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NPI 1407887938 · Chicago, IL · Gastroenterology Physician
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Richard Bone is a gastroenterology physician provider located in Chicago, Illinois. This profile covers 123 Medicare and 305 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 | Richard Bone |
| Address | 9831 S Western Ave |
| City | Chicago |
| State | IL |
| ZIP | 60643 |
| Taxonomy | Gastroenterology Physician |
| NPI Enumerated | July 5, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $28.2M |
| Medicare | $1.8M |
This provider’s billing is heavily Medicaid‑weighted: lifetime Medicaid revenue is $28.2M compared with $1.8M in Medicare, indicating that Medicaid is the primary payer driving scale for this entity rather than Medicare. Analysts should treat this as a Medicaid‑centered operation when modeling revenue risk or network impact.
The NPI was enumerated on 2006-07-05 (~20 years ago), showing long tenure in the Medicare/Medicaid systems; the multi‑decade presence is consistent with an established billing footprint and sustained claim volume.
The code mix is dominated by laboratory, testing, and vaccine activity rather than high‑acuity procedural gastroenterology: Medicare top codes include 91322 (SARS–CoV–2 vaccine), 36415 (venipuncture), and 80053 (CMP), while Medicaid top codes include U0003 (SARS–CoV‑2 NAAT), 87389 (HIV screening), and 84443 (TSH). This pattern—high volumes of specimen collection (e.g., 36415: 23.6K claims on Medicare) and high volumes of NAAT and screening tests on Medicaid (e.g., U0003: 54K claims, $4M revenue)—strongly suggests the provider functions operationally as a high‑volume testing and specimen‑collection site or as a billing hub for laboratory testing.
Revenue concentration is high at the code level for both payers: the top 3 Medicare codes account for 41.4% of the provider’s total Medicare revenue (notably including 91322 at $340.6K, 20.8% of Medicare revenue), and the top 3 Medicaid codes account for 36.5% of total Medicaid revenue (driven by U0003 at $4M, 20.0% of Medicaid revenue). These concentrations mean shifts in reimbursement or utilization for a small set of codes could materially affect overall revenue.
On competitive standing, the provider ranks at or near the top for many high‑volume codes: Medicare 91322 ranks #20 of 29357 providers nationally (100th percentile; notably above typical national volume) and Medicare 36415 is #114 of 86467 (100th percentile; notably above typical national volume). At the state level, several Medicaid codes show very strong positions (e.g., 84443 ranks #4 of 534 in‑state at the 99th percentile, and U0003 ranks #12 of 350 in‑state at the 97th percentile), indicating this provider is a major in‑state participant for infectious disease testing and routine lab panels.
Multiple codes are flagged as statistical outliers in the supplied descriptors and merit attention: Medicaid 87481 is described as an “extreme outlier, far above typical state volume” (rank #2 of 58), Medicaid 0001A and 0002A are both labeled “extreme outlier, far above typical state volume” with #2 statewide ranks, and Medicare 0124A is labeled an “extreme outlier, far above typical national volume.” These flagged outliers indicate a pattern of unusually high volume for specific services relative to peers and should be considered during utilization reviews.
Operational detail supports a high throughput, low‑unit‑revenue model: large claim counts with low average paid/claim appear across many lab panels and common tests (examples on Medicare include 36415 with 23.6K claims at $8 avg paid/claim and 80053 with 14.9K claims at $10 avg paid/claim). For payers, this suggests overall revenue is generated by scale rather than high per‑service reimbursement, so cost exposure is concentrated in volume rather than unit price.
For contracting and network strategy, the combination of Medicaid dominance, concentrated revenue in a small set of codes (top‑3 shares of 41.4% Medicare and 36.5% Medicaid), and high percentile ranks imply that targeted negotiations or utilization management focused on a handful of lab and infectious‑disease codes (e.g., U0003, 87389, 91322) will address a disproportionate share of spend. Given the provider’s state‑level prominence on several tests and vaccines (including codes labeled “extreme outlier”), payers should prioritize audit and rate discussions around those specific high‑volume codes when assessing network impact and cost containment opportunities.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
123 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 91322 | This code represents a SARS–CoV–2 vaccine product administered by intramuscular injection to reduce the patient’s risk of contracting COVID–19. The dosage is 50 mcg/0.5 mL. | 2,450 | $140 | $340.6K |
| 36415 | In this procedure, the provider inserts a needle into a vein to collect a blood sample. | 23,620 | $10 | $188.9K |
| 80053 | The lab analyst performs a comprehensive metabolic panel, or CMP test in which he measures the blood level of 14 chemicals the code descriptor lists for the panel. | 14,890 | $10 | $148.9K |
| 80061 | The lab analyst performs a lipid panel test in which he measures the blood level of cholesterol and fats called triglycerides in the blood. | 10,890 | $10 | $141.5K |
| 84443 | The lab analyst performs a test to measure the amount of thyroid–stimulating hormone (TSH), a hormone produced in the pituitary gland that helps regulate thyroid function. The typical specimen is the… | 6,750 | $20 | $107.9K |
| 90480 | The provider administers the first or only component of a SARS–CoV–2 (COVID–19) vaccine by intramuscular injection to reduce the patient's risk of contracting COVID–19. | 2,450 | $40 | $102.7K |
| 85025 | A complete blood count (better known as a CBC) is a blood test request by a doctor that provides detailed information about various types of cells in a patient's blood. Usually a pathologist or a… | 14,410 | $10 | $100.8K |
| 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… | 3,130 | $30 | $87.5K |
| 82306 | The lab analyst measures the vitamin D level, typically on a serum specimen. This analyte, commonly known as vitamin D, is not really a vitamin, but is an important steroid hormone that is produced… | 2,400 | $30 | $67.2K |
| 83036 | Sugar in the bloodstream can get attached to the hemoglobin in red blood cells. Once the sugar is attached, it stays there for the lifetime of the red blood cell (around 120 days or over 3 months).… | 6,770 | $10 | $60.9K |
Showing 1–10 of 123
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 123 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
123 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| U0003 | 82 | 100 | 230 | $70 | $249.1K |
| 81513 | 2 | 10 | 80 | $140 | $118.9K |
| U0005 | 85 | 100 | 270 | $20 | $86.3K |
| 87481 | 24 | 60 | 120 | $30 | $47.3K |
| 88305 | 30 | 580 | 610 | $30 | $38.2K |
| 87088 | 19 | 30 | 140 | $10 | $31.9K |
| 80197 | 4 | 10 | 160 | $10 | $29.6K |
| 86480 | 14 | 20 | 40 | $60 | $23.1K |
| 87186 | 20 | 40 | 70 | $10 | $21.4K |
| 91322 | 1 | 850 | 110 | $140 | $20.6K |
Showing 1–10 of 123
Medicaid revenue breakdown by year and by CPT/HCPCS procedure code, including monthly billing trends and the top codes driving revenue.
