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NPI 1467401182 · Washington, DC · Internal Medicine Physician
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Gilbert Daniel is a internal medicine physician provider located in Washington, District of Columbia. This profile covers 24 Medicare and 5 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 | Gilbert Daniel |
| Address | 650 Pennsylvania Ave Se Ste 330 |
| City | Washington |
| State | DC |
| ZIP | 20003 |
| Taxonomy | Internal Medicine Physician |
| NPI Enumerated | May 9, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $308.7K |
| Medicaid | $43.5K |
Medicare is the primary payer by scale for this provider: total Medicare revenue is $308.7K compared with total Medicaid revenue of $43.5K, indicating the practice derives the bulk of its public-payer income from Medicare rather than Medicaid. The Medicare revenue base is concentrated in a few E/M and facility codes, while Medicaid receipts are much smaller in absolute terms.
Revenue concentration is high on both payers’ top codes. On Medicare, the precomputed top-3 codes (99309, 99214, 99233) account for 63.2% of total Medicare revenue, led by 99309 at $93.9K (1K claims, $93 avg paid/claim; 30.4% of Medicare revenue). On Medicaid, the precomputed top-3 codes (99214, 99215, 99232) account for 94.7% of total Medicaid revenue, driven by 99214 at $25.4K (686 claims, $37 avg paid/claim; 58.1% of Medicaid revenue).
The code mix indicates a hybrid primary-care and facility-facing practice. High Medicare revenue from 99309 (nursing facility subsequent care) and strong volumes of 99233 and 99232 (hospital inpatient subsequent care) alongside office E/M codes 99214/99213 suggest the clinician provides longitudinal primary care plus inpatient and nursing facility coverage. The presence of transition-of-care codes 99495/99496 and remote monitoring codes 99457/99490/99454 further supports a practice model that manages post-acute transitions and employs RPM services.
Competitive standing on Medicare shows notable national percentile placement but is characterized in the source as routine volume for these codes. The top Medicare codes rank in the ~89th–93th percentiles nationally (99309: 89th percentile, described as "typical, unremarkable volume for this code"; 99214: 92th percentile, "typical, unremarkable volume for this code"; 99233: 93th percentile, "typical, unremarkable volume for this code"), indicating above-average national activity without labeling the provider as an outlier or a dominant national operator.
State-level competitiveness on Medicaid is modest. Medicaid top codes rank around the middle to lower half of in-state peers (99214: 49th percentile, described as "typical, unremarkable volume for this code"; 99215: 40th percentile, "typical, unremarkable volume for this code"; 99232: 18th percentile, "typical, unremarkable volume for this code"), suggesting a modest in-state presence for fee-for-service Medicaid compared with other DC providers.
Practice tenure is long and likely contributes to the mixed-site service pattern: the NPI was enumerated on 2006-05-09 (~20 years ago), indicating an established clinician who has had time to develop nursing facility, inpatient, and outpatient referral relationships. That longevity is consistent with the mix of facility-based E/M codes and ongoing chronic care management services recorded.
Despite a diversified set of billable services, there are no extreme statistical outliers in the Medicare code mix: many sizable codes beyond the top three (for example, G0439, 99497, 99490) are described in the source as "typical, unremarkable volume for this code," and several RPM and care-transition codes appear at modest revenue slices (e.g., 99457 at $4.4K, 99490 at $6.3K). This pattern suggests steady, multi-channel billing rather than abrupt utilization spikes in a single unusual code.
