transient billing spike; analysts should therefore treat these utilization and concentration patterns as stable targets for clinical program design, payment integrity checks, and focused benchmarking against national peers for the specific biologic agents and infusion services identified above.

Medicare: Complete Services Breakdown

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

56 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)	20,080	$30	$682.5K
J9312	Injection, rituximab, 10 mg	8,550	$60	$538.6K
J3262	Injection, tocilizumab, 1 mg	105,880	$10	$529.4K
J0897	Injection, denosumab, 1 mg	23,100	$20	$415.8K
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)	103,600	$1	$414.4K
J1745	Injection, infliximab, excludes biosimilar, 10 mg	12,440	$30	$323.4K
J0490	Injection, belimumab, 10 mg	7,120	$40	$277.5K
J3111	Injection, romosozumab-aqqg, 1 mg	21,000	$10	$168K
J1602	Injection, golimumab, 1 mg, for intravenous use	11,700	$10	$117K
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…	1,260	$90	$107.2K

Showing 1–10 of 56

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 56 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Alabama Distribution

Richard Jones — 15 of 25 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

56 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0129	4	30	8,530	$30	$390.9K
J0717	4	10	94,400	$1	$360.6K
J0490	1	10	7,120	$40	$274.1K
J9312	1	10	2,800	$60	$262.7K
J3262	2	10	44,890	$1	$229.1K
J1602	14	20	16,100	$10	$189.5K
J3111	4	10	18,900	$10	$177.3K
J1745	1	30	3,020	$30	$107.2K
J0897	5	200	3,120	$20	$97.7K
86235	23	20	380	$20	$37.9K

Showing 1–10 of 56

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Ryan Mathew	GA	Rheumatology Physician	$308.4K	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
New Beacon Healthcare Group, LLC	AL	Community Based Hospice Care Agency	$0	$11M
Reliant Renal Care - Alabama, LLC	AL	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$3.9M
Landreth & Associates Inc	AL	Optometrist	$0	$1.5M
Sakina Kamal	AL	Cardiovascular Disease Physician	$531.4K	$0
Geoffrey Alilonu	AL	Nephrology Physician	$442.8K	$0
Adam Richardson	AL	MOHS-Micrographic Surgery Physician	$298.4K	$0
Jeffery Weeks	AL	Dermatology Physician	$255.9K	$0
Charles Gambla	AL	Dermatology Physician	$248.9K	$0
Clinton Mcentyre	AL	Family Medicine Physician	$180K	$0
Sunil Chandra	AL	Internal Medicine Physician	$170.4K	$0

Richard Jones — Billing Profile & Reimbursement Data

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Richard Jones — 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