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

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

Scott Lewis (NPI 1336368505)

Field	Value
Entity Type	Individual
Organization	Scott Lewis
Address	26 Oxford Way
City	Somerset
State	KY
ZIP	42503
Taxonomy	Rheumatology Physician
NPI Enumerated	April 25, 2007

Payer Source	Total Paid
Medicare	$1.5M
Medicaid	$0

Key Findings

This provider is effectively single‑payer with Medicare as the sole recorded public payer: Total Medicare revenue is $1.5M while Medicaid billing is listed as none. The absence of Medicaid claims on file indicates the provider’s Medicare activity drives the entire documented public-revenue profile and suggests limited direct engagement with Medicaid populations or billing systems.

Revenue is highly concentrated in a small set of biologic drug codes: the precomputed top three Medicare codes by revenue account for 70.9% of this provider's total Medicare revenue. That concentration signals a business model focused on high-cost injected biologic therapies rather than a broad mix of office-only visits or outpatient procedures.

J0129 is the single largest revenue driver: J0129 accounts for $663K and 43.7% of Medicare revenue and ranks #144 of 1221 providers nationally (88th percentile; typical, unremarkable volume for this code). This dominant position for abatacept billing indicates heavy reliance on in-office administration of this specific biologic within the practice.

The second and third top revenue codes reinforce a biologics-heavy rheumatology practice: J0717 (certolizumab pegol) brings $243.2K (16.0%) and ranks #315 of 848 nationally (63th percentile; typical, unremarkable volume), while J3262 (tocilizumab) contributes $170K (11.2%) and ranks #360 of 618 (42th percentile; typical, unremarkable volume). Together these codes show the practice treats populations requiring multiple targeted biologic agents.

The code mix shows on-site infusion and injection capability beyond drug-only billing: notable administration and infusion-related codes appear (for example, J1602 $131K, 96365 $13.7K, 96413 $14.1K, and J1745 $29K). Presence of these administration and infusion codes paired with high biologic drug revenue suggests the provider operates with staff and space to deliver parenteral therapies rather than purely prescribing self-administered agents.

Clinical lab testing is consistent with specialty rheumatology care: ENA testing 86235 ($21.1K), CCP testing 86200 ($2.1K), ANA 86038 ($1.6K), and dsDNA assays 86225/86226 (combined revenue listed individually) appear among the top codes. This lab footprint supports ongoing autoimmune disease diagnosis and monitoring typical of a rheumatology practice that manages complex systemic autoimmune conditions.

Competitive standing across codes is mixed: the provider ranks relatively high nationally for J0129 (#144 of 1221, 88th percentile) and above-typical for some E/M and administration codes (for example, 99214 ranks #50551 of 479517, 89th percentile; 96372 is notably above typical at the 96th percentile). Other biologic codes show only modest or below‑median national standing (for example, J3262 at the 42th percentile), indicating the practice is a significant regional user of specific biologics but not uniformly dominant across all biologic agents.

Operational tenure is long-established: NPI enumerated 2007-04-25 (~19 years ago), which suggests the provider has sustained Medicare relationships and practice continuity. Combined with the concentrated biologic and infusion billing profile, this tenure supports a picture of a stable, specialty rheumatology practice focused on in-office administration of high-cost biologic therapies to Medicare beneficiaries.

Medicare: Complete Services Breakdown

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

33 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)	19,500	$30	$663K
J0717	Injection, certolizumab pegol, 1 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)	60,800	$1	$243.2K
J3262	Injection, tocilizumab, 1 mg	33,990	$10	$170K
J1602	Injection, golimumab, 1 mg, for intravenous use	13,100	$10	$131K
J0490	Injection, belimumab, 10 mg	1,640	$40	$58.9K
J0897	Injection, denosumab, 1 mg	2,280	$20	$43.3K
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…	490	$80	$40.2K
99204	The 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…	280	$110	$29.1K
J1745	Injection, infliximab, excludes biosimilar, 10 mg	1,120	$30	$29K
J3111	Injection, romosozumab-aqqg, 1 mg	3,570	$10	$28.6K

Showing 1–10 of 33

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 33 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Kentucky Distribution

Scott Lewis — 2 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Kentucky

Full comparison — all codes billed, vs. state median

33 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0129	8	30	9,700	$30	$415.4K
J0717	12	30	46,400	$1	$288.1K
J3262	5	10	33,960	$1	$183.8K
J1602	9	20	11,560	$10	$141.6K
J1745	9	10	2,010	$30	$93.6K
J0490	1	10	1,640	$40	$59.6K
J0897	37	80	2,280	$20	$59.6K
J3111	4	10	4,200	$10	$41.7K
96413	20	50	100	$90	$16.7K
99214	636	7,230	110	$70	$14.1K

Showing 1–10 of 33

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Faith Healthcare Inc	KY	Federally Qualified Health Center (FQHC)	$0	$3M
Timothy Lonesky	KY	Rheumatology Physician	$1.5M	$0
Roneka Ravenell	IN	Rheumatology Physician	$1.3M	$0
Sarah Estes	KY	Family Nurse Practitioner	$981.6K	$0
Dana Mann	KY	Family Nurse Practitioner	$824.8K	$0
Melissa Cheng	KY	Nurse Practitioner	$703.4K	$0
Natasha Smith	KY	Family Nurse Practitioner	$658K	$0
Amanda Evans	KY	Family Nurse Practitioner	$562K	$0
Megan Fackler	KY	Family Nurse Practitioner	$497.5K	$0
Emily Langlois	KY	Nurse Practitioner	$450.3K	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Morrland Healthcare LLC	KY	Community/Behavioral Health Agency	$0	$54.8M
Applied Behavioral Advancements, LLC	KY	Community/Behavioral Health Agency	$0	$29.2M
Protea Behavioral Health Counseling, PLLC	KY	Professional Counselor	$0	$24.4M
Lake Cumberland Regional Hospital, LLC	KY	Internal Medicine Physician	$0	$15.6M
Cumberland Behavior Group, LLC	KY	Community/Behavioral Health Agency	$0	$15.2M
Quest Counseling	KY	Mental Health Counselor	$0	$12.5M
Lake Cumberland Recovery, Inc	KY	Substance Use Disorder Rehabilitation Clinic/Center	$0	$11.8M
Achievements Through Actions	KY	Developmentally Disabled Services Day Training Agency	$0	$10M
Lake Cumberland Surgery Center LP	KY	Ambulatory Surgical Clinic/Center	$1M	$8.7M
Adult Day Health, Inc.	KY	Adult Day Care Clinic/Center	$0	$8.9M

Scott Lewis — 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