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NPI 1225185465 · Encino, CA · Otolaryngology Physician
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Harvey Paley is a otolaryngology physician provider located in Encino, California. This profile covers 10 Medicare and 6 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.
Provider details (source: NPPES NPI Registry)
| Field | Value |
|---|---|
| Entity Type | Individual |
| Organization | Harvey Paley |
| Address | 15910 Ventura Blvd Ste 1510 |
| City | Encino |
| State | CA |
| ZIP | 91436 |
| Taxonomy | Otolaryngology Physician |
| NPI Enumerated | January 3, 2007 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $8.9M |
| Medicaid | $19.7K |
This provider is heavily Medicare-weighted: Lifetime Medicare revenue is $8.9M versus total Medicaid revenue of $19.7K, so Medicare is the clear dominant payer for this practice and Medicaid represents only a very small share of billed revenue. The scale gap suggests the provider’s business operations and revenue risk are primarily tied to Medicare payment patterns rather than to Medicaid.
Medicare revenue is highly concentrated: the top 3 Medicare codes by revenue (31525, 99309, 31231) account for 74.5% of this provider’s total Medicare revenue. That concentration indicates that a few procedure and E/M codes drive the majority of Medicare dollars for this NPI, making those codes key levers for any utilization or reimbursement review.
On the service-line profile, the mix is split between procedure-driven ENT work and high-volume nursing facility E/M visits. High-volume procedure codes include 31525 (31.4K claims, $130 avg paid/claim) and 31231 (36.4K claims, $30 avg paid/claim), while nursing facility E/M codes such as 99309 (16.1K claims, $90 avg paid/claim) and 99305 also appear prominently, which together suggest a practice model centered on diagnostic endoscopy/laryngoscopy services plus extensive SNF/long-term care care delivery.
For Medicare procedural codes this provider is a national-level outlier: 31525 ranks #1 of 80 (100th percentile; extreme outlier, far above typical national volume), 99309 ranks #2 of 28092 (100th percentile; extreme outlier), and 31231 ranks #1 of 6206 (100th percentile; extreme outlier). Those ranks indicate this NPI is a dominant national performer for those specific CPTs rather than a modest local contributor, and benchmarking or peer-comparison work should treat these lines as exceptionally high-volume.
In contrast, the provider’s Medicaid activity is small and relatively typical within the state. The top Medicaid codes 99305, 31525, and 31231 together account for 77.8% of Medicaid revenue, but the in-state ranks are middling (for example, 99305 is #111 of 270, 59th percentile and 31525 is #3 of 5, 50th percentile), which indicates no analogous statewide dominance on the Medicaid side and suggests Medicaid flows mirror the same service mix but at much lower scale.
Several high-volume CPTs show low average paid per claim (for example 31231 at $30 avg paid/claim and 69210 at $13 avg paid/claim) alongside very large claim counts, implying a volume-driven revenue model where overall dollars are generated by high throughput of relatively low-dollar procedures. This pattern is consistent with procedural ENT work combined with frequent nursing-facility follow-up visits and should be considered when assessing utilization intensity or operating efficiency.
The provider’s NPI was enumerated on 2007-01-03 (~19 years ago), indicating a long tenure in the Medicare/Medicaid billing environment. That longevity, combined with $8.9M in Medicare revenue, signals an established practice footprint and sustained Medicare-facing operations over many years.
While multiple nursing facility E/M codes are prominent across both payers, the statistical characterization differs by payer: Medicare volumes for leading codes are labeled “extreme outlier” at the national level, whereas Medicaid ranks for the same codes fall into more typical in-state percentiles. This divergence means the provider should be treated as an outsized national actor for specific Medicare CPTs but as a routine/state-typical participant in Medicaid for the same service lines.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
10 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 31525 | The provider uses a laryngoscope to look directly inside the larynx, which is the voice box, to detect any abnormality. He may or may not perform tracheoscopy to visualize the trachea, which is the… | 31,430 | $130 | $4.1M |
| 99309 | The provider sees a patient for a subsequent nursing facility care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or the provider… | 16,060 | $90 | $1.4M |
| 31231 | In this procedure, the provider inserts an endoscope into the nasal cavity to examine the structures of the nasal cavity on one or both sides. | 36,440 | $30 | $1.1M |
| 99305 | The provider sees a patient for an initial nursing facility care visit involving evaluation and management (E/M). The visit involves moderate medical decision making or the provider spends at least… | 9,200 | $110 | $1M |
| 69210 | The provider uses an instrument such as a curette, vacuum evacuation, or forceps to remove entrapped wax from a patient's external auditory canal. | 35,150 | $10 | $456.9K |
| 99304 | The provider sees a patient for an initial nursing facility care visit involving evaluation and management (E/M). The visit involves straightforward or low medical decision making or the provider… | 6,480 | $70 | $434.4K |
| 99308 | The provider sees a patient for a subsequent nursing facility care visit involving evaluation and management (E/M). The visit involves a low level of medical decision making and/or the provider… | 4,830 | $60 | $294.3K |
| 99307 | The provider sees a patient for a subsequent nursing facility care visit involving evaluation and management (E/M). The visit involves a straightforward level of medical decision making or the… | 1,610 | $30 | $54.7K |
| 99306 | The provider sees a patient for an initial nursing facility care visit involving evaluation and management (E/M). The visit involves high medical decision making, and/or the provider spends at least… | 50 | $150 | $7.6K |
| 92504 | In this diagnostic procedure, the provider uses a microscope to examine the ears of a patient. He may also sometimes examine the patient’s nose for direct visualization to help with diagnosis… | 70 | $10 | $580 |
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 10 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
Medicaid revenue breakdown by year and by CPT/HCPCS procedure code, including monthly billing trends and the top codes driving revenue.
