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    OpenPayerNPI Medicare & MedicaidByron Nielsen
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    Byron Nielsen — Billing Profile & Reimbursement Data

    NPI 1316157928 · Yankton, SD · Nephrology Physician

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    Byron Nielsen is a nephrology physician provider located in Yankton, South Dakota. This profile covers 60 Medicare and 0 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.

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    Provider details (source: NPPES NPI Registry)

    FieldValue
    Entity TypeIndividual
    OrganizationByron Nielsen
    Address1104 W 8th St
    CityYankton
    StateSD
    ZIP57078
    TaxonomyNephrology Physician
    NPI EnumeratedMay 23, 2007

    Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)

    Payer SourceTotal Paid
    Medicare$378.6K
    Medicaid$0

    Key Findings

    This provider is effectively a Medicare-only biller: lifetime Medicare revenue is reported as $378.6K and there is no Medicaid billing on file (none). That payer mix indicates the practice’s revenue exposure is concentrated in Medicare rather than split across Medicaid/Medicare populations, which is relevant for payers evaluating network sufficiency in South Dakota.

    Revenue is heavily concentrated in a few high-value nephrology services: the precomputed top 3 Medicare codes by revenue account for 43.6% of this provider's total Medicare revenue. The three top drivers are 99214 (21.0% of Medicare revenue; 910 claims; $74.6K revenue), 90961 (12.7%; 206 claims; $45.1K revenue), and 90960 (9.9%; 130 claims; $35K revenue), indicating a small number of services generate a large share of payments.

    The code mix is characteristic of an outpatient nephrology practice with active ESRD management: multiple monthly ESRD oversight codes (90961, 90960, 90962) appear among top-revenue items and 90935 (hemodialysis) is also present. High counts of lab and monitoring codes — for example 82610 (858 claims; $15.4K revenue) and 83970 (721 claims; $28.8K revenue) — and frequent venipuncture 36415 (988 claims; $7.9K revenue) reinforce that chronic kidney disease and dialysis monitoring form the core service line.

    Two of the provider’s revenue-driving codes show above-typical national volume: 99214 ranks #14473 of 479517 providers nationally (97th percentile; notably above typical national volume) and 90961 ranks #226 of 6091 providers nationally (96th percentile; notably above typical national volume). By contrast, 90960 ranks #3821 of 6549 (41th percentile; typical, unremarkable volume), indicating strong national standing for outpatient evaluation visits and monthly ESRD management in some modalities but only typical participation in others.

    The practice demonstrates high throughput for routine labs and injections consistent with nephrology care: lab panels and single-analyte tests appear frequently (e.g., 80051: 922 claims; $6.5K revenue; 94th percentile rank #39 of 601; 82565: 925 claims; $4.6K revenue; 97th percentile rank #152 of 5066) and J1439 (ferric carboxymaltose) shows $32.3K revenue with 32.3K claims. These patterns suggest ongoing chronic care management requiring frequent lab surveillance and intermittent parenteral iron therapy.

    Presence of inpatient and observation E/M codes indicates some hospital-based activity in addition to clinic care: 99232 (183 claims; $11K revenue), 99223 (71 claims; $9.4K revenue), and 99222 (36 claims; $3.5K revenue) are all in the top codes. This mix implies the provider manages both outpatient nephrology panels and inpatient consults or follow-ups, contributing to a diversified care footprint within nephrology.

    Operationally, the bundle of ESRD management codes (90961, 90960, 90962) alongside hemodialysis code 90935 and numerous lab codes suggests the provider maintains an active dialysis/ESRD patient panel rather than exclusively episodic consults. The specific claim counts and revenue for those codes (90961: 206 claims/$45.1K; 90960: 130 claims/$35K; 90962: 68 claims/$10.5K; 90935: 71 claims/$3.8K) indicate ESRD oversight is a material component of the practice’s Medicare revenue.

    The provider’s NPI tenure is long-established: enumerated on 2007-05-23 (~19 years ago), which may reflect sustained practice presence in Yankton, SD. For payers and competitive analysts, that longevity combined with concentrated Medicare revenue and an ESRD-focused code mix signals a stable, Medicare-centered nephrology practice with limited Medicaid footprint.

    Medicare: Total Revenue Breakdown by CPT/HCPCS Code

    Medicare revenue breakdown by CPT/HCPCS procedure code.

