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

Why is the Medicaid comparison limited to Indiana 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. Indiana (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.

Douglas Smith (NPI 1407832025)

Field	Value
Entity Type	Individual
Organization	Douglas Smith
Address	8902 N Meridian St
City	Indianapolis
State	IN
ZIP	46260
Taxonomy	Rheumatology Physician
NPI Enumerated	December 15, 2005

Payer Source	Total Paid
Medicare	$1.5M
Medicaid	$0

Key Findings

DOUGLAS SMITH is essentially a Medicare-focused rheumatology practice with $1.5M in lifetime Medicare revenue and no Medicaid billing on file, making his payer mix effectively single-payer (Medicare) for the dataset provided. This concentration implies his operational footprint and revenue streams are driven almost entirely by Medicare patients and services.

Revenue is highly concentrated in a small set of biologic drug codes: the precomputed top 3 Medicare codes account for 66.5% of total Medicare revenue, with J0129 alone representing $632K (42.4% of Medicare revenue). This indicates the practice’s business model centers on in-office or clinician-supervised infusions/injections of high-cost specialty rheumatologic biologics.

The top revenue driver, J0129 (abatacept), is a large share of the book ($632K) and ranks #151 of 1221 providers nationally (88th percentile), indicating this provider has a materially above-average but not dominant national presence for abatacept administration. The code-level rank and percentile suggest a significant, established infusion volume relative to peers rather than an outlier extreme.

Other biologic infusion codes J3262 (tocilizumab) and J1745 (infliximab) together account for a further sizable portion of revenue ($201.4K and $158.6K respectively) and, combined with J0129, form the concentrated top-3 that drive two-thirds of Medicare revenue. J3262 sits around the median national volume (52th percentile, rank #300 of 618) while J1745 is stronger (81th percentile, rank #261 of 1352), portraying a mixed competitive profile across different biologics.

Beyond drug administration, procedural and E/M activity shows meaningful support of infusion services: 96413 (chemotherapy/infusion administration) and 96415 (add-on infusion hours) are both flagged as notably above typical national volume (94th and 97th percentiles respectively), with 96413 contributing $54.5K. High relative ranks on infusion administration codes imply substantial time-based infusion throughput and a practice workflow oriented to multi-hour infusion sessions.

Office evaluation and management coding is present but secondary to infusion/biologic revenue: 99214 generated $73.9K and ranks in the 97th percentile nationally (notably above typical), indicating robust E/M encounters for established patients that likely accompany infusion care. Lower volumes on other E/M codes (99213, 99204, 99205) suggest the practice focuses on follow-up/infusion management visits rather than high volumes of new patient consultations.

Clinical lab testing and rheumatology-specific diagnostics are billed at typical volumes for specialists (examples include 86200 CCP testing, 86140 CRP, 85025 CBC, and 80053 CMP), each contributing smaller revenue shares and ranking within typical percentiles. These lab services appear to support biologic therapy monitoring rather than driving revenue.

Tenure data shows the NPI was enumerated on 2005-12-15 (~21 years ago), indicating a long-established provider presence in Indianapolis. That tenure, combined with above-typical infusion and E/M ranks, supports an interpretation of a stable, mature infusion-focused rheumatology practice rather than a new entrant.

Medicare: Complete Services Breakdown

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

50 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J0129	Injection, abatacept, 10 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)	19,150	$30	$632K
J3262	Injection, tocilizumab, 1 mg	40,280	$10	$201.4K
J1745	Injection, infliximab, excludes biosimilar, 10 mg	6,100	$30	$158.6K
J0717	Injection, certolizumab pegol, 1 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)	28,800	$1	$115.2K
J1602	Injection, golimumab, 1 mg, for intravenous use	9,500	$10	$104.5K
J0897	Injection, denosumab, 1 mg	4,680	$20	$84.2K
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…	890	$80	$73.9K
96413	Chemotherapy is a therapeutic procedure used for the treatment of cancer via the use of chemical agents. These chemical agents (drugs) work on the cancerous cells of the body to destroy them. These…	570	$100	$54.5K
96401	The provider administers nonhormonal, antineoplastic chemotherapy drugs subcutaneously or intramuscularly to the patient.	290	$50	$15.2K
96415	In this add on procedure, the provider continues administration of a chemotherapy drug into a vein using an infusion technique. He uses this code to report each additional hour of infusion beyond the…	360	$20	$7.6K

Showing 1–10 of 50

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 50 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Indiana Distribution

Douglas Smith — 4 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Indiana

Full comparison — all codes billed, vs. state median

50 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0129	5	30	10,630	$30	$391.1K
J3262	8	10	46,210	$1	$263.4K
J0717	14	20	42,400	$1	$198.8K
J1602	9	20	9,500	$10	$167.1K
J1745	4	20	3,990	$30	$119.4K
J0897	56	220	2,730	$20	$74.9K
96413	6	120	140	$90	$19.1K
86235	4	10	150	$20	$15.9K
99214	219	10,540	110	$80	$15.5K
82306	94	110	50	$30	$11.7K

Showing 1–10 of 50

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Christopher Wu	IN	Rheumatology Physician	$1.3M	$0
Tracy Brenner	PA	Rheumatology Physician	$1.2M	$0
Randall Reed	IN	Rheumatology Physician	$1.2M	$0
Kathleen Thomas	IN	Rheumatology Physician	$933.8K	$0
Jeremy Schue	IN	Rheumatology Physician	$548K	$0
Sarah Thomas	IN	Rheumatology Physician	$116.8K	$0
Laurie Dawley	IN	Rheumatology Physician	$48.7K	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
St. Vincent Hospital & Health Care Center, Inc.	IN	General Acute Care Hospital	$0	$58.9M
Cep America LLC	IN	Emergency Medicine Physician	$0	$28.6M
St Vincent Pediatric Subspecialties	IN	Pediatrics Physician	$0	$20.8M
St Vincent Physician Services Hospital And Health Care Center	IN	Family Medicine Physician	$0	$14M
Imaging Associates Of Indiana, PC	IN	Diagnostic Radiology Physician	$0	$9.7M
Rebecca Bolon	IN	Orthodontics and Dentofacial Orthopedics Dentistry	$0	$9M
Shadeland Anesthesia & Pain Associates Inc.	IN	Interventional Pain Medicine Physician	$0	$7.1M
Singh Bullard Pediatric Dentistry, P.C.	IN	Pediatric Dentistry	$0	$7M
Alta Healthcare	IN	Home Health Agency	$0	$6.6M
Indiana Hemophilia & Thrombosis Center, Inc.	IN	Hematology & Oncology Physician	$0	$5.6M

Douglas Smith — Billing Profile & Reimbursement Data

Sign up for Douglas Smith — Billing Profile & Reimbursement Data policy alerts

Douglas Smith — Billing Profile & Reimbursement Data

Sign up for Douglas Smith — Billing Profile & Reimbursement Data policy alerts

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