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NPI 1235257957 · Christiansted, VI · Procedural Dermatology Physician
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Carolyn Merritt is a procedural dermatology physician provider located in Christiansted, U.S. Virgin Islands. This profile covers 15 Medicare and 3 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 | Carolyn Merritt |
| Address | 4031 Estate Lagrande Princess |
| City | Christiansted |
| State | VI |
| ZIP | 00820 |
| Taxonomy | Procedural Dermatology Physician |
| NPI Enumerated | March 27, 2007 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $43.7K |
| Medicaid | $27.3K |
This provider bills meaningfully to both Medicare and Medicaid but at different scales: total Medicare revenue is $43.7K while total Medicaid revenue is $27.3K, so Medicare represents the larger single payer relationship but Medicaid remains a substantial portion of lifetime revenue. The NPI has been enumerated since 2007-03-27 (~19 years ago), indicating a sustained practice presence that serves both payer populations.
Revenue concentration differs by payer: for Medicare the top three codes account for 35.3% of Medicare revenue, driven by 99213 (12.6%, $5.5K), 12032 (12.5%, $5.5K), and 99212 (10.2%, $4.5K). By contrast Medicaid is highly concentrated — the top three Medicaid codes account for 100.0% of Medicaid revenue, with 99203 contributing $15.6K (57.3%) and 99202 contributing $11.1K (40.5%).
The code mix is consistent with an office-based procedural dermatology practice that pairs evaluation-and-management with minor surgical procedures: Medicare top codes include E/M visits (99213, 99212, 99214) alongside procedural codes for wound repair (12032, $5.5K) and skin biopsy (11104, $4K). Medicaid billing skews heavily to new-patient E/M visits (99203 and 99202 together compose the entirety of Medicaid revenue), suggesting different patient pathways or referral patterns between payers.
Medicare competitive standing is mixed by service line: routine E/M work such as 99213 ranks #181202 of 457151 (60th percentile; typical, unremarkable volume for this code), indicating typical national activity for office visits, while procedural work shows variance — 11104 ranks #605 of 6872 (91th percentile; typical, unremarkable volume for this code), marking biopsies as a relative strength compared with national peers. Repair code 12032 ranks #3669 of 6420 (41th percentile; typical, unremarkable volume for this code), suggesting intermediate activity on intermediate repairs.
In-state Medicaid competitive standing shows the provider is a meaningful participant for new-patient visits: 99203 ranks #6 of 20 in-state (74th percentile; typical, unremarkable volume for this code) and 99202 ranks #2 of 4 in-state (67th percentile; typical, unremarkable volume for this code), though the small in-state peer counts mean those percentiles should be interpreted with caution. The Medicaid profile indicates local demand for initial dermatology evaluations rather than procedural volume billed to Medicaid.
Operational implications: the combination of Medicare procedural codes (12032, 11104, 11102) and frequent E/M codes implies a practice that balances minor surgical care with routine clinic visits; Medicare revenues include significant payments for intermediate wound repair and punch biopsies ($5.5K and $4K respectively), supporting a model that does in-office procedures. Medicaid revenue, concentrated in 99203 ($15.6K) and 99202 ($11.1K), suggests incoming new patients and possibly referral-driven evaluations that do not translate into equivalent procedural billing through Medicaid.
The statistical descriptors attached to most reported codes are uniformly “typical, unremarkable volume for this code,” which indicates no obvious anomalous billing patterns at the code level despite the revenue concentration by payer. An exception in comparative intensity is that 11104 appears toward the higher end of national activity (91th percentile), pointing to a comparatively stronger biopsy workload relative to peers.
Given the long enumeration date (2007-03-27 (~19 years ago)) and the mix of E/M plus procedure revenue across both payers, the provider appears to operate a stable, office-based procedural dermatology practice with modest national visibility for common office codes and relatively stronger activity in biopsy procedures on the Medicare side, while Medicaid activity is concentrated in new-patient evaluations in-state.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
15 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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… | 100 | $50 | $5.5K |
| 12032 | This CPT® code is used for the intermediate repair of wounds to the scalp, axillae, trunk and/or extremities (excluding hands and feet) that are 2.6 to 7.5 cm in size. | 30 | $220 | $5.5K |
| 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,… | 120 | $40 | $4.5K |
| 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… | 60 | $80 | $4.3K |
| 11104 | The provider biopsies a skin lesion using a punch technique with a sharp hollow instrument; punch biopsies are commonly performed for deeper circular skin lesions. | 50 | $80 | $4K |
| 99203 | The 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… | 60 | $70 | $3.8K |
| 17110 | The provider destroys benign lesions using techniques such as chemosurgery, cryosurgery, electrosurgery, or others. This code reports the destruction of one to 14 lesions other than skin tags or… | 60 | $70 | $3.6K |
| 11102 | The provider biopsies a single skin lesion using a tangential (side–ways) approach; he shaves off the lesion or scoops it out with a knife or curette. | 60 | $60 | $3.2K |
| 99202 | The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves straightforward medical decision making, and/or the provider… | 70 | $40 | $2.6K |
| 99204 | The provider sees a new 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 provider… | 20 | $90 | $1.9K |
Showing 1–10 of 15
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 15 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.
3 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 99203 | The 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… | 220 | $70 | $15.6K |
| 99202 | The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves straightforward medical decision making, and/or the provider… | 200 | $60 | $11.1K |
| 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,… | 10 | $50 | $610 |
How this provider's Medicaid billing volume and revenue compare to other U.S. Virgin Islands providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. U.S. Virgin Islands median
3 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 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,… | 16 | 20 | 130 | $110 | $64.8K |
| 99202 | The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves straightforward medical decision making, and/or the provider… | 2 | 10 | 110 | $80 | $45.9K |
| 99203 | The 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… | 6 | 20 | 80 | $90 | $27K |
Other providers in the same ZIP code as Carolyn Merritt, ranked by combined Medicare and Medicaid revenue.
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