    View: Bar Chart1 / 2

    Medicare: Complete Services Breakdown

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

    60 rows

    CPT/HCPCS CodeDescriptionClaimsAvg PaidRevenue
    99214The 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…910$80$74.6K
    90961The provider manages all the services associated with the monthly care of a patient who is 20 years old or older and has a condition known as end stage renal disease, or ESRD. For this service, the…210$220$45.1K
    90960The provider manages all the services associated with the monthly care of a patient who is 20 years old or older and has a condition known as end stage renal disease or ESRD. For this service, the…130$270$35K
    J1439Injection, ferric carboxymaltose, 1 mg32,250$1$32.3K
    83970Parathyroid hormone test measures the level of PTH in the blood. This test is done to ascertain the level of calcium and evaluate the parathyroid function.720$40$28.8K
    99213The 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…340$60$19K
    82610The lab analyst performs the technical lab test to measure the amount of a protein, typically in the blood, called cystatin C.860$20$15.4K
    99232The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…180$60$11K
    90962The provider manages all the services associated with the monthly care of a patient who is 20 years old or older and has a condition known as end stage renal disease or ESRD. For this service, the…70$150$10.5K
    99204The 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…90$110$9.6K

    Showing 1–10 of 60

    Medicare: Competitive Analysis & Benchmarks

    How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 60 CPT/HCPCS codes.

    View: State1 / 2

    Full comparison — all codes billed, vs. state median

    60 rows

    CPT/HCPCS CodeRankProvider CountMedian ClaimsAvg PaidAverage Revenue
    909601120150$260$44.3K
    90961420140$220$33.4K
    J143921026,630$1$23K
    82610110860$20$15.6K
    8397021040$40$12.9K
    99214201,66090$70$11.4K
    9923319029060$90$10.8K
    9923216157080$60$9.2K
    9096231060$150$8.6K
    906775211020$280$7.7K

    Showing 1–10 of 60

    Related Providers

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

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    Santee Sioux Tribe Of NebraskaNEClinic/Center$0$10.6M
    Yankton Medical Clinic PCSDInternal Medicine Physician$0$6.3M
    Chad LaurichSDVascular Surgery Physician$3.2M$0
    NPI 1588636484——$3.2M$0
    Ryan GeraetsSDOphthalmology Physician$3M$0
    John BormesSDOphthalmology Physician$2.6M$0
    Elizabeth AtchisonSDOphthalmology Physician$1.7M$0
    Ashar LuqmanIANephrology Physician$1.4M$0
    Taylor SlingsbySDRetina Specialist (Ophthalmology) Physician$1.4M$0
    Ty HansonSDDermatology Physician$1.2M$0

    Nearby Providers

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

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    Ability Building Services, Inc.SDIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility$0$39.2M
    Lewis & Clark Behavioral Health Services, Inc.SDCommunity/Behavioral Health Agency$0$24M
    Yankton PhSDAssisted Living Facility (Mental Illness)$0$4.1M
    Cedar Vilage Assisted Living CenterSDAssisted Living Facility (Mental Illness)$0$2.4M
    Heartland Psychological ServicesSDPsychiatry Physician$0$1.3M
    Avera At HomeSDHome Health Agency$0$1M
    Sacred Heart Health ServicesSDRural Acute Care Hospital$0$942.8K
    Mary Lee VillanuevaSDHematology & Oncology Physician$788.7K$0
    Sacred Heart Health ServicesSDEmergency Care Clinic/Center$0$766.6K
    Kore Cares In Home Services, LLCSDIn Home Supportive Care Agency$0$700.6K

    Frequently Asked Questions

    References

    1. 1.Medicare Physician & Other Practitioner by Provider and Service. CMS.gov.Provider-level Medicare Part B utilization and payment data.
    2. 2.NPPES NPI Registry. CMS.gov.National Provider Identifier registry used for provider enumeration and taxonomy metadata.

    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

    Medicare Revenue by CPT/HCPCS Code
    Claims Volume vs. South Dakota Distribution
    Byron Nielsen — 9 of 25 codes billed far more than typical (above p95)
    p5–p95 (all providers)p25–p75MedianThis providerOutlier
    Rank Distribution — South Dakota