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

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

Joshua Roylance (NPI 1275610388)

Field	Value
Entity Type	Individual
Organization	Joshua Roylance
Address	1489 South Rd
City	Woodstock
State	VT
ZIP	05091
Taxonomy	Physical Therapist
NPI Enumerated	November 1, 2006

Payer Source	Total Paid
Medicare	$221.4K
Medicaid	$0

Key Findings

This provider’s Medicare billing is concentrated in classic physical therapy treatment codes: 97112 (neuromuscular reeducation, $74.2K revenue), 97110 (therapeutic exercise, $62.1K revenue), and 97140 (manual therapy, $50.9K revenue). Together these three hands-on/therapy codes align with an outpatient, treatment-intensive service model rather than a primarily consultative or diagnostic practice.

The top three Medicare codes account for 85.1% of this provider’s total Medicare revenue, with lifetime Medicare revenue reported as $221.4K. This heavy concentration means most of the practice’s Medicare dollars come from repeated therapy procedures rather than a broad mix of services.

Payer mix is effectively single-payer Medicare: the record shows $221.4K in total Medicare revenue and explicitly notes no Medicaid billing on file. The absence of Medicaid billing suggests the provider’s public-payer footprint is concentrated in Medicare beneficiaries rather than a dual Medicare–Medicaid panel.

In national competitive standing this clinician is an outlier on volume for the top therapy codes: 97112 ranks #371 of 61940 providers (99th percentile; extreme outlier), 97110 ranks #1411 of 79999 providers (98th percentile; extreme outlier), and 97140 ranks #318 of 65133 providers (100th percentile; extreme outlier). Those ranks indicate far higher-than-typical national volume for each of these treatment codes, signaling a dominant presence among peers on these specific services.

Claim counts for the top treatment codes are very high—3.9K claims for 97110, 3.4K claims for 97140, and 3.2K claims for 97112—while average paid per claim is modest ($16 for 97110, $15 for 97140, $23 for 97112). The combination of high claim volume and modest per-claim payments is consistent with a high-throughput, visit-based PT operation where revenue is driven by repeat, short-duration treatment units.

Evaluation and re-evaluation codes are present but represent a much smaller share of revenue: 97161 generated $16.6K (7.5% of Medicare revenue) across 221 claims and 97164 generated $3.4K (1.6% of Medicare revenue) across 67 claims. This mix suggests the practice performs evaluations but derives most revenue from ongoing treatment sessions rather than frequent new evaluations.

The provider’s code-level percentiles and the “extreme outlier” labels for multiple treatment CPTs point to a practice that is unusually active in delivering hands-on therapeutic services compared with national peers. For payers and network managers this profile signals a high-volume therapy provider who would meaningfully contribute to capacity for musculoskeletal and rehabilitation care in a given market.

The provider’s NPI was enumerated on 2006-11-01 (~20 years ago), indicating long-tenure in the Medicare system; combined with the concentrated, high-volume therapy billing pattern, this suggests a sustained practice model rather than a short-term or recently pivoted operation.

Medicare: Complete Services Breakdown

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

6 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
97112	Neuromuscular reeducation is a therapeutic treatment (exercise) performed by a physician in an attempt to reduce impairments and restore function through the application of clinical skills and/or…	3,220	$20	$74.2K
97110	Therapeutic exercise is a form of physical therapy that utilizes specially designed exercises and activities to help patients gain better mobility and fitness levels. Normally used on patients with…	3,880	$20	$62.1K
97140	Manual therapy is a form of physical therapy which uses the controlled movement and pressure of hands to treat various disorders of soft tissues and joints, eg, chronic back pain. Manual therapy…	3,390	$20	$50.9K
97161	The provider, typically a physical therapist, conducts a physical therapy evaluation that includes history to rule out any adverse factors that will affect care; observes whether the patient's…	220	$80	$16.6K
97530	The provider uses various activities during direct contact with the patient to improve the patient’s functional performance. Use this code for each 15 minutes of activity.	530	$20	$12.8K
97164	The provider, typically a physical therapist, conducts a physical therapy re–evaluation that includes history review and standardized tests and measures to assess body structure and function; she…	70	$50	$3.4K

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 6 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Vermont Distribution

Joshua Roylance — 4 of 6 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Vermont

Full comparison — all codes billed, vs. state median

6 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
97530	33	130	270	$20	$9.7K
97110	1	230	400	$20	$9.2K
97112	1	180	200	$20	$6.8K
97140	2	210	250	$20	$6.1K
97161	1	160	30	$70	$2.4K
97164	7	40	20	$50	$2.4K

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Upper Valley Rehabilitation, Inc.	VT	Specialist	$0	$216.6K
Margaret Roylance	VT	Occupational Therapist	$3.5K	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Dalene Washburn	VT	Clinical Social Worker	$0	$411.2K
Cathleen Kwiecinski	VT	Mental Health Counselor	$0	$233.4K
Town Of Woodstock	VT	Ambulance	$124.9K	$0
Judi Friedman	VT	Medical Physician Assistant	$3K	$0
Betty Fields	VT	Nurse Practitioner	$990	$0

Joshua Roylance — Billing Profile & Reimbursement Data

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Joshua Roylance — 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