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

Why is the Medicaid comparison limited to 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. 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.

David Carleton (NPI 1508073644)

Field	Value
Entity Type	Individual
Organization	David Carleton
Address	7650 E Parham Rd Ste 304
City	Richmond
State	VA
ZIP	23294
Taxonomy	Rheumatology Physician
NPI Enumerated	May 17, 2007

Payer Source	Total Paid
Medicare	$4.3M
Medicaid	$0

Key Findings

This provider is effectively single‑payer in the datasets: total Medicare revenue is $4.3M while there is no Medicaid billing on file, so Medicare dominates all reported public-payer activity for this NPI. The absence of Medicaid claims suggests analyses of payer mix, utilization, or access should focus on Medicare populations and Medicare-contracted arrangements rather than state Medicaid dynamics.

Revenue is highly concentrated in a small set of biologic drug codes: the top three Medicare codes by revenue account for 76.6% of this provider’s total Medicare revenue. The three drivers are J3262 ($2M, 45.3%), J0717 ($1.1M, 23.9%), and J1745 ($333.7K, 7.4%), indicating that a very large share of revenue depends on a few high-cost injectable/infusion products.

Code mix and service-lines point to an infusion-oriented rheumatology practice: the top revenue codes are J3262 (tocilizumab), J0717 (certolizumab pegol), and J1745 (infliximab), all parenteral biologics commonly administered under supervision. High-volume administration/infusion CPTs such as 96413 and 96401 also appear as extreme outliers nationally, which supports the conclusion that the practice provides in‑office infusion services and associated chemotherapy/biologic administration workflows.

The provider is a national outlier on specific biologics and infusion activity: J3262 ranks #1 of 618 providers nationally (100th percentile; extreme outlier) and J0717 ranks #8 of 848 providers nationally (99th percentile; extreme outlier), signaling dominant national‑level volumes for these particular drugs. J1745 also ranks well above peers (#47 of 1352, 97th percentile; notably above typical national volume), so the practice is a major national participant for several infusion biologics rather than a modest local prescriber.

Visit-level activity shows an active follow-up panel consistent with ongoing biologic management: 99214 appears with $130.2K revenue and is described as an extreme outlier (rank #4019 of 479517, 99th percentile), indicating a substantial volume of moderate‑complexity established‑patient visits. Higher‑level new or established visit codes (99215, 99204) are present but at more typical or modest percentiles, which suggests most ambulatory workload is longitudinal management rather than a high volume of very complex new evaluations.

While the top codes dominate, the provider still bills a broader mix of biologics and supportive services: codes such as J9312 (rituximab), J1602 (golimumab IV), and J0897 (denosumab) appear in the top list and are described at typical percentiles, indicating a diversified biologic formulary beyond the two dominant agents. Lab and basic procedure codes (e.g., CMP, CBC, arthrocentesis) are present at low dollar impact, consistent with office‑based rheumatology support services rather than a high-volume diagnostics center.

The concentration in a few administered biologics carries operational and contracting implications: with J3262 and J0717 alone representing the lion’s share of Medicare revenue, inventory management, buy‑and‑bill reimbursement terms, and payer contract language for infused drugs will materially affect practice margins and cash flow. For payers or ACOs evaluating network adequacy or cost drivers, this profile flags a provider whose spend is driven primarily by in‑office biologic administration rather than high volumes of outpatient procedures or ancillary testing.

The provider has established tenure in the Medicare program, with the NPI enumerated on 2007-05-17 (~19 years ago), which supports interpreting current patterns as the output of a well‑established practice rather than a short-lived billing anomaly. Given long tenure plus the documented national outlier ranks on specific infusion codes, this appears to be a sustained, specialty infusion practice model rather than a transient billing pattern.

Medicare: Complete Services Breakdown

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

29 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J3262	Injection, tocilizumab, 1 mg	409,360	$10	$2M
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)	270,800	$1	$1.1M
J1745	Injection, infliximab, excludes biosimilar, 10 mg	12,830	$30	$333.7K
J9312	Injection, rituximab, 10 mg	4,300	$60	$270.9K
J1602	Injection, golimumab, 1 mg, for intravenous use	20,300	$10	$203K
J0897	Injection, denosumab, 1 mg	10,380	$20	$186.8K
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…	1,450	$90	$130.2K
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…	1,040	$100	$105.3K
96401	The provider administers nonhormonal, antineoplastic chemotherapy drugs subcutaneously or intramuscularly to the patient.	1,360	$60	$79.1K
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…	230	$130	$30.2K

Showing 1–10 of 29

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 29 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Virginia Distribution

David Carleton — 6 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Virginia

Full comparison — all codes billed, vs. state median

29 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J3262	1	20	75,870	$1	$383.3K
J0717	1	30	74,500	$1	$361.7K
J9312	2	10	3,950	$60	$259.5K
J1745	5	30	4,540	$30	$200.2K
J1602	6	20	13,430	$10	$176.7K
J0897	33	340	2,820	$20	$89.3K
96413	3	230	250	$100	$28.5K
99214	115	12,890	140	$80	$21K
96401	3	180	110	$60	$11.5K
20611	79	230	60	$70	$10.5K

Showing 1–10 of 29

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Kara Foster-weiss	VA	Family Medicine Physician	$2.2M	$0
Virginia Physicians, Inc.	VA	Clinical Medical Laboratory	$1.9M	$1.9K
Steven Maestrello	VA	Rheumatology Physician	$1.1M	$0
Minh Tran	VA	Internal Medicine Physician	$198.2K	$0
William Morrissette	VA	Family Medicine Physician	$179.6K	$0
Stuart Motley	VA	Internal Medicine Physician	$156.3K	$0
Garrison Bennett	VA	Family Medicine Physician	$153.8K	$0
Yauna Williams	FL	Family Nurse Practitioner	$152.5K	$0
John Barnes	VA	Family Medicine Physician	$137.7K	$0
Helen Adams	VA	Family Medicine Physician	$136.4K	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Behavioral Health Services Of Virginia Corporation	VA	Community/Behavioral Health Agency	$0	$25.1M
Aaa Home Health Care LLC	VA	Home Health Agency	$0	$13.8M
River City Comprehensive Counseling Services, LLC	VA	Community/Behavioral Health Agency	$0	$10.7M
Commonwealth Radiology P C	VA	Diagnostic Radiology Physician	$0	$9.6M
Insight Physicians PC	VA	Psychiatry Physician	$0	$8.4M
River City Comprehensive Counseling Services, LLC	VA	Community/Behavioral Health Agency	$0	$7.4M
Family Focus, LLC	VA	Case Management Agency	$0	$7.3M
Pony-care Transportation, Inc	VA	Non-emergency Medical Transport (VAN)	$0	$6.7M
Michael Strachan	VA	Rheumatology Physician	$2.9M	$0
Tammy Spring	VA	Rheumatology Physician	$1.3M	$0

David Carleton — 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