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.

Roy Heaton (NPI 1265526974)

Field	Value
Entity Type	Individual
Organization	Roy Heaton
Address	2517 North Glebe Road
City	Arlington,
State	VA
ZIP	22207
Taxonomy	Family Medicine Physician
NPI Enumerated	October 3, 2006

Payer Source	Total Paid
Medicare	$90.6K
Medicaid	$0

Medicare: Complete Services Breakdown

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

5 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…	870	$70	$61K
98926	The provider performs controlled manual pressure in three to four body regions to treat somatic and nonsomatic disorders.	770	$40	$27.8K
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…	10	$60	$900
90688	This code represents a vaccine product administered into the muscle to protect against four strains of influenza (flu). It uses split virus technology and is given as a 0.5 mL dose.	30	$20	$620
G0008	Administration of influenza virus vaccine	30	$20	$600

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 5 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Virginia Distribution

Roy Heaton — 1 of 5 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

5 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99213	278	12,440	90	$60	$10K
98926	2	20	70	$30	$7.1K
99203	4,177	4,920	30	$70	$3.8K
G0008	2,537	3,490	70	$30	$3.1K
90688	36	80	30	$20	$760

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Omair Yousuf	VA	Clinical Cardiac Electrophysiology Physician	$467.2K	$0
Mary Sebastian	VA	Surgery Physician	$92.6K	$0
Patricia Mwesigwa	VA	Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician	$80.8K	$1.1K
Kenneth Heaton	VA	Family Medicine Physician	$69.4K	$0
Prosperity Rx Arlington	VA	Pharmacy	$30.6K	$0

Roy Heaton — Billing Profile & Reimbursement Data

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Roy Heaton — Billing Profile & Reimbursement Data

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Medicare: Total Revenue Breakdown by CPT/HCPCS Code

Medicare: Complete Services Breakdown

Medicare: Competitive Analysis & Benchmarks

Nearby Providers

Frequently Asked Questions

References