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

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

Stephen Smith (NPI 1235138009)

Key Findings

Field	Value
Entity Type	Individual
Organization	Stephen Smith
Address	3950 Kresge Way
City	Louisville
State	KY
ZIP	40207
Taxonomy	Dermatology Physician
NPI Enumerated	July 14, 2005

Payer Source	Total Paid
Medicare	$1M
Medicaid	$0

This provider’s Medicare billing mix is concentrated in procedural dermatology consistent with the listed taxonomy (Dermatology Physician): high-volume shave excisions and lesion destruction dominate the caseload while surgical pathology is also material. Representative codes include 11313 (1.9K claims), 17004 (1.1K claims), and 88305 (6.8K claims), which together reflect a practice focused on minor skin surgery with routine submission of specimens for pathology review.

Revenue is highly concentrated in a small set of Medicare codes: the precomputed top 3 codes by revenue account for 53.4% of this provider’s total Medicare revenue. Those top three are 11313 ($230.5K, 22.4%), 88305 ($175.6K, 17.1%), and 17004 ($142.9K, 13.9%), showing that a majority of the $1M in Medicare revenue is driven by a handful of procedural and pathology services.

Several individual procedure codes show national dominance in volume for this specialty. Code 11313 ranks #1 of 49 (100th percentile; extreme outlier, far above typical national volume for this code), 11312 ranks #1 of 527 (100th percentile; extreme outlier), 11303 ranks #1 of 166 (100th percentile; extreme outlier), and 11308 ranks #2 of 122 (99th percentile; extreme outlier), indicating this provider performs shave excisions at volumes well above most peers nationally.

Pathology work (88305) is an important part of revenue but is less extreme relative to peers: 88305 shows 6.8K claims and $175.6K revenue and is ranked #431 of 14580 providers nationally (97th percentile; typical, unremarkable volume). That combination—very high absolute specimen counts but a percentile labeled as typical—suggests that while pathology contributes materially to revenue it is a common downstream billing stream among dermatology peers rather than a unique outlier on its own.

Operational throughput is evident from very large counts of small-unit and add-on codes that together add meaningful revenue: 17003 shows 7.5K claims at $5 avg paid/claim for $37.4K revenue (3.6%), and J7345 records 14K claims at $1 avg paid/claim for $14K revenue (1.4%). These volumes imply many individual lesion treatments per encounter and a high clinic throughput model where numerous low‑paid units aggregate into a nontrivial portion of total Medicare receipts.

This provider is effectively single-payer in public programs: Total Medicare revenue is $1M while Total Medicaid revenue is none (no Medicaid billing on file). The lack of Medicaid billing means the practice’s public-payor exposure is concentrated in Medicare, which reduces Medicaid-related complexity but concentrates reimbursement and regulatory exposure on a single federal program.

The provider’s NPI was enumerated 2005-07-14 (~21 years ago), indicating long tenure on the Medicare rolls. That multi-decade presence supports the view of an established, consistent billing profile and offers a longer historical window for trend or peer benchmarking analyses.

The pattern of multiple codes labeled as statistical outliers (for example, extreme outlier for 11313, 17004, 11312, 11303 and 17003) combined with concentrated revenue in the top 3 codes suggests this is a highly specialized, procedure-heavy operation. For payers and analysts, this profile merits competitive benchmarking and operational review (referral sources, scheduling/capacity, specimen handling) to understand how this provider’s high-volume procedural mix compares to regional peers and to inform network, audit, or contracting decisions.

Medicare: Complete Services Breakdown

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

27 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
11313	The provider shaves off a single epidermal or dermal lesion of 2.0 cm or greater in diameter from the face, ears, eyelids, nose, lips, or mucous membranes.	1,920	$120	$230.5K
88305	The physician, typically a pathologist, performs a level IV examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally…	6,760	$30	$175.6K
17004	The provider destroys 15 or more premalignant lesions using techniques such as chemosurgery, cryosurgery, electrosurgery, or others.	1,140	$130	$142.9K
11312	The provider shaves off a single epidermal or dermal lesion of 1.1 to 2.0 cm in diameter from the face, ears, eyelids, nose, lips, or mucous membranes.	1,590	$60	$92.2K
11308	The provider shaves off a single epidermal or dermal lesion greater than 2.0 cm in diameter from the skin of the scalp, neck, hands, feet, or genitals.	1,550	$60	$86.9K
11303	The provider shaves off a single epidermal or dermal lesion greater than 2.0 cm in diameter from the skin of the trunk, arms, or legs.	1,070	$70	$69.7K
17003	In this add–on procedure, the provider destroys a premalignant lesion using techniques such as chemosurgery, cryosurgery, electrosurgery, or others. This code is appropriate for the second through…	7,480	$10	$37.4K
11901	This code describes an intralesional injection of a corticosteroid, such as triamcinolone acetonide, for treatment of large nodules, keloids, lichenified hyperkeratotic lesions, and numerous other…	890	$40	$36.5K
99212	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,…	760	$40	$28K
17000	The provider destroys a premalignant lesion using techniques such as chemosurgery, cryosurgery, electrosurgery, or others. This code reports the destruction of the first or only lesion.	970	$30	$24.2K

Showing 1–10 of 27

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Access Adult Health Day Care Center	KY	Adult Day Care Clinic/Center	$0	$71M
Baptist Healthcare System Inc.	KY	General Acute Care Hospital	$0	$62.4M
Commonwealth Pain Associates, PLLC	KY	Interventional Pain Medicine Physician	$0	$42.2M
Access Adult Health Day Care Center	KY	Adult Day Care Clinic/Center	$0	$32.6M
Gould's Discount Medical LLC	KY	Durable Medical Equipment & Medical Supplies	$0	$32.1M
Path Forward Of Kentucky Inc.	KY	Community/Behavioral Health Agency	$0	$22.1M
Tatyanas Case Management, LLC	KY	Adult Day Care Clinic/Center	$0	$14.2M
Center For Behavioral Health Kentucky LLC	KY	Methadone Clinic	$299.5K	$13.2M
Pediatric And Neonatal Specialists	KY	Pediatrics Physician	$0	$8.8M
Emergency Medical Associates, Psc	KY	Emergency Medicine Physician	$0	$8M

Stephen 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

Nearby Providers

Frequently Asked Questions

References

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
11313	1	10	1,920	$120	$230.1K
11308	1	10	1,550	$60	$87.4K
88305	3	180	590	$30	$33.2K
11901	1	10	460	$40	$18.9K
11303	1	10	20	$70	$18.8K
11312	1	10	60	$60	$16.9K
11102	187	230	120	$60	$9.6K
17000	7	270	210	$30	$8.9K
J7345	2	20	4,950	$1	$8.5K
17004	2	120	30	$110	$8.4K