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    OpenPayerNPI Medicare & MedicaidMary Ella Carter
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    Mary Ella Carter — Billing Profile & Reimbursement Data

    NPI 1194750224 · Washington, DC · Plastic Surgery Physician

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    Mary Ella Carter is a plastic surgery physician provider located in Washington, District of Columbia. This profile covers 58 Medicare and 0 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.

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    Provider details (source: NPPES NPI Registry)

    FieldValue
    Entity TypeIndividual
    OrganizationMary Ella Carter
    Address5215 Loughboro Rd Nw Ste 430
    CityWashington
    StateDC
    ZIP20016
    TaxonomyPlastic Surgery Physician
    NPI EnumeratedJuly 11, 2006

    Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)

    Payer SourceTotal Paid
    Medicare$942.2K
    Medicaid$0

    Key Findings

    This provider’s Medicare activity accounts for the bulk of observed public-payer revenue with lifetime Medicare revenue of $942.2K and no Medicaid billing on file, making the practice effectively single-payer (Medicare) in the available claims data. Analysts should treat this profile as Medicare-centric when benchmarking payer mix or access patterns because there are no state Medicaid claims to compare.

    Revenue concentration on Medicare is meaningful: the precomputed top 3 Medicare codes by revenue account for 29.2% of this provider’s total Medicare revenue. Those top three are 13121 ($103.1K, 12.9%), 99213 ($66.5K, 8.3%), and 13160 ($64.6K, 8.0%), indicating a mix of high-revenue procedural work and frequent office visits together driving a large share of income.

    The code mix is characteristic of a plastic surgery practice focused on complex soft-tissue repair and wound management: high-volume repair codes such as 13121 (278 claims) and 13131 (184 claims), debridement codes like 11042 (409 claims), and excision codes for malignant lesions such as 11603 (169 claims) appear among the top billers. This combination of layered closures, debridement, and lesion excision points to an outpatient surgical workflow handling both acute wounds and oncologic skin procedures.

    Several specific codes mark the provider as a national outlier in volume for certain procedures. Notably, 13160 ranks #1 of 78 providers nationally (100th percentile; extreme outlier) and 13121 ranks #42 of 3302 (99th percentile; extreme outlier), while evaluation-and-management code 99213 ranks #8534 of 457151 (98th percentile; extreme outlier), indicating above-typical or dominant activity in these procedures and routine visit types compared with national peers.

    At the same time, not all codes are extreme outliers: codes such as 13132 ($56.4K, 7.0%) and multiple reconstructive codes (e.g., 14060 at $35.9K and 14040 at $20.1K) sit in more typical percentile ranges (80th–90th percentiles or lower), suggesting the provider is highly concentrated and nationally prominent in a subset of procedures but otherwise follows expected volume patterns for other services. This mixed profile is important for competitor mapping and network adequacy assessments.

    Office visit and outpatient evaluation activity is a significant operational component of the practice: 99213 shows 887 claims and $66.5K in revenue, 99212 shows 508 claims, and 99203 shows 364 claims with $32.8K in revenue. The high counts of these E/M codes alongside procedure volumes indicate a model that combines serialized clinic visits with procedural throughput rather than a purely procedure-only or consult-only practice.

    The provider shows strong activity in both reconstructive/anatomic repairs and skin cancer surgery lines: excision codes such as 11603 ($21.8K) and 11606 ($21.6K) and complex closure codes such as 13151 ($21.1K) and 13101 ($20.2K) are material contributors to revenue. For payers and contracting teams, this suggests the clinician performs a meaningful volume of operative dermatologic and reconstructive work that could be directed into referral pathways for wound care and skin oncology.

    The provider has an established NPI history with enumeration dated 2006-07-11 (~20 years ago), indicating long tenure in the Medicare program. Combined with the concentrated high-volume procedural profile, this tenure supports interpreting current high-percentile rankings as the result of sustained clinical practice rather than a short-term fluctuation in reported activity.

    Medicare: Total Revenue Breakdown by CPT/HCPCS Code

    Medicare revenue breakdown by CPT/HCPCS procedure code.

