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NPI 1336128016 · Columbia, SC · Emergency Medicine Physician
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Joel Waldrop is a emergency medicine physician provider located in Columbia, South Carolina. This profile covers 31 Medicare and 3 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.
Provider details (source: NPPES NPI Registry)
| Field | Value |
|---|---|
| Entity Type | Individual |
| Organization | Joel Waldrop |
| Address | 111 Doctor Cir |
| City | Columbia |
| State | SC |
| ZIP | 29203 |
| Taxonomy | Emergency Medicine Physician |
| NPI Enumerated | January 11, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $2.4M |
| Medicaid | $9.3K |
Payer mix is heavily Medicare-skewed: the provider has $2.4M in lifetime Medicare revenue versus $9.3K in lifetime Medicaid revenue, making Medicare the dominant payer by a very wide margin and effectively a single-payer practice for material revenue. Medicaid activity is de minimis in scale compared with Medicare.
The code mix indicates a care-management and post-acute services focus rather than high-volume emergency-department episodic care: multiple chronic care management codes (99489, 99487, 99490, 99439) dominate Medicare revenue and the profile also includes home-health certification/re-certification codes (G0180, G0179) plus nursing facility and home/residence visit codes (99309, 99348, 99349). Taken together, these codes suggest this practice operates substantial longitudinal care coordination, home-health oversight, and nursing facility/home-visit services.
The provider is a national outlier on several care-management measures: 99489 ranks #3 of 1836 providers and is described as an "extreme outlier, far above typical national volume for this code," and 99487 ranks #5 of 2701 providers and is likewise described as an "extreme outlier." These rankings indicate unusually high national volume specifically for complex chronic care management services.
Home-health and post-acute oversight activity is meaningfully above typical: G0180 (770 claims, $28.5K) ranks #38 of 18863 providers and is labeled an "extreme outlier," while G0179 (432 claims, $13K) ranks #105 and is described as "notably above typical national volume." This supports the interpretation that the provider has substantial involvement in home-health plan certification and re-certification.
Medicaid billing is concentrated in office E/M visits and is modest in-state: the top Medicaid code 99214 accounts for 94.3% of Medicaid revenue ($8.8K from 111 claims) and ranks #1598 of 2483 in-state (35th percentile), indicating typical, unremarkable in-state volume for office visit billing. The remaining Medicaid codes (87804 and 87880) are very small contributors (3.9% and 1.8% of Medicaid revenue, respectively) and rank low in-state.
The provider’s taxonomy and tenure: the record lists Emergency Medicine Physician and the NPI was enumerated 2006-01-11 (~20 years ago), indicating long-standing enrollment and an established billing footprint that has produced the observed, unusually large care-management and post-acute volumes over time. This tenure increases confidence that the pattern reflects a sustained operational model rather than a short-term anomaly.
High revenue concentration creates sensitivity to policy or reimbursement changes: because the top three Medicare codes account for 89.0% of Medicare revenue and the top three Medicaid codes account for 100.0% of Medicaid revenue, any changes to payment rules, coverage, or audit focus for chronic care management, home health certification, or high-volume E/M codes could materially affect the provider’s revenue profile. Payers and analysts should monitor those specific code groups (99489, 99487, G0180/G0179, and 99214) for changes in utilization or policy impact.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
31 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 99489 | The clinical staff provides services directed by the provider to support and coordinate a patient’s care across multiple disciplines. The patient has two or more chronic conditions that place the… | 29,790 | $50 | $1.5M |
| 99487 | The clinical staff provides services directed by the provider to support and coordinate a patient’s care across multiple disciplines. The patient has two or more chronic conditions that place the… | 5,150 | $100 | $494.2K |
| 99309 | The provider sees a patient for a subsequent nursing facility care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or the provider… | 880 | $80 | $69.3K |
| 99349 | The provider sees an established patient for a home or residence visit involving evaluation and management (E/M). The visit involves moderate medical decision making or the provider spends at least… | 690 | $90 | $62K |
| 99490 | The clinical staff provides services directed by the provider to support and coordinate a patient’s care across multiple disciplines. The patient has two or more chronic conditions that place the… | 930 | $40 | $41.1K |
| 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… | 450 | $90 | $41K |
| 99439 | The clinical staff provides services directed by the provider to support and coordinate a patient’s care across multiple disciplines. The patient has two or more chronic conditions that place the… | 1,040 | $30 | $35.4K |
| G0180 | Physician or allowed practitioner certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review… | 770 | $40 | $28.5K |
| G0179 | Physician or allowed practitioner re-certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and… | 430 | $30 | $13K |
| 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… | 110 | $60 | $7K |
Showing 1–10 of 31
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 31 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
31 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| 99489 | 1 | 340 | 360 | $50 | $41.4K |
| 99349 | 80 | 530 | 240 | $80 | $30.4K |
| 99309 | 66 | 470 | 290 | $70 | $29.9K |
| 99214 | 1,651 | 7,860 | 160 | $80 | $23.2K |
| 99487 | 1 | 350 | 80 | $80 | $15.7K |
| 99308 | 259 | 390 | 120 | $50 | $12.9K |
| 99213 | 3,474 | 7,690 | 100 | $60 | $10.8K |
| 87637 | 53 | 100 | 40 | $140 | $9.4K |
| 99215 | 1,786 | 2,360 | 40 | $120 | $9.3K |
| 99490 | 25 | 650 | 80 | $40 | $8.9K |
Showing 1–10 of 31
Medicaid revenue breakdown by year and by CPT/HCPCS procedure code, including monthly billing trends and the top codes driving revenue.
View: By Year1 / 3
Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.
3 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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… | 110 | $80 | $8.8K |
| 87804 | The analyst performs an immunoassay with direct optical, meaning visual, observation to detect influenza, also called flu, in a patient sample, typically a throat or nasal swab or nasal washings. | 30 | $10 | $360 |
| 87880 | The analyst performs an immunoassay with direct optical, meaning visual, observation to detect Streptococcus, group A, in a patient sample, typically a throat swab. | 10 | $10 | $170 |
How this provider's Medicaid billing volume and revenue compare to other South Carolina providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. South Carolina median
3 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 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… | 1,598 | 2,480 | 350 | $80 | $246K |
| 87804 | The analyst performs an immunoassay with direct optical, meaning visual, observation to detect influenza, also called flu, in a patient sample, typically a throat or nasal swab or nasal washings. | 470 | 540 | 350 | $20 | $52K |
| 87880 | The analyst performs an immunoassay with direct optical, meaning visual, observation to detect Streptococcus, group A, in a patient sample, typically a throat swab. | 501 | 540 | 240 | $10 | $35.8K |
Other providers in the same ZIP code as Joel Waldrop, ranked by combined Medicare and Medicaid revenue.
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