Operational risk for payers and contracting teams should focus on the high concentration of revenue in a few codes and settings: with 63.2% of Medicare revenue coming from three codes and 94.7% of Medicaid revenue from three codes, payers should prioritize audit, network negotiations, and utilization management around nursing-facility care (99309), established-office visits (99214/99215), and hospital follow-up visits (99233/99232) to understand service mix drivers and capacity constraints.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
24 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 99309 | The provider sees a patient for a subsequent nursing facility care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or the provider… | 1,010 | $90 | $93.9K |
| 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… | 560 | $90 | $52.5K |
| 99233 | The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the… | 470 | $100 | $48.7K |
| 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… | 300 | $80 | $22.9K |
| 99232 | The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or… | 320 | $70 | $22.1K |
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 90 | $150 | $13.4K |
| 99223 | The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the… | 70 | $150 | $10.6K |
| 99497 | The provider discusses and shares planning with a patient, his family, or an individual representing the patient, regarding the future health care needs of the patient. Use this code for the first 30… | 120 | $60 | $6.8K |
| 99490 | The clinical staff provides services directed by the provider to support and coordinate a patient’s care across multiple disciplines. The patient has two or more chronic conditions that place the… | 110 | $60 | $6.3K |
| G0438 | Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit | 30 | $190 | $5.8K |
Showing 1–10 of 24
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 24 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
24 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| 99309 | 13 | 60 | 270 | $80 | $45.5K |
| 99233 | 69 | 650 | 90 | $100 | $17.6K |
| 99214 | 74 | 1,400 | 90 | $100 | $15.3K |
| 99215 | 580 | 660 | 50 | $130 | $12.3K |
| G0439 | 87 | 250 | 60 | $140 | $12.2K |
| 99457 | 11 | 20 | 100 | $40 | $11.2K |
| 99490 | 9 | 20 | 100 | $50 | $10.8K |
| 99232 | 60 | 640 | 70 | $70 | $10K |
| 99454 | 15 | 20 | 180 | $50 | $9.7K |
| 99306 | 33 | 40 | 30 | $140 | $9.7K |
Showing 1–10 of 24
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.
5 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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… | 690 | $40 | $25.4K |
| 99215 | The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the… | 160 | $70 | $10.5K |
| 99232 | The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or… | 50 | $120 | $5.5K |
| 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… | 90 | $20 | $2.1K |
| 90756 | This code represents a flu vaccine product that protects against four strains of influenza. It is derived from cell cultures, contains no antibiotics, and is administered as a 0.5 mL injection into… | 20 | $10 | $160 |
How this provider's Medicaid billing volume and revenue compare to other District of Columbia providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. District of Columbia median
5 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 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… | 155 | 310 | 750 | $70 | $321.6K |
| 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… | 248 | 320 | 620 | $50 | $313.6K |
| 99215 | The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the… | 72 | 120 | 300 | $120 | $287.3K |
| 99232 | The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or… | 55 | 70 | 320 | $40 | $259.9K |
| 90756 | This code represents a flu vaccine product that protects against four strains of influenza. It is derived from cell cultures, contains no antibiotics, and is administered as a 0.5 mL injection into… | 15 | 20 | 60 | $10 | $810 |
Other providers in the same ZIP code as Gilbert Daniel, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Universal Home Healthcare Inc. | DC | Home Health Agency | $0 | $69.8M |
| Community Connections Inc | DC | Mental Health Clinic/Center (Including Community Mental Health Center) | $0 | $69.4M |
| Iya Homes And Community Solutions, LLC | DC | Community/Behavioral Health Agency | $0 | $11.3M |
| Psi Services 111 Inc. | DC | Developmentally Disabled Services Day Training Agency | $0 | $5.4M |
| Husband Therapeutics | DC | Home Health Agency | $0 | $2.7M |
| Juanita Bryant | DC | Retina Specialist (Ophthalmology) Physician | $1.9M | $239.4K |
| Grubbs Pharmacy Of Dc Inc | DC | Community/Retail Pharmacy | $106.5K | $935.3K |
| Alfred Burris | DC | Cardiovascular Disease Physician | $469.2K | $356.3K |
| Christopher Burris | DC | Ophthalmology Physician | $127.7K | $642.6K |
| Phase Ll Academy | DC | Specialist | $0 | $751.8K |
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