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

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

Edward Fels (NPI 1508086083)

Field	Value
Entity Type	Individual
Organization	Edward Fels
Address	51 Sewall St
City	Portland
State	ME
ZIP	04102
Taxonomy	Specialist
NPI Enumerated	April 26, 2007

Payer Source	Total Paid
Medicare	$266.6K
Medicaid	$0

Key Findings

This provider’s Medicare billing is concentrated in infused biologic medications and outpatient E/M visits, indicating an infusion-focused specialty practice: J1602 (golimumab) is by far the largest revenue driver at $163.4K and appears to be the core service line, with supporting chemotherapy/infusion codes (96413, 96365, 96415) and office visits (99214, 99213) comprising meaningful secondary activity. The code mix points to regular