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 West Virginia for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to West Virginia 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. West Virginia (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.

Alison Poole (NPI 1407026172)

Field	Value
Entity Type	Individual
Organization	Alison Poole
Address	100 Tracy Way
City	Charleston
State	WV
ZIP	25311
Taxonomy	Physician Assistant
NPI Enumerated	March 10, 2008

Payer Source	Total Paid
Medicare	$584.9K
Medicaid	$0

Key Findings

This provider has reported Total Medicare revenue of $584.9K and Total Medicaid revenue of none (no Medicaid billing on file), making their billing footprint effectively single-payer and heavily reliant on Medicare receipts. The absence of any Medicaid claims on file indicates limited or no participation in state Medicaid billing under this NPI.

Revenue is highly concentrated: the precomputed top 3 Medicare codes account for 95.2% of this provider's total Medicare revenue, with Q4197 generating $323.1K (55.2%) and Q4194 generating $216.5K (37.0%). These two add-on skin-substitute codes alone represent the vast majority of billed Medicare dollars, leaving routine E/M and other procedure codes as marginal revenue contributors.

The code mix (Q4197 and Q4194 as the largest revenue drivers, plus 15275 and 15271 also present) indicates a practice focused on skin-substitute applications and wound coverage—services commonly associated with outpatient wound care or procedural dermatologic/podiatric management. The presence of debridement and nail-debridement codes (e.g., 15275, 15271, 11721, 11720) alongside procedure-level claims supports an operation that provides device-based wound therapies and related minor surgical procedures rather than primarily office-based chronic care.

Competitive standing by code is mixed: Q4197 ranks #14 of 82 (84th percentile) and is described as typical, unremarkable volume for this code, suggesting the provider is a relatively prominent user of Puraply xt among the limited national cohort billing that code. Q4194 ranks #51 of 69 (26th percentile; typical, unremarkable volume for this code), while the office visit code 99213 ranks #51752 of 457151 (89th percentile; typical, unremarkable volume for this code), indicating above-average E/M activity relative to the large national universe but otherwise modest positioning on the specific skin-substitute codes.

Claim and payment detail reinforce the device-driven revenue model: Q4197 shows 2.5K claims at $128 avg paid/claim for $323.1K revenue, while Q4194 shows 268 claims at $808 avg paid/claim for $216.5K revenue. The high avg paid/claim for Q4194 compared with Q4197 and the substantive claim volume for Q4197 together explain how two add-on product codes generate the lion's share of revenue despite differing unit prices and frequencies.

Routine office visits and minor procedures contribute only a small share of revenue: 99213 accounts for $16.9K (2.9%) on 332 claims, 15275 accounts for $12.2K (2.1%) on 122 claims, and other procedure codes (e.g., 11721, 20605, 11056) each represent well under 1% of Medicare dollars. Several of these smaller codes are ranked low in national cohorts (for example 11042 and other low-volume codes) and are labeled as typical, unremarkable volume for those codes, consistent with an operation that relies on a narrow set of high-dollar product codes rather than broad procedural diversity.

The provider’s NPI was enumerated on 2008-03-10 (~18 years ago), indicating an established billing history; combined with the concentrated Medicare-only revenue profile and dominant use of skin-substitute add-on codes, this suggests a stable, niche clinical practice model that is not leveraging Medicaid as part of its payer mix. Analysts should treat this entity as a Medicare-centric, wound/product-focused practitioner when evaluating competitive placement or contracting opportunities.

Medicare: Complete Services Breakdown

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

13 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
Q4197	Puraply xt, per square centimeter (add-on, list separately in addition to primary procedure)	2,520	$130	$323.1K
Q4194	Novachor, per square centimeter (add-on, list separately in addition to primary procedure)	270	$810	$216.5K
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…	330	$50	$16.9K
15275	The provider uses a skin substitute, such as an allograft or xenograft, to cover wounds on the face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, up to…	120	$100	$12.2K
11721	The provider surgically debrides (debulks or removes) 6 or more abnormal, diseased, or infected nails.	190	$30	$4.6K
15271	The provider uses a skin substitute, such as an allograft or xenograft, to cover wounds on the patient’s trunk, arms, and/or legs up to an area of 100 cm2. This code covers up to the first 25 cm2.	40	$90	$3.9K
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…	50	$60	$3K
20605	In this procedure, the provider inserts a needle through the skin of a patient and into an intermediate joint or bursa and then uses the syringe attachment to the needle to remove fluid or he may…	40	$30	$1.3K
11056	The provider removes 2 to 4 benign hyperkeratotic lesions by using surgical instruments like a scalpel or curette.	20	$50	$1K
11042	The provider uses surgical instruments to remove the dead tissue in skin down to the subcutaneous layer and including the epidermis and dermis, up to the first 20 cm2.	10	$70	$920

Showing 1–10 of 13

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 13 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. West Virginia Distribution

Alison Poole — 0 of 13 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — West Virginia

Full comparison — all codes billed, vs. state median

13 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
Q4197	3	10	4,340	$130	$580.5K
Q4194	3	10	810	$810	$531.5K
15275	3	10	90	$110	$20.3K
15271	3	10	90	$120	$19.1K
11042	56	60	90	$70	$13.6K
11721	42	60	240	$30	$9.6K
99213	303	2,860	80	$50	$7.5K
11720	37	40	190	$20	$6.3K
11056	28	30	80	$50	$5.9K
99203	282	940	30	$60	$2.8K

Showing 1–10 of 13

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
First Care Medical Clinic, PA	NC	Internal Medicine Physician	$0	$15.5M
Bradley Hoffman	WV	Foot & Ankle Surgery Podiatrist	$4.9M	$0
Carrie Frame	WV	Foot & Ankle Surgery Podiatrist	$1.7M	$0
Neurological Associates, Inc.	WV	Neurological Surgery Physician	$0	$795.4K
Katlin Lindsey	WV	Physician Assistant	$309.8K	$0
Benedict Okwara	NC	Internal Medicine Physician	$280.8K	$0
Paul Legg	WV	Orthopaedic Surgery Physician	$132.1K	$0
Jason Castle	WV	Orthopaedic Surgery Physician	$109.8K	$0
Charles Shuff	VA	Orthopaedic Surgery Physician	$102.5K	$0
Shazia Arain	NC	Internal Medicine Physician	$48K	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Charleston Treatment Center, LLC	WV	Methadone Clinic	$234.5K	$16.8M
Associated Radiologists, Inc.	WV	Diagnostic Radiology Physician	$0	$8M
Charleston Treatment Center, LLC.	WV	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$3.1M
West Virginia Health Right, Inc.	WV	Health Service Clinic/Center	$0	$2.7M
Charleston Treatment Center, LLC	WV	Methadone Clinic	$0	$2.6M
Ashley Patnoe	WV	Pediatric Dentistry	$0	$2.2M
Daymark Inc.	WV	Mental Illness Community Based Residential Treatment Facility	$0	$1.5M
Capital City Pediatrics PLLC	WV	Pediatrics Physician	$0	$762.4K
Greenbrier Vision Center Inc	WV	Optometrist	$0	$761.1K
Johnsey Leef	WV	Diagnostic Radiology Physician	$139.1K	$0

Alison Poole — 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