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

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

Paul Utrie (NPI 1326065368)

Field	Value
Entity Type	Individual
Organization	Paul Utrie
Address	2223 Lime Kiln Rd
City	Green Bay
State	WI
ZIP	54311
Taxonomy	Rheumatology Physician
NPI Enumerated	July 16, 2006

Payer Source	Total Paid
Medicare	$1.3M
Medicaid	$0

Key Findings

This provider’s payment profile is effectively single-payer: lifetime Medicare revenue is $1.3M and there is no Medicaid billing on file (none). The absence of Medicaid activity means any payer-mix analysis or contracting strategy should treat Medicare as the dominant public payer exposure for this practice.

Revenue is highly concentrated in biologic drug administration: the precomputed top 3 Medicare codes account for 71.8% of total Medicare revenue, with J0129 (470.1K, 35.8%), J3262 (273.4K, 20.8%), and J1602 (200.5K, 15.3%) together driving the bulk of receipts. That concentration signals a business model built around high-cost injectable biologics rather than office-based E/M or procedural revenue streams.

The CPT/HCPCS mix and supporting infusion codes indicate an infusion-oriented rheumatology practice. Codes for infusion administration and supportive consumables appear in the top codes (96413, 96365, J7050) alongside high-revenue biologics J0129, J3262, and J1602, implying the provider operates an on-site infusion/administration service requiring nursing and infusion throughput capacity.

Competitive standing on the highest-revenue biologics is generally in the middle-to-upper range nationally rather than dominant: J0129 ranks #286 of 1221 providers (77th percentile, typical, unremarkable volume), J3262 ranks #206 of 618 providers (67th percentile, typical, unremarkable volume), and J1602 ranks #295 of 1041 providers (72th percentile, typical, unremarkable volume). These ranks indicate consistent, non-leading participation in national biologic administration.

There is a notable relative weakness for rituximab (J9312) versus peers: J9312 accounts for $88.2K (6.7% of Medicare revenue) but ranks #304 of 317 providers (4th percentile, typical, unremarkable volume), suggesting the provider uses a broader biologic mix but does not compete strongly on rituximab infusion volumes. This pattern may reflect clinical preference, referral patterns, or formulary access rather than an operational limitation on infusion capacity.

Office evaluation-and-management revenue is secondary to drug/infusion receipts: 99214 generated $44.4K (3.4% of Medicare revenue) across 510 claims, while lower-level office codes (99213, 99204, 99215) contribute minimal shares. The relative small contribution from E/M suggests the practice derives most margin from medication administration rather than high volumes of billed office visit intensity.

Operational signals from procedure counts support an active infusion workflow: 586 claims for J7050 (normal saline) and 254 claims for 96413 (chemotherapy/infusion administration) alongside numerous biologic injections indicate frequent IV or infusion encounters and ongoing use of infusion consumables. Payers and network planners should read this as evidence the provider maintains infusion capability and associated staffing.

The provider has an established NPI tenure (NPI enumerated 2006-07-16 (~20 years ago)), which combined with $1.3M lifetime Medicare revenue suggests a stable, mid-sized Medicare infusion practice over time rather than a recently opened or high-growth enterprise. For competitive or contracting considerations, expect predictable biologic-administration volume without the scale of national high-volume infusion centers.

Medicare: Complete Services Breakdown

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

27 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J0129	Injection, abatacept, 10 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)	13,830	$30	$470.1K
J3262	Injection, tocilizumab, 1 mg	54,680	$10	$273.4K
J1602	Injection, golimumab, 1 mg, for intravenous use	20,050	$10	$200.5K
J1745	Injection, infliximab, excludes biosimilar, 10 mg	6,060	$30	$157.6K
J9312	Injection, rituximab, 10 mg	1,400	$60	$88.2K
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…	510	$90	$44.4K
96413	Chemotherapy is a therapeutic procedure used for the treatment of cancer via the use of chemical agents. These chemical agents (drugs) work on the cancerous cells of the body to destroy them. These…	250	$100	$24.4K
J0897	Injection, denosumab, 1 mg	1,080	$20	$19.5K
96365	The provider administers the initial intravenous infusion of a medication or other substance for a period up to one hour to prevent, treat, or diagnose a condition or disease.	320	$50	$15.3K
96415	In this add on procedure, the provider continues administration of a chemotherapy drug into a vein using an infusion technique. He uses this code to report each additional hour of infusion beyond the…	200	$20	$3.9K

Showing 1–10 of 27

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 27 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Wisconsin Distribution

Paul Utrie — 1 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Wisconsin

Full comparison — all codes billed, vs. state median

27 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0129	3	10	8,170	$30	$286.2K
J9312	7	10	2,580	$60	$234.8K
J1602	6	10	11,900	$10	$206.3K
J3262	3	10	35,280	$1	$191.4K
J1745	8	20	6,060	$30	$168.9K
J0897	53	60	2,220	$20	$69.3K
96413	9	80	110	$90	$12.7K
99214	223	9,800	80	$70	$9.2K
99215	2,719	3,320	30	$110	$6.3K
96365	7	90	50	$50	$5.8K

Showing 1–10 of 27

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Thedacare, Incorporated	WI	Family Medicine Physician	$0	$14.8M
Mercy Health System Corporation	WI	Multi-Specialty Clinic/Center	$0	$13.2M
Thedacare Regional Medical Center - Appleton, Inc.	WI	General Acute Care Hospital	$0	$11.5M
Dickinson County Healthcare System	MI	General Acute Care Hospital	$0	$10.2M
Thedacare Medical Center - Berlin, Inc.	WI	Critical Access Hospital	$0	$9.4M
Thedacare, Incorporated	WI	Community Based Hospice Care Agency	$0	$8.3M
Thedacare, Incorporated	WI	Durable Medical Equipment & Medical Supplies	$0	$7.4M
Orthopedic Surgery Center Of Green Bay, LLC	WI	Ambulatory Surgical Clinic/Center	$2M	$0
Debbie Lim	WI	Rheumatology Physician	$1.8M	$0
Tower Clock Surgery Center LLC	WI	Ambulatory Surgical Clinic/Center	$1.2M	$428.6K

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Eric Lund	WI	Clinical Psychologist	$0	$77.1M
Baycare Aurora, LLC	WI	General Acute Care Hospital	$0	$25.4M
County Of Brown	WI	Clinic/Center	$0	$21.1M
Caravel Autism Health, LLC	WI	Behavior Analyst	$0	$18.5M
County Of Brown	WI	Community/Behavioral Health Agency	$0	$8.2M
Visiting Nurse Association Of Wisconsin, Inc.	WI	Home Infusion Therapy Pharmacy	$0	$5M
Baycare Clinic LLP	WI	Emergency Medicine Physician	$0	$3.6M
County Of Brown	WI	Case Management Agency	$0	$3.3M
Aegis Group Inc	WI	Land Ambulance	$1.2M	$1.6M
Visiting Nurse Association Of Wisconsin, Inc	WI	Home Health Agency	$0	$2.7M

Paul Utrie — 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