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

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

Michael Smith (NPI 1205871035)

Field	Value
Entity Type	Individual
Organization	Michael Smith
Address	701 E Hampden Ave Ste 410
City	Englewood
State	CO
ZIP	80113
Taxonomy	Rheumatology Physician
NPI Enumerated	June 17, 2006

Payer Source	Total Paid
Medicare	$2M
Medicaid	$0

Key Findings

MICHAEL SMITH (Rheumatology Physician) in ENGLEWOOD, CO shows $2M in total Medicare revenue and no Medicaid billing on file, making his practice effectively single‑payer (Medicare) at the claims level. The NPI was enumerated 2006-06-17 (~20 years ago), indicating a long-established Medicare billing history to evaluate for trend and utilization patterns.

Revenue is highly concentrated in a small set of biologic/infusion drugs: J0129 ($501.6K, 25.7%), J1569 ($360.4K, 18.5%) and J1745 ($248.3K, 12.7%) together account for 56.9% of this provider’s total Medicare revenue. This precomputed top‑3 share highlights that more than half of Medicare dollars are driven by a narrow set of high-cost injectable agents.

The code mix and counts point to an infusion- and in‑office drug administration business model: large claim volumes for biologics and injectables are present (J0129 15.2K claims, J1569 10K claims, J1745 9.9K claims), alongside infusion/chemotherapy administration codes such as 96413, 96415, 96365 and 96366. These patterns are consistent with a clinic that delivers frequent IV/subcutaneous biologic therapy and maintains nursing/infusion capacity rather than a purely office‑visit focused practice.

Competitive standing on the top biologics is mixed: J1569 ranks #56 of 542 providers nationally and is in the 90th percentile (described as typical, unremarkable volume for this code), J1745 ranks #94 of 1352 and is in the 93th percentile (typical, unremarkable volume), and J0129 ranks #242 of 1221 at the 80th percentile (typical, unremarkable volume). In plain terms, the provider is a high‑volume but not dominant national participant for several infused biologics, with stronger relative standing on immune globulin and infliximab compared with peers.

Several procedural and administration codes are flagged as above typical national volume and underline throughput intensity: 99214 (96th percentile; notably above typical national volume), 96413 (93th percentile; notably above typical national volume), 96415 (96th percentile; notably above typical national volume), and 96372 (97th percentile; notably above typical national volume). This combination of high E&M and infusion administration throughput suggests significant clinic visit volume and repeated infusion encounters per patient.

Operational footprint is further evidenced by high counts of lower‑paid per‑claim injections that cumulatively contribute material revenue: for example, J0717 49.2K claims and J3262 29.2K claims appear alongside the higher-dollar biologic claims, indicating frequent administration of multiple injectable therapies. These high claim counts imply established workflows for repeated dosing and supply handling.

The absence of any Medicaid billing ("none below — this provider has no Medicaid billing on file") creates a concentrated payer exposure to Medicare; analysts and payers should treat Medicaid as not material for network contracting or utilization comparisons. This single‑payer concentration increases sensitivity to Medicare reimbursement and policy changes for infused biologics and related administration codes.

Long tenure (NPI enumerated 2006-06-17 (~20 years ago)) combined with sustained, high percentile volumes on infusion and administration codes suggests an established infusion service line with an experienced Medicare patient base. For payers or competitors evaluating network capacity or potential partnerships, the provider represents a stable, Medicare-centric infusion/interventional rheumatology node rather than a balanced Medicaid/Medicare outpatient provider.

Medicare: Complete Services Breakdown

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

39 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)	15,200	$30	$501.6K
J1569	Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g., liquid), 500 mg	10,010	$40	$360.4K
J1745	Injection, infliximab, excludes biosimilar, 10 mg	9,930	$30	$248.3K
J9312	Injection, rituximab, 10 mg	3,250	$60	$201.5K
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)	49,200	$1	$196.8K
J3262	Injection, tocilizumab, 1 mg	29,240	$1	$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…	830	$90	$71.3K
J1602	Injection, golimumab, 1 mg, for intravenous use	5,800	$10	$63.8K
J0897	Injection, denosumab, 1 mg	3,360	$20	$60.5K
96413	Chemotherapy is a therapeutic procedure used for the treatment of cancer via the use of chemical agents. These chemical agents (drugs) work on the cancerous cells of the body to destroy them. These…	560	$100	$55K

Showing 1–10 of 39

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 39 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Colorado Distribution

Michael Smith — 10 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Colorado

Full comparison — all codes billed, vs. state median

39 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0129	8	30	6,280	$30	$250.4K
J9312	6	10	3,000	$60	$193.6K
J3262	11	20	28,180	$1	$158.6K
J0717	9	10	37,200	$1	$134.2K
J1569	2	10	3,660	$40	$131.1K
J1745	4	40	3,180	$30	$110.6K
J1602	20	20	8,100	$10	$108.9K
J0897	73	140	2,580	$20	$68.8K
96413	14	140	130	$100	$19.7K
90694	898	700	30	$70	$14.8K

Showing 1–10 of 39

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Christopher Koenig	KS	Rheumatology Physician	$2.3M	$0
Kalista Engelman	MO	Rheumatology Physician	$1.7M	$0
Julian Magadan	MO	Rheumatology Physician	$1.7M	$0
Tina Shah	MO	Rheumatology Physician	$1.6M	$0
Kent Huston	MO	Rheumatology Physician	$1.5M	$0
Anita Zachariah	IN	Rheumatology Physician	$1.3M	$0
Eric Westerman	CO	Rheumatology Physician	$1.3M	$0
Shirley Wang	KS	Rheumatology Physician	$1.2M	$0
Robert Spencer	CO	Rheumatology Physician	$1.1M	$0
Cherie Reichart	CO	Rheumatology Physician	$1.1M	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Hca Healthone LLC	CO	General Acute Care Hospital	$0	$19.6M
Marion Health Associates, Inc.	CO	Assisted Living Facility	$0	$5.1M
Carepoint Emergency Medicine, PLLC	CO	Emergency Medicine Physician	$0	$4.1M
Novamed Surgery Center Of Denver LLC	CO	Ambulatory Surgical Clinic/Center	$2M	$248.7K
Evoke Medical Care LLC	CO	Cardiology Technician	$2M	$190.1K
Christopher Benton	CO	Hematology & Oncology Physician	$1.8M	$0
Healthone Ridge View Endoscopy Center, LLC	CO	Ambulatory Surgical Clinic/Center	$695.4K	$114.4K
James Twede	CO	Dermatology Physician	$750.3K	$0
Amanda Parker	CO	Surgery Physician	$692.9K	$0
Cher, LLC	CO	Diagnostic Radiology Physician	$198.1K	$397.7K

Michael Smith — 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