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Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.
305 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| U0003 | Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high… | 53,970 | $80 | $4M |
| 87389 | The lab analyst performs a test to screen for human immunodeficiency virus, called HIV. The test screens for antigens of the HIV 1 virus and antibodies to the HIV 1 and HIV 2 viruses using an… | 24,290 | $80 | $2M |
| 84443 | The lab analyst performs a test to measure the amount of thyroid–stimulating hormone (TSH), a hormone produced in the pituitary gland that helps regulate thyroid function. The typical specimen is the… | 84,590 | $20 | $1.4M |
| 80053 | The lab analyst performs a comprehensive metabolic panel, or CMP test in which he measures the blood level of 14 chemicals the code descriptor lists for the panel. | 133,490 | $10 | $1.3M |
| 87491 | The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique. | 26,630 | $50 | $1.2M |
| 87591 | The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique. | 26,190 | $50 | $1.2M |
| 87481 | The lab analyst performs a test for Candida species using amplified nucleic acid probe technique. | 9,580 | $90 | $814.6K |
| 80061 | The lab analyst performs a lipid panel test in which he measures the blood level of cholesterol and fats called triglycerides in the blood. | 98,190 | $10 | $785.5K |
| 87661 | The lab analyst performs a test for Trichomonas vaginalis using nucleic acid amplified probe technique. | 24,520 | $30 | $686.5K |
| 85025 | A complete blood count (better known as a CBC) is a blood test request by a doctor that provides detailed information about various types of cells in a patient's blood. Usually a pathologist or a… | 133,400 | $10 | $667K |
Showing 1–10 of 305
How this provider's Medicaid billing volume and revenue compare to other Illinois providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Illinois median
305 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 81513 | The lab analyst performs the technical lab test on a vaginal fluid specimen for quantitative real–time amplification of RNA markers for three bacterial species listed in the code descriptor, and… | 3 | 10 | 210 | $70 | $1.4M |
| G0480 | Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but… | 60 | 70 | 570 | $50 | $565.6K |
| U0003 | Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high… | 12 | 350 | 400 | $70 | $514.7K |
| 87799 | The lab analyst performs a test to quantify infection with an infectious agent, not otherwise specified in another code, using a nucleic acid probe technique. Use this code if you know the laboratory… | 21 | 20 | 500 | $30 | $399.9K |
| 87636 | The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, and influenza B using a multiplex amplified nucleic… | 78 | 130 | 70 | $120 | $240.2K |
| 80307 | The lab analyst performs presumptive drug test(s) via instrumented chemistry analyzers to screen for any number of drug classes on a single date. | 68 | 280 | 1,120 | $30 | $218.9K |
| U0005 | Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, cdc or non-cdc,… | 20 | 210 | 680 | $20 | $206.4K |
| 87633 | The lab analyst performs a test to identify a respiratory virus using amplified nucleic acid probe technique. He may also use a multiplex reverse transcription technique. The provider does this for… | 63 | 170 | 150 | $200 | $190.9K |
| 87389 | The lab analyst performs a test to screen for human immunodeficiency virus, called HIV. The test screens for antigens of the HIV 1 virus and antibodies to the HIV 1 and HIV 2 viruses using an… | 5 | 250 | 450 | $40 | $185.7K |
| 87801 | The lab analyst performs a test for multiple infectious agents using amplified nucleic acid probe technique. | 3 | 110 | 150 | $40 | $184.1K |
Showing 1–10 of 305
Other providers in the same ZIP code as Richard Bone, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Activstyle LLC | IL | Durable Medical Equipment & Medical Supplies | $0 | $11.6M |
| Easter Seals Metropolitan Chicago, Inc. | IL | Case Management Agency | $0 | $6M |
| James Davenport | IL | Clinical Psychologist | $98.9K | $4.6M |
| Addus Healthcare Inc | IL | In Home Supportive Care Agency | $0 | $3M |
| Vascular Access Centers Of Illinois At Morgan Park, LLC | IL | Ambulatory Surgical Clinic/Center | $1.1M | $0 |
| Helen Tcheng | IL | Pediatrics Physician | $36.1K | $477.2K |
| Charles Preyar | IL | Clinical Social Worker | $21.4K | $365.8K |
| Hamid Nazeer | IL | Vascular & Interventional Radiology Physician | $140.1K | $108K |
| Kristin Walsh | IL | Physical Therapist | $92.9K | $0 |
| Prentiss Taylor | IL | Internal Medicine Physician | $19.2K | $36.3K |
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