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NPI 1396747846 · Paducah, KY · Dermatology Physician
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Halden Ford is a dermatology physician provider located in Paducah, Kentucky. This profile covers 28 Medicare and 2 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 | Halden Ford |
| Address | 3101 Parisa Dr |
| City | Paducah |
| State | KY |
| ZIP | 42003 |
| Taxonomy | Dermatology Physician |
| NPI Enumerated | August 15, 2005 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $1.3M |
| Medicaid | $4.5K |
This provider’s business is overwhelmingly Medicare-funded: reported Medicare revenue is $1.3M versus Medicaid revenue of $4.5K, so Medicare is the dominant payer and Medicaid represents a negligible share of lifetime revenue. The magnitude gap indicates the practice operates primarily in the Medicare market rather than relying on Medicaid volumes.
Revenue concentration on Medicare is very high: the precomputed top 3 Medicare codes by revenue account for 87.4% of this provider's total Medicare revenue. Those top three Medicare codes are J3245 ($1M, 78.0%), 99213 ($83.3K, 6.4%), and 17000 ($40.2K, 3.1%), which shows that a single drug code (J3245) plus a small number of E&M and lesion-destruction procedures drive most Medicare receipts.
The practice’s service mix points to a hybrid medical–procedural dermatology operation: J3245 (tildrakizumab) is billed at very high volume (9.3K claims, $110 avg paid/claim, $1M revenue) consistent with routine in-office biologic injections for conditions such as psoriasis, while high counts of E&M codes (99213, 99212, 99214) and procedure codes for biopsies and lesion destruction (11102, 11104, 17000/17003) indicate concurrent management of medical dermatology and procedural skin care. Together these patterns suggest the clinic combines frequent injection administration with substantial biopsy and lesion-treatment throughput.
Competitive standing varies by service: the provider ranks #17 of 225 for J3245 nationally (92th percentile; notably above typical national volume), indicating a nationally significant role among tildrakizumab administrators. At the same time, 99213 on Medicare is an extreme outlier (rank #2474 of 457151, 99th percentile) and 11104 is also an extreme outlier (rank #33 of 6872, 100th percentile), which underscores atypically high office-visit and punch-biopsy volumes compared with peers for those specific codes.
Medicaid billing is both small in scale and concentrated: the precomputed top 3 Medicaid codes account for 100.0% of Medicaid revenue, with 99213 responsible for $3.4K (74.9%) and 88305 for $1.2K (25.1%). Both Medicaid ranks are low in-state (99213 at the 23th percentile and 88305 at the 11th percentile), indicating the provider is not a major Medicaid participant and that Medicaid contributes little to competitive position within Kentucky.
The mix of extreme/high percentiles on specific Medicare codes combined with minimal Medicaid receipts implies concentrated operational dependencies: the practice likely maintains infrastructure for frequent biologic administration (inventory, injection workflows) and high outpatient visit throughput, while exposure to changes in reimbursement or utilization for J3245 and high-volume E&M codes could materially affect revenue. This concentration also means payer shifts toward Medicaid or changes in drug coverage would have limited immediate offset from existing Medicaid billing.
Tenure is long-standing: the NPI was enumerated on 2005-08-15 (~21 years ago), indicating an established presence in the market which may support steady referral and patient panels that align with the high injection and E&M volumes observed. Longevity combined with the concentrated code mix suggests an entrenched clinical model focused on biologic therapy delivery alongside routine dermatologic procedures.
Operationally, several codes flagged as “notably above typical” or “extreme outlier” signal unusually high volumes for specific services rather than broad-based dominance across many code families. That pattern—national prominence for J3245 and very high E&M and punch-biopsy volumes—portrays a specialist practice that is a major provider for a narrow set of dermatology services on Medicare, while maintaining only a modest Medicaid footprint.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
28 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J3245 | Injection, tildrakizumab, 1 mg | 9,300 | $110 | $1M |
| 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… | 1,440 | $60 | $83.3K |
| 17000 | The 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. | 1,120 | $40 | $40.2K |
| 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… | 240 | $90 | $20.1K |
| 11102 | The 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. | 310 | $60 | $20K |
| 11104 | The provider biopsies a skin lesion using a punch technique with a sharp hollow instrument; punch biopsies are commonly performed for deeper circular skin lesions. | 240 | $80 | $19.2K |
| 99212 | The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,… | 490 | $30 | $15.2K |
| 99203 | The provider sees a new 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 provider… | 180 | $70 | $12.9K |
| 88305 | The 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… | 570 | $20 | $12.5K |
| 17003 | In this add–on procedure, the provider destroys a premalignant lesion using techniques such as chemosurgery, cryosurgery, electrosurgery, or others. This code is appropriate for the second through… | 2,360 | $1 | $9.4K |
Showing 1–10 of 28
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 28 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
28 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J3245 | 1 | 10 | 4,900 | $110 | $616.7K |
| 88305 | 92 | 180 | 590 | $30 | $33.2K |
| 99214 | 1,875 | 7,230 | 110 | $70 | $14.1K |
| 11102 | 27 | 230 | 120 | $60 | $9.6K |
| J7308 | 9 | 20 | 30 | $310 | $9.2K |
| 17000 | 5 | 270 | 210 | $30 | $8.9K |
| 17004 | 59 | 120 | 30 | $110 | $8.4K |
| 12032 | 65 | 80 | 30 | $180 | $8.4K |
| 17110 | 106 | 260 | 100 | $60 | $8.4K |
| 99213 | 22 | 7,250 | 80 | $50 | $7.7K |
Showing 1–10 of 28
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.
2 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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… | 130 | $30 | $3.4K |
| 88305 | The 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… | 70 | $20 | $1.2K |
How this provider's Medicaid billing volume and revenue compare to other Kentucky providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Kentucky median
2 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 88305 | The 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… | 113 | 130 | 2,450 | $60 | $382.4K |
| 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… | 2,576 | 3,340 | 1,020 | $30 | $296K |
Other providers in the same ZIP code as Halden Ford, ranked by combined Medicare and Medicaid revenue.
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