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

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

John Fox (NPI 1194047605)

Field	Value
Entity Type	Individual
Organization	John Fox
Address	78-7070 Alii Drive A301
City	Kailua Kona
State	HI
ZIP	96740
Taxonomy	Clinical Social Worker
NPI Enumerated	February 25, 2010

Payer Source	Total Paid
Medicaid	$286.4K
Medicare	$0

Medicaid: Complete Services Breakdown

Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.

1 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
90837	In this service, the provider performs psychotherapy, a series of technique for treating the psychiatric disorders of the patient. The treatment session typically lasts for a minimum of 53 minutes or…	2,890	$100	$286.4K

Medicaid: Competitive Analysis & Benchmarks

How this provider's Medicaid billing volume and revenue compare to other Hawaii providers billing the same CPT/HCPCS codes.

Claims Volume vs. Hawaii Distribution

John Fox — 0 of 1 code billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Hawaii

Full comparison — all codes billed, vs. Hawaii median

1 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
90837	In this service, the provider performs psychotherapy, a series of technique for treating the psychiatric disorders of the patient. The treatment session typically lasts for a minimum of 53 minutes or…	57	440	500	$90	$116.1K

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
West Hawaii Community Health Center, Inc.	HI	Federally Qualified Health Center (FQHC)	$0	$46.8M
S&g Labs Hawaii LLC	HI	Clinical Medical Laboratory	$292.7K	$15.1M
Full Life	HI	Developmentally Disabled Services Day Training Agency	$0	$11M
Liberty Dialysis - Hawaii LLC	HI	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$9M
Mf Med Inc	HI	Pain Medicine (Anesthesiology) Physician	$0	$4.3M
Jennifer Logigian	HI	Dentist	$0	$1.8M
Transformation Health Network	HI	Urgent Care Clinic/Center	$0	$1.7M
Access Capabilities, Inc	HI	Community/Behavioral Health Agency	$0	$1.3M
Alii Health Center	HI	Multi-Specialty Clinic/Center	$0	$799.9K
Edwin Herd	HI	Pediatrics Physician	$0	$640.5K

John Fox — Billing Profile & Reimbursement Data

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John Fox — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Nearby Providers

Frequently Asked Questions

References