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

Why is the Medicaid comparison limited to South Dakota 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. South Dakota (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.

Kelly Delaney-nelson (NPI 1356752067)

Field	Value
Entity Type	Individual
Organization	Kelly Delaney-nelson
Address	575 N Sioux Point Rd
City	Dakota Dunes
State	SD
ZIP	57049
Taxonomy	Rheumatology Physician
NPI Enumerated	May 15, 2014

Payer Source	Total Paid
Medicare	$463.5K
Medicaid	$0

Key Findings

This provider is effectively single-payer in scope: lifetime Medicare revenue totals $463.5K while Medicaid revenue is listed as none, indicating no Medicaid billing on file and a heavy operational dependence on Medicare reimbursement. That concentration means payer-specific Medicare policies will disproportionately affect the practice’s revenue stream.

Revenue concentration is high: the precomputed top 3 Medicare codes by revenue account for 90.6% of this provider's total Medicare revenue, with J0717 alone contributing $327.3K (69.5%). J1745 contributes $71.8K (15.2%) and 99214 contributes $27.8K (5.9%), so a small number of codes drive nearly all reported Medicare revenue.

The code mix indicates a rheumatology practice oriented around physician‑administered biologic therapies and in‑office infusion/administration services: J0717 (certolizumab pegol) shows 81.8K claims, $4 avg paid/claim, $327.3K revenue, and J1745 (infliximab) shows 2.8K claims, $26 avg paid/claim, $71.8K revenue. These biologic administration codes dominate revenue and suggest on‑site infusion or supervised injection workflows rather than primarily outpatient clinic visits or procedures.

Clinical visit volume and complexity appear secondary to drug administration: 99214 (320 claims, $87 avg paid/claim, $27.8K revenue) is the third top revenue code but represents only 5.9% of Medicare revenue; higher‑level new and established visit codes such as 99205 and 99215 are present but contribute relatively small shares ($13.1K and $10.7K respectively). This pattern is consistent with a practice whose revenue model is driven by high‑cost medications rather than face‑to‑face E/M encounters.

Competitive standing by code is mixed. J0717 ranks #203 of 848 providers nationally (76th percentile; typical, unremarkable volume for this code), indicating stronger than average national activity on that biologic code; by contrast, J1745 ranks #707 of 1352 providers nationally (48th percentile; typical, unremarkable volume for this code), showing median participation, while 99214 ranks #93114 of 479517 providers nationally (81th percentile; typical, unremarkable volume for this code), suggesting above‑median E/M volume relative to the broad national pool.

There are several notable code‑level percentile outliers in ancillary services that illuminate service patterns: 73130 X‑ray of the hand ranks #1032 of 20344 providers nationally (95th percentile; typical, unremarkable volume for this code) and 96372 injection administration ranks #5203 of 58224 providers nationally (91th percentile; typical, unremarkable volume for this code), both indicating unusually frequent use versus peers. Conversely, DXA 77080 is at the 4th percentile (rank #16240 of 17308; typical, unremarkable volume for this code), suggesting low use of bone density testing relative to other providers.

Operational and contracting implications flow from the heavy reliance on physician‑administered biologic drug codes: with J0717 and J1745 accounting for the majority of revenue ($327.3K and $71.8K respectively), the practice’s financial performance will be sensitive to reimbursement changes for drug administration, payer policies on physician‑administered drugs, and gross‑to‑net pricing shifts. Payers and network managers should treat drug administration reimbursement and supportive infusion services as the primary levers for vendor negotiations.

The provider has an established NPI tenure, enumerated on 2014-05-15 (~12 years ago), which supports the interpretation of a stable practice pattern over time rather than a transient or newly established billing profile. Tenure combined with the concentrated biologic revenue profile suggests an embedded treatment model focused on ongoing chronic therapy management for rheumatologic conditions.

Medicare: Complete Services Breakdown

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

16 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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)	81,820	$1	$327.3K
J1745	Injection, infliximab, excludes biosimilar, 10 mg	2,760	$30	$71.8K
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…	320	$90	$27.8K
99205	The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the provider…	90	$150	$13.1K
99215	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the…	90	$130	$10.7K
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…	60	$80	$5.2K
73130	In this procedure, the provider takes a minimum of three X–ray images of a patient’s hand to check for any fracture, swelling, or reason of pain in the hand.	160	$30	$4.3K
96372	A therapeutic, prophylactic, or diagnostic substance (a fluid, a drug, etc.) is injected via intramuscular or subcutaneous route into the patient's body. The procedure is performed by the physician…	240	$10	$2.4K
73630	In this diagnostic procedure, the provider takes a minimum of three views of the foot to assess injury, fracture, arthritis, tumor, or congenital abnormality.	100	$20	$2.3K
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…	30	$60	$1.9K

Showing 1–10 of 16

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 16 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. South Dakota Distribution

Kelly Delaney-nelson — 3 of 16 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — South Dakota

Full comparison — all codes billed, vs. state median

16 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0717	1	10	33,600	$1	$175.6K
J1745	4	10	4,300	$30	$97.2K
96413	11	10	110	$100	$13.5K
99214	252	1,660	90	$70	$11.4K
99215	115	450	40	$100	$7.5K
99213	1,354	1,710	80	$50	$6.4K
99205	11	180	30	$130	$5.1K
96415	8	10	70	$20	$2K
77080	78	80	60	$10	$2K
73630	36	80	90	$10	$1.2K

Showing 1–10 of 16

Related Providers

Other providers that share a Tax Identification Number (TIN) with Kelly Delaney-nelson, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Gundersen Lutheran Medical Center Inc	WI	General Acute Care Hospital	$0	$74.3M
Mercy Health System Corporation	WI	Multi-Specialty Clinic/Center	$0	$13.2M
Gundersen Clinic Ltd	WI	Clinic/Center	$0	$10.1M
Moundview Memorial Hospital & Clinics, Inc	WI	Critical Access Hospital	$0	$8.9M
Palmer Lutheran Health Center, Inc	IA	Rural Health Clinic/Center	$0	$6M
Memorial Hospital Of Boscobel	WI	Critical Access Hospital	$0	$5.4M
Tri-county Memorial Hospital, Inc.	WI	Critical Access Hospital	$0	$4.1M
Peter Bracha	FL	Retina Specialist (Ophthalmology) Physician	$4M	$0
St. Joseph's Health Services, Inc.	WI	Critical Access Hospital	$0	$3.9M
Cnos PC	SD	Orthopaedic Surgery Physician	$0	$3.6M

Nearby Providers

Other providers in the same ZIP code as Kelly Delaney-nelson, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Dunes Dental 4 Kids, LLP	SD	Pediatric Dentistry	$0	$3.3M
Chad Laurich	SD	Vascular Surgery Physician	$3.2M	$0
Liem Som Oei Md PC	SD	Nephrology Physician	$0	$2.4M
Ear Nose And Throat Consultants And Hearing Services Plc	SD	Otolaryngology Physician	$0	$2.2M
Oral Surgery Assocates, P.C.	SD	Oral and Maxillofacial Surgery (Dentist)	$0	$2.1M
Dunes Anesthesia PC	SD	Pain Medicine (Anesthesiology) Physician	$0	$1.1M
Midlands Clinic, P.C.	SD	Specialist	$0	$822.9K
Dunes Medical Laboratories	SD	Clinical Medical Laboratory	$303K	$416.6K
Beth Bruening	SD	Ophthalmology Physician	$704.9K	$2.2K
Neal Khurana	SD	Vascular & Interventional Radiology Physician	$704.3K	$0

Kelly Delaney-nelson — 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