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    OpenPayerNPI Medicare & MedicaidJames Wharton
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    James Wharton — Billing Profile & Reimbursement Data

    NPI 1386619203 · Lexington, KY · Dermatology Physician

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    James Wharton is a dermatology physician provider located in Lexington, Kentucky. This profile covers 30 Medicare and 0 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.

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    Provider details (source: NPPES NPI Registry)

    FieldValue
    Entity TypeIndividual
    OrganizationJames Wharton
    Address2195 Harrodsburg Rd Ste 2
    CityLexington
    StateKY
    ZIP40504
    TaxonomyDermatology Physician
    NPI EnumeratedFebruary 22, 2006

    Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)

    Payer SourceTotal Paid
    Medicare$924.5K
    Medicaid$0

    Key Findings

    This provider is effectively a Medicare-only practice: lifetime Medicare revenue is $924.5K and there is no Medicaid billing on file. The practice’s payer mix is therefore highly concentrated in Medicare, with no recorded Medicaid activity to diversify revenue or patient mix.

    Revenue is highly concentrated in three procedure lines: the precomputed top-three Medicare codes account for 76.3% of this provider’s total Medicare revenue, driven primarily by J3245, 17311, and 17312. J3245 alone contributes $493.6K (53.7% of Medicare revenue), while 17311 and 17312 contribute $137.8K (15.0%) and $69.8K (7.6%), respectively, indicating reliance on a small number of high-revenue services.

    The code mix aligns with a dermatology practice that combines high-volume biologic administration with surgical skin-cancer care: J3245 (tildrakizumab injections) dominates revenue, and Mohs surgery codes 17311 and 17312 together form the second-largest revenue cluster. This pattern suggests the operation supports both in-office biologic therapy administration and multi-staged surgical excisions with pathology workflows.

    Competitive standing on J3245 is middling nationally: the provider ranks #76 of 225 providers nationally for J3245 (67th percentile; typical, unremarkable volume). Despite a non-outlier national rank, J3245 is the single largest revenue driver here — a business-strength in terms of revenue concentration even if volume is not extreme compared with peers.

    Mohs surgery activity is moderate to above-median versus national peers: 17311 ranks #1119 of 2969 (62th percentile; typical, unremarkable volume) and 17312 ranks #684 of 2770 (75th percentile; typical, unremarkable volume). Those placements indicate consistent procedural throughput in skin cancer excision relative to the national dermatology cohort rather than dominant market share.

    Outpatient evaluation and pathology support procedural volumes: 99213 generates $32.6K (3.6% of Medicare revenue) and ranks #20471 of 457151 (96th percentile; notably above typical national volume), signaling a comparatively high rate of established-patient office visits. Complementary pathology work is present via 88305 ($38.4K, 4.2% of Medicare revenue), which ranks #4838 of 14580 (67th percentile; typical, unremarkable volume), consistent with biopsy and surgical specimen review associated with Mohs and excisions.

    The provider has long tenure in the Medicare program, with an NPI enumeration date of 2006-02-22 (~20 years ago), indicating an established practice that has built procedural and infusion components over time. Long-standing enrollment may support stable referral relationships and operational continuity for the combined injection and surgical services.

    From a contracting and strategic perspective, the combination of a single-payer footprint (Medicare-only billing on file) and a top-heavy revenue profile concentrated in J3245 and Mohs procedures represents both an opportunity and a concentration risk: payers and network managers should note the reliance on biologic injection revenue and procedural oncology services when evaluating reimbursement rates, prior authorization policies, or inclusion in value-based arrangements.

    Medicare: Total Revenue Breakdown by CPT/HCPCS Code

    Medicare revenue breakdown by CPT/HCPCS procedure code.