    View: Bar Chart1 / 2

    Medicare: Complete Services Breakdown

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

    58 rows

    CPT/HCPCS CodeDescriptionClaimsAvg PaidRevenue
    13121This is for a complex repair of a wound to the scalp, arms, and/or legs.  This wound should be 2.6 to 7.5 cm in size.280$370$103.1K
    99213The 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…890$80$66.5K
    13160This procedure is performed on sites of injury such as abdominal wounds and/or contaminated lacerations to avoid infection and re–epithelialize new tissue.110$580$64.6K
    13131The provider repairs a wound measuring 1.1 cm to 2.5 cm in size of the cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet, which may require scar revision, debridement extensive…180$350$64K
    13132The provider repairs a wound measuring 2.6 cm to 7.5 cm in size of the cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet, which may require scar revision, debridement extensive…140$420$56.4K
    11042The 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 cm2.410$110$44.2K
    14060The provider replaces the lesions in the eyelids, nose, ears, or lips, with the healthy tissues from an adjacent site. This code represents a defect of 10 cm2 or less.60$580$35.9K
    13120This is for a complex repair of a wound 1.1 to 2.5 cm in size on the scalp, arms, and/or legs.110$310$33.9K
    99203The provider sees a new 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 provider…360$90$32.8K
    29581The provider applies a layered bandage to the lower leg, ankle, and foot, to treat venous stasis ulcers and venous insufficiency, the failure of the blood veins immediately below the skin. A…620$50$29.5K

    Showing 1–10 of 58

    Medicare: Competitive Analysis & Benchmarks

    How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 58 CPT/HCPCS codes.

    View: State1 / 2

    Full comparison — all codes billed, vs. state median

    58 rows

    CPT/HCPCS CodeRankProvider CountMedian ClaimsAvg PaidAverage Revenue
    1406011060$580$35.9K
    13120110110$310$33.9K
    1312111030$340$25.8K
    1313111050$300$25.5K
    13132110100$300$24.9K
    1404011040$480$20.1K
    2760311060$320$19.3K
    1316011020$600$16.9K
    992143961,40090$100$15.3K
    1160611040$340$13.8K

    Showing 1–10 of 58

    Related Providers

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

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    Annal MelethGAOphthalmology Physician$2.2M$0
    Paul BannenMDHematology & Oncology Physician$1.4M$0
    Nihar PatelTXHematology & Oncology Physician$1.2M$0
    Omid FatemiCAInterventional Cardiology Physician$1M$0
    Jack FlyerMDCardiovascular Disease Physician$906.4K$0
    Ashkan BahraniMDHematology & Oncology Physician$839.3K$0
    Mahnaz MomeniVARheumatology Physician$753.9K$0
    Tahira AhmedNYDiagnostic Radiology Physician$708.7K$0
    Somprak BoonpongmaneeWAGastroenterology Physician$660.1K$0
    Alexander MarkMDDiagnostic Radiology Physician$580.2K$0

    Nearby Providers

    Other providers in the same ZIP code as Mary Ella Carter, ranked by combined Medicare and Medicaid revenue.

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    Lucy Webb Hayes National Training School For Deaconesses & MissionarieDCGeneral Acute Care Hospital$0$19.1M
    Jeffrey SteinbergDCFoot & Ankle Surgery Podiatrist$13.3M$0
    Friendship PlaceDCCase Management Agency$0$5.6M
    Wisconsin Ave Psychiatric Center IncDCPsychiatric Hospital$0$3.1M
    Iona Senior ServicesDCAdult Health Nurse Practitioner$0$1.1M
    Jaydot LLCDCCase Management Agency$0$820.6K
    Edward TannerDCGynecologic Oncology Physician$786.3K$2.1K
    Brandi PageDCRadiation Oncology Physician$761K$0
    Joshua YamamotoDCCardiovascular Disease Physician$688.3K$0
    Wisconsin Avenue Psychiatric CenterDCPsychiatry Physician$0$678K

    Frequently Asked Questions

    References

    1. 1.Medicare Physician & Other Practitioner by Provider and Service. CMS.gov.Provider-level Medicare Part B utilization and payment data.
    2. 2.NPPES NPI Registry. CMS.gov.National Provider Identifier registry used for provider enumeration and taxonomy metadata.

    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

    Medicare Revenue by CPT/HCPCS Code
    Claims Volume vs. District of Columbia Distribution
    Mary Ella Carter — 16 of 25 codes billed far more than typical (above p95)
    p5–p95 (all providers)p25–p75MedianThis providerOutlier
    Rank Distribution — District of Columbia