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

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

James Simsarian (NPI 1235108986)

Field	Value
Entity Type	Individual
Organization	James Simsarian
Address	3020 Hamaker Ct
City	Fairfax
State	VA
ZIP	22031
Taxonomy	Neurology Physician
NPI Enumerated	March 15, 2006

Payer Source	Total Paid
Medicare	$3.8M
Medicaid	$0

Key Findings

This provider’s Medicare business is highly concentrated: Total Medicare revenue is $3.8M and the precomputed top-3 Medicare codes account for 96.5% of that revenue. The single HCPCS drug code J2350 alone represents $3.6M (94.0% of this provider's total Medicare revenue), indicating the practice’s income is dominated by a single infusion product rather than distributed across broad office-based E/M or diagnostic services.

J2350 activity is an extreme national outlier for this provider: the record shows 80.7K claims at $45 avg paid/claim and $3.6M revenue, and the provider ranks #3 of 105 providers nationally (98th percentile; extreme outlier, far above typical national volume for this code). That ranking signals this clinician is a major national-volume administrator of ocrelizumab (J2350) relative to peers reporting the same code.

Beyond the dominant drug revenue, the provider bills a mix of infusion and chemotherapy/infusion administration codes (96413, 96415, 96365, 96374, 96375) plus episodic office E/M and diagnostics (99214, 99215, 99213, EEG codes 95819/95816). This combination of codes and the Neurology Physician taxonomy suggests the operation functions as an ambulatory neurology infusion practice that also provides standard outpatient visits and in-house diagnostic testing such as EEG and vascular ultrasound.

There are notable secondary volume signals outside J2350: 93880 (260 claims, $174 avg paid/claim, $45.2K revenue) ranks #1039 of 21316 providers nationally (95th percentile; notably above typical national volume), indicating above-typical vascular duplex utilization relative to peers. By contrast, core E/M codes such as 99214 (529 claims, $101 avg paid/claim, $53.4K revenue) rank in the 91th percentile (44581 of 479517 providers) and are described as typical, showing routine office visit volume rather than unusually high E/M billing.

The provider effectively operates on a single-payer basis: Total Medicaid revenue is none (no Medicaid billing on file), so Medicare ($3.8M) constitutes the entirety of reported public-payor volume. That absence of Medicaid billing means state Medicaid exposure and related reimbursement dynamics are not a current factor for this clinician’s reported revenue.

Concentration risk is material: with $3.6M tied to J2350 out of $3.8M total Medicare revenue, any changes in coverage policy, pricing, or patient mix for ocrelizumab could materially affect revenue. This degree of dependence on one infused medication makes payer contract terms, prior authorization practices, and drug reimbursement policy particularly consequential for the provider’s financial stability.

Competitive standing varies by service line: for J2350 the provider is a national-volume leader (rank #3 of 105; 98th percentile; extreme outlier), while for many office E/M and diagnostic codes the provider sits at typical or modest national percentiles (examples: 99215 ranks #8386 of 145531, 94th percentile; 95819 ranks #891 of 2575, 64th percentile). This pattern indicates dominance in a specialized infusion niche but conventional participation in routine neurology outpatient care.

The provider has long tenure in the Medicare program, with NPI enumerated 2006-03-15 (~20 years ago). That multi-decade enrollment, coupled with the high J2350 volume, suggests an established infusion-focused neurology practice rather than a newly developed service line.

Medicare: Complete Services Breakdown

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

22 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J2350	Injection, ocrelizumab, 1 mg	80,700	$50	$3.6M
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…	530	$100	$53.4K
93880	Duplex scanning of arteries for the evaluation of blood flow is a type of non–invasive vascular diagnostic process. A physician can visualize and selectively assess the flow patterns of peripheral…	260	$170	$45.2K
99215	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the…	250	$140	$34.4K
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…	190	$110	$21.8K
95819	Electroencephalogram or EEG is a diagnostic test that uses small electrodes attached to the scalp to measure the electrical activity of the brain. In this procedure the provider performs the EEG…	40	$400	$17.5K
99213	The 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…	160	$70	$11.1K
96365	The provider administers the initial intravenous infusion of a medication or other substance for a period up to one hour to prevent, treat, or diagnose a condition or disease.	180	$60	$10.2K
95816	Electroencephalogram or EEG is a diagnostic test that uses small electrodes attached to the scalp to measure the electrical activity of the brain. In this procedure the provider performs the EEG…	20	$360	$8.4K
99205	The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the provider…	30	$170	$5K

Showing 1–10 of 22

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 22 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Virginia Distribution

James Simsarian — 3 of 21 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Virginia

Full comparison — all codes billed, vs. state median

22 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J2350	1	10	25,200	$40	$1.8M
96413	139	230	250	$100	$28.5K
99214	1,784	12,890	140	$80	$21K
95819	25	60	30	$220	$12.8K
95816	51	90	30	$170	$10.2K
99213	4,106	12,440	90	$60	$10K
99215	260	4,030	40	$120	$9.5K
93880	24	420	60	$80	$7.9K
96365	42	220	100	$50	$6.5K
99205	755	1,620	30	$150	$5.7K

Showing 1–10 of 22

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Amy Stone	VA	Neurology Physician	$765.3K	$0
Mark Tekrony	VA	Neurology Physician	$349.6K	$0
Robert Kurtzke	VA	Neurology Physician	$313.4K	$0
Richard Cho	VA	Neurology Physician	$298.1K	$0
Nicole Dietz	VA	Neurology Physician	$268.1K	$0
Candace Bryan	VA	Neurology Physician	$262.9K	$0
Marco Castro	VA	Neurology Physician	$237.3K	$0
Randolph Stephenson	VA	Neurology Physician	$201.3K	$0
Matthew Churchill	VA	Neurology Physician	$193.7K	$0
Robert Richard	VA	Neurology Physician	$178.8K	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
A Kind & Caring Home Care,llc	VA	Home Health Agency	$0	$35.7M
Alpha Home Care Services LLC	VA	Home Health Agency	$0	$32.2M
Community Living Alternatives, Corp.	VA	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$31M
Gateway Healthcare Services LLC	VA	Home Health Agency	$0	$22.1M
Praise Home Health Services, Inc	VA	Home Health Agency	$0	$22M
Grace Home Healthcare, LLC	VA	Home Health Agency	$0	$20.5M
Aloha Home Healthcare Services,llc	VA	Home Health Agency	$0	$13.1M
Precious Care At Home Services Inc	VA	Home Health Aide	$0	$12.5M
Inova Health Care Services	VA	Clinical Medical Laboratory	$5.4M	$6.8M
Pediatric Specialists Of Virginia, LLC	VA	Pediatrics Physician	$0	$11.3M

James Simsarian — 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