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.

Joshua Adler (NPI 1285851568)

Field	Value
Entity Type	Individual
Organization	Joshua Adler
Address	5604 Virginia Beach Blvd
City	Virginia Beach
State	VA
ZIP	23462
Taxonomy	Pediatric Occupational Therapist
NPI Enumerated	April 19, 2007

Payer Source	Total Paid
Medicare	$11.3K
Medicaid	$0

Medicare: Complete Services Breakdown

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

3 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
97167	The occupational therapist (OT) performs an evaluation requiring clinical decision–making of high analytic complexity, which includes analysis of occupational profile, problem–focused assessment…	90	$70	$5.5K
97542	In this procedure, the provider assesses the patient’s need for a wheelchair and teaches him wheelchair maneuvering skills.	310	$20	$5.2K
97166	The occupational therapist (OT) performs an evaluation requiring clinical decision–making of moderate analytic complexity, which includes analysis of occupational profile, problem–focused assessment…	10	$70	$750

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 3 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Virginia Distribution

Joshua Adler — 1 of 3 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

3 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
97542	2	20	180	$20	$2.8K
97166	98	100	30	$80	$2.3K
97167	1	10	20	$70	$2.2K

Joshua Adler — Billing Profile & Reimbursement Data

Sign up for Joshua Adler — Billing Profile & Reimbursement Data policy alerts

Joshua Adler — Billing Profile & Reimbursement Data

Sign up for Joshua Adler — Billing Profile & Reimbursement Data policy alerts

Medicare: Total Revenue Breakdown by CPT/HCPCS Code

Medicare: Complete Services Breakdown

Medicare: Competitive Analysis & Benchmarks

Frequently Asked Questions

References