View: By Year1 / 3
Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.
6 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 99305 | The provider sees a patient for an initial nursing facility care visit involving evaluation and management (E/M). The visit involves moderate medical decision making or the provider spends at least… | 140 | $60 | $7.8K |
| 31525 | The provider uses a laryngoscope to look directly inside the larynx, which is the voice box, to detect any abnormality. He may or may not perform tracheoscopy to visualize the trachea, which is the… | 300 | $20 | $4.8K |
| 31231 | In this procedure, the provider inserts an endoscope into the nasal cavity to examine the structures of the nasal cavity on one or both sides. | 350 | $10 | $2.8K |
| 99309 | The provider sees a patient for a subsequent nursing facility care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or the provider… | 70 | $40 | $2.4K |
| 69210 | The provider uses an instrument such as a curette, vacuum evacuation, or forceps to remove entrapped wax from a patient's external auditory canal. | 380 | $10 | $1.9K |
| 92504 | In this diagnostic procedure, the provider uses a microscope to examine the ears of a patient. He may also sometimes examine the patient’s nose for direct visualization to help with diagnosis… | 10 | $10 | $60 |
How this provider's Medicaid billing volume and revenue compare to other California providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. California median
6 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 31525 | The provider uses a laryngoscope to look directly inside the larynx, which is the voice box, to detect any abnormality. He may or may not perform tracheoscopy to visualize the trachea, which is the… | 3 | 10 | 300 | $50 | $659.3K |
| 31231 | In this procedure, the provider inserts an endoscope into the nasal cavity to examine the structures of the nasal cavity on one or both sides. | 71 | 170 | 200 | $80 | $124.2K |
| 99309 | The provider sees a patient for a subsequent nursing facility care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or the provider… | 791 | 1,000 | 440 | $30 | $72K |
| 69210 | The provider uses an instrument such as a curette, vacuum evacuation, or forceps to remove entrapped wax from a patient's external auditory canal. | 103 | 380 | 110 | $20 | $15.5K |
| 99305 | The provider sees a patient for an initial nursing facility care visit involving evaluation and management (E/M). The visit involves moderate medical decision making or the provider spends at least… | 111 | 270 | 90 | $30 | $14.6K |
| 92504 | In this diagnostic procedure, the provider uses a microscope to examine the ears of a patient. He may also sometimes examine the patient’s nose for direct visualization to help with diagnosis… | 121 | 130 | 280 | $10 | $14.2K |
Other providers in the same ZIP code as Harvey Paley, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Freedom Vision Surgery Center LLC | CA | Ambulatory Surgical Clinic/Center | $3.9M | $56.2K |
| Encino Outpatient Surgery Center, LLC | CA | Clinic/Center | $2M | $0 |
| Christian Sanfilippo | CA | Retina Specialist (Ophthalmology) Physician | $2M | $0 |
| Amir Guerami | CA | Ophthalmology Physician | $1.9M | $0 |
| Hajir Dadgostar | CA | Ophthalmology Physician | $1.9M | $2.3K |
| Metrolab, Inc. | CA | Clinical Medical Laboratory | $177.5K | $1.5M |
| Darius Gharib | CA | Internal Medicine Physician | $1.2M | $379.6K |
| John Rezapour | CA | Ophthalmology Physician | $1.2M | $6.8K |
| Yousef Mehrabi | CA | Pediatrics Physician | $985.3K | $92.8K |
| Gabriel Vorobiof | CA | Cardiovascular Disease Physician | $1M | $4.4K |
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