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NPI 1376528026 · Washington, DC · Gastroenterology Physician
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Javad Khalilzadeh is a gastroenterology physician provider located in Washington, District of Columbia. This profile covers 15 Medicare and 9 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 | Javad Khalilzadeh |
| Address | 106 Irving St Nw |
| City | Washington |
| State | DC |
| ZIP | 20010 |
| Taxonomy | Gastroenterology Physician |
| NPI Enumerated | December 14, 2005 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $1.4M |
| Medicare | $463K |
This provider receives materially more from Medicaid than Medicare, with total Medicaid revenue of $1.4M compared with total Medicare revenue of $463K, indicating the provider’s payer mix is weighted toward Medicaid at the practice level. Both payers are active, so analyses should treat this as a dual-payer operation rather than single-payer or Medicare-dominant.
Revenue is highly concentrated within a very small set of codes for each payer: the top 3 Medicare codes account for 82.6% of the provider’s Medicare revenue, while the top 3 Medicaid codes account for 94.5% of the provider’s Medicaid revenue. That concentration signals that a few high-volume E/M and endoscopy codes drive the bulk of reimbursement and therefore fiscal performance for this clinician.
The code mix points to an inpatient/observation-focused gastroenterology practice with procedural capability. The highest-revenue codes are hospital inpatient/observation E/M codes (99232, 99223, 99231) supplemented by diagnostic and therapeutic upper‑GI endoscopy codes such as 43239 and 43246, which together imply the clinician spends substantial time on inpatient management and performs EGDs and related procedures.
Medicare competitive standing is extreme for key inpatient E/M codes: 99232 generated $279.9K (60.4% of this provider’s Medicare revenue) and ranks #211 of 177383 nationally (100th percentile; extreme outlier), and 99223 produced $82.4K (17.8% of Medicare revenue) and ranks #512 of 139583 (100th percentile; extreme outlier). These national ranks indicate this provider operates at far higher Medicare volume for those inpatient E/M services than typical peers.
On Medicaid the provider is also a high-volume state player for the dominant E/M code: 99232 accounts for $1.1M and 27.4K claims (75.8% of the provider’s Medicaid revenue) and ranks #4 of 68 in-state (96th percentile; described as typical, unremarkable volume in the source). 99223 is the second Medicaid driver with $215.9K (15.3% of Medicaid revenue) and a rank of #8 of 40 in-state (82th percentile; typical, unremarkable), which together show strong in-state inpatient E/M volume.
Certain procedure codes show unusually high standing versus peers, reinforcing a procedural footprint: Medicare 43246 ranks #8 of 752 (99th percentile; notably above typical national volume) and Medicare 43247 ranks #5 of 146 (97th percentile; extreme outlier). On Medicaid, 43246 appears with $7.6K revenue and is the only provider listed in-state for that code (rank #1 of 1; no state peer volume comparison available), suggesting unique procedural billing patterns in the state dataset.
The provider’s billing profile includes both high-volume, lower-dollar Medicaid activity (e.g., 27.4K claims for 99232 at $39 avg paid/claim) and much smaller claim counts on Medicare for the same codes (e.g., 4.1K claims for Medicare 99232 at $69 avg paid/claim). This contrast suggests the practice manages large inpatient caseloads under Medicaid while maintaining a smaller Medicare inpatient volume, which has implications for care access, capacity planning, and payer-specific contract negotiations.
This clinician has a long tenure in the NPI registry (enumerated 2005-12-14, ~21 years ago), which supports interpretation of these patterns as established practice behavior rather than a short-term anomaly. Given the extreme concentration of revenue in a few codes for both payers, stakeholders should prioritize monitoring reimbursement and utilization trends for 99232, 99223, and the top endoscopy codes when assessing financial risk or negotiating payer arrangements.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
15 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 99232 | The 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… | 4,060 | $70 | $279.9K |
| 99223 | The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the… | 550 | $150 | $82.3K |
| 99231 | The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a straightforward or low level of medical… | 480 | $40 | $20.6K |
| 43239 | The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum where he removes one or more tissue biopsy specimens for diagnostic analysis. | 200 | $100 | $19.6K |
| 43246 | The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum to direct the placement of a tube through the skin and abdominal tissues into the… | 90 | $170 | $15.3K |
| 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… | 80 | $140 | $10.7K |
| 45388 | In this procedure, the provider performs flexible colonoscopy to destroy one or more tumors, polyps, or other lesions. The procedure includes, but does not require, guide wire passage and dilating… | 40 | $240 | $9.9K |
| 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… | 70 | $90 | $6.6K |
| 45378 | The provider examines the colon and rectum using a colonoscope, a flexible tube with a camera at its inserted end. If he sees any areas of abnormal mucosa or tissue, he takes samples using a brush… | 40 | $160 | $6.3K |
| 43247 | The provider examines the esophagus, stomach, and first portion of the small intestine with a flexible esophagogastroduodenoscope, a tubular instrument with a light source and camera, which he… | 50 | $50 | $2.6K |
Showing 1–10 of 15
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 15 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
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.
9 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 99232 | The 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… | 27,360 | $40 | $1.1M |
| 99223 | The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the… | 2,350 | $90 | $215.9K |
| 43239 | The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum where he removes one or more tissue biopsy specimens for diagnostic analysis. | 1,000 | $50 | $47.8K |
| 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… | 520 | $60 | $32.4K |
| 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… | 290 | $80 | $23.4K |
| 99254 | The provider sees a patient for an inpatient or observation consultation involving evaluation and management (E/M). The E/M involves a moderate level of medical decision making or the provider spends… | 50 | $180 | $9.4K |
| 43246 | The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum to direct the placement of a tube through the skin and abdominal tissues into the… | 130 | $60 | $7.6K |
| 99285 | The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a high level of medical decision making. | 40 | $110 | $4.5K |
| 43247 | The provider examines the esophagus, stomach, and first portion of the small intestine with a flexible esophagogastroduodenoscope, a tubular instrument with a light source and camera, which he… | 10 | $40 | $510 |
How this provider's Medicaid billing volume and revenue compare to other District of Columbia providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. District of Columbia median
9 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 99285 | The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a high level of medical decision making. | 23 | 30 | 4,480 | $140 | $3.5M |
| 43239 | The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum where he removes one or more tissue biopsy specimens for diagnostic analysis. | 8 | 20 | 310 | $530 | $605.1K |
| 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… | 174 | 310 | 750 | $70 | $321.6K |
| 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… | 62 | 120 | 300 | $120 | $287.3K |
| 99232 | The 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… | 4 | 70 | 320 | $40 | $259.9K |
| 99223 | The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the… | 8 | 40 | 300 | $100 | $193.8K |
| 99254 | The provider sees a patient for an inpatient or observation consultation involving evaluation and management (E/M). The E/M involves a moderate level of medical decision making or the provider spends… | 9 | 10 | 190 | $140 | $66.5K |
| 43246 | The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum to direct the placement of a tube through the skin and abdominal tissues into the… | 1 | 10 | 130 | $60 | $7.6K |
| 43247 | The provider examines the esophagus, stomach, and first portion of the small intestine with a flexible esophagogastroduodenoscope, a tubular instrument with a light source and camera, which he… | 1 | 10 | 10 | $40 | $500 |
Other providers in the same ZIP code as Javad Khalilzadeh, ranked by combined Medicare and Medicaid revenue.
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