    View: Bar Chart1 / 2

    Medicare: Complete Services Breakdown

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

    30 rows

    CPT/HCPCS CodeDescriptionClaimsAvg PaidRevenue
    J3245Injection, tildrakizumab, 1 mg4,700$110$493.6K
    17311Mohs surgery is a multi–staged procedure that is performed to excise a malignant lesion layer by layer, along with histo–pathological assessment. The assessment is performed to ensure that the…320$440$137.8K
    17312Mohs surgery is a multi–staged method of excising a malignant lesion layer by layer, along with histo–pathological assessment, to ensure negative malignancy of the margins.240$300$69.8K
    88305The physician, typically a pathologist, performs a level IV examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally…820$50$38.4K
    99213The 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…580$60$32.6K
    11102The provider biopsies a single skin lesion using a tangential (side–ways) approach; he shaves off the lesion or scoops it out with a knife or curette.320$60$18.7K
    17000The provider destroys a premalignant lesion using techniques such as chemosurgery, cryosurgery, electrosurgery, or others. This code reports the destruction of the first or only lesion.520$30$16.7K
    17110The provider destroys benign lesions using techniques such as chemosurgery, cryosurgery, electrosurgery, or others. This code reports the destruction of one to 14 lesions other than skin tags or…220$70$15.4K
    12052This CPT® code is used for the intermediate repair of wounds to the face, ears, eyelids, nose, lips and/or mucous membranes that are 2.6 to 5.0 cm in size.100$120$12.2K
    17313Mohs surgery is a multi–staged method of excising a malignant lesion layer by layer, along with histo–pathological assessment, to ensure negative malignancy of the margins.30$440$11.5K

    Showing 1–10 of 30

    Medicare: Competitive Analysis & Benchmarks

    How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 30 CPT/HCPCS codes.

    View: State1 / 2

    Full comparison — all codes billed, vs. state median

    30 rows

    CPT/HCPCS CodeRankProvider CountMedian ClaimsAvg PaidAverage Revenue
    J32454104,900$110$616.7K
    173111930450$410$171.3K
    17312830190$300$68.9K
    17313243070$430$36.9K
    8830567180590$30$33.2K
    15260212030$710$24.7K
    13132364080$200$20K
    992143,7797,230110$70$14.1K
    1110225230120$60$9.6K
    1700043270210$30$8.9K

    Showing 1–10 of 30

    Related Providers

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

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    Kentucky Medical Services Foundation, IncKYInternal Medicine Physician$0$110.4M
    Columbus Radiology CorpOHDiagnostic Radiology Physician$0$49.9M
    Kentucky Medical Services FoundationKYNurse Practitioner$0$12.5M
    Ryan HallARHematology & Oncology Physician$4.6M$0
    Kyle ThompsonIDRetina Specialist (Ophthalmology) Physician$4.5M$0
    Modern Dermatology Of Kentucky LLCKYDermatology Physician$0$3.7M
    Matthew ColeTNOphthalmology Physician$3.3M$0
    North Fork Valley Community Health Board, Inc.KYFamily Medicine Physician$0$3.2M
    Kentucky Medical Services FoundationKYClinical Pathology/Laboratory Medicine Physician$0$3M
    Gregory LeeGAOphthalmology Physician$2.9M$6.3K

    Nearby Providers

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

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    Saint Joseph Health System, IncKYGeneral Acute Care Hospital$0$85.5M
    Kentuckyone Health Medical Group, Inc.KYFamily Medicine Physician$0$38.9M
    Maxim Healthcare Services Inc.KYHome Health Agency$0$20.5M
    Hospice Of The Bluegrass, IncKYCommunity Based Hospice Care Agency$0$17.9M
    Columbus Medical Services, LLCKYCase Management Agency$0$12.1M
    Hospice Of The Bluegrass, IncKYCommunity Based Hospice Care Agency$0$9.3M
    Horn And Associates In Rehabilitation PLLCKYRehabilitation Practitioner$0$8.3M
    New Lexington Clinic, PscKYMulti-Specialty Clinic/Center$0$8.2M
    Serenity KeepersKYAdult Mental Health Clinic/Center$0$7.9M
    Lexington Surgery Center LtdKYAmbulatory Surgical Clinic/Center$1.3M$5.4M

    Frequently Asked Questions

    References

    1. 1.Medicare Physician & Other Practitioner by Provider and Service. CMS.gov.Provider-level Medicare Part B utilization and payment data.
    2. 2.NPPES NPI Registry. CMS.gov.National Provider Identifier registry used for provider enumeration and taxonomy metadata.

    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

    Medicare Revenue by CPT/HCPCS Code
    Claims Volume vs. Kentucky Distribution
    James Wharton — 2 of 25 codes billed far more than typical (above p95)
    p5–p95 (all providers)p25–p75MedianThis providerOutlier
    Rank Distribution — Kentucky