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 U.S. Virgin Islands for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to U.S. Virgin Islands 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. U.S. Virgin Islands (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.

James Nelson (NPI 1376768739)

Field	Value
Entity Type	Individual
Organization	James Nelson
Address	9003 Havensight Shopp Ctr Ste 305
City	St Thomas
State	VI
ZIP	00802
Taxonomy	Neurology Physician
NPI Enumerated	April 13, 2007

Payer Source	Total Paid
Medicare	$143.2K
Medicaid	$0

Key Findings

This provider reports $143.2K in total Medicare revenue and has no Medicaid billing on file, making their public payor footprint effectively single-payer Medicare; the NPI was enumerated on 2007-04-13 (~19 years ago), indicating long-tenured enrollment.

Revenue is highly concentrated in a small set of services: the precomputed top 3 codes 99214, 95819, and 95810 account for 70.0% of this provider's total Medicare revenue, signaling reliance on a narrow set of visit and diagnostic services.

The code mix combines office/clinic E/M work with neurodiagnostic and sleep testing: 99214 (589 claims, $80 avg paid/claim, $47.1K revenue, 32.9%), 95819 (102 claims, $346 avg paid/claim, $35.3K revenue, 24.6%), and 95810 (39 claims, $459 avg paid/claim, $17.9K revenue, 12.5%) suggest an outpatient neurology practice that pairs routine established-patient visits with EEG and polysomnography services.

At the code level this provider shows modest-to-strong competitive positions on specific services: 99214 ranks #36760 of 479517 (92th percentile; typical, unremarkable volume for this code), 95819 ranks #330 of 2575 (87th percentile; typical, unremarkable volume for this code), and 95810 ranks #1565 of 3514 (54th percentile; typical, unremarkable volume for this code), implying above-average national standing on EEG relative volume while most volumes are characterized as typical.

There are a few notable specialty-level outliers despite the small overall revenue base: 93784 (ambulatory blood pressure monitoring) ranks #9 of 140 (94th percentile; typical, unremarkable volume for this code) which indicates unusually high relative activity on a specific monitoring service even though it represents only $2.1K (1.5%) of Medicare revenue.

The practice balances a high volume of mid-level office visits with lower-volume, higher-paid diagnostic procedures: 99214 accounts for 589 claims and $47.1K in revenue (32.9%), while diagnostic studies such as 95819 and 95810 generate fewer claims but a large share of revenue, reflecting a service mix that depends on both visit volume and procedure-based reimbursement.

Some additional procedure and consult activity is present but limited in scale: 99205 (83 claims, $118 avg paid/claim, $9.8K revenue, 6.8%) and 99232 (104 claims, $62 avg paid/claim, $6.4K revenue, 4.5%) show the provider sees new consults and inpatient follow-ups, but these codes are smaller contributors to overall Medicare revenue.

The combination of a single-payer Medicare concentration and a top-3-code concentration (70.0%) suggests revenue vulnerability to changes in Medicare reimbursement or referral patterns for EEG/sleep services; this profile also highlights potential growth opportunities in broadening payer mix or diversifying service lines beyond the dominant diagnostic and established-patient visit codes.

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
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…	590	$80	$47.1K
95819	Electroencephalogram or EEG is a diagnostic test that uses small electrodes attached to the scalp to measure the electrical activity of the brain. In this procedure the provider performs the EEG…	100	$350	$35.3K
95810	Polysomnography refers to the continuous and simultaneous monitoring and recording of various physiological and pathophysiological parameters of sleep for six or more hours with physician review,…	40	$460	$17.9K
95811	During the study, the physician monitors the sleep pattern of the patient, along with different bodily functions during the sleep cycle extending over a period of six hours or more.	30	$470	$12.3K
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…	80	$120	$9.8K
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…	100	$60	$6.4K
95911	In this procedure, the provider performs nine or ten nerve conduction studies, a diagnostic test to evaluate function, especially the electrical conduction ability of the motor and sensory nerves of…	10	$160	$2.3K
95886	The provider assesses the electrical activity of a muscle in the extremity and related paraspinal areas. At the same session as a separately reportable nerve conduction study. He studies five or more…	30	$80	$2.2K
93784	The provider prescribes ambulatory blood pressure monitoring in which a patient wears a device continuously that automatically measures blood pressure at intervals over a period of 24 hours and…	70	$30	$2.1K
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	$70	$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. U.S. Virgin Islands Distribution

James Nelson — 2 of 16 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — U.S. Virgin Islands

Full comparison — all codes billed, vs. state median

16 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
95819	1	10	100	$350	$35.3K
99214	8	80	100	$80	$15.5K
99232	7	10	140	$60	$12.8K
95810	1	10	20	$460	$12.1K
95811	1	10	20	$470	$10.9K
99213	65	80	100	$50	$7.6K
99205	1	20	30	$140	$4.9K
95911	1	10	10	$160	$2.3K
93784	1	10	70	$30	$2.1K
95886	1	10	30	$70	$2.1K

Showing 1–10 of 16

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Vi Government Hospital And Health Facilities Corp	VI	General Acute Care Hospital	$0	$23.6M
Vi Neurological Medical Group Inc.	VI	Internal Medicine Physician	$0	$773.4K
Kevin Stewart	VI	Ophthalmology Physician	$469.5K	$0
Walter Rohloff	VI	Nephrology Physician	$85.2K	$100.3K
Leslie Kingslow	DC	Pulmonary Disease Physician	$176.8K	$0
James Gasho	MD	Orthopaedic Surgery Physician	$172.1K	$0
Reva Richardson	VI	Internal Medicine Physician	$154.4K	$0
Jeanette Dilan-koetje	MO	Internal Medicine Physician	$133.6K	$0
David Weisher	VI	Medical Specialty Clinic/Center	$103.3K	$0
John Shuster	WA	Orthopaedic Surgery of the Spine Physician	$101.4K	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Duanne Jones	VI	Public Health Dentistry	$0	$33.2M
The St Thomas East End Medical Center Corporation	VI	Federal Public Health Clinic/Center	$0	$12.8M
Aac-air Ambulance Caribbean Inc.	VI	Air Ambulance	$2M	$8.6M
Vi Relocation Services And Rentals LLC	VI	Land Ambulance	$0	$6.8M
Alicia Prentice	VI	Home Health Aide	$0	$3.9M
Stretcher Plus, LLC	VI	Non-emergency Medical Transport (VAN)	$0	$2.8M
Cog Restore, LLC	VI	Rehabilitation Clinic/Center	$0	$2.1M
Dept Of Health, Govt Of Vi Ems St Thomas	VI	Land Ambulance	$0	$1.5M
Vi Oral Surgery, Inc	VI	Oral and Maxillofacial Surgery (Dentist)	$0	$1.4M
Department Of Health	VI	Ambulatory Family Planning Facility	$0	$1.3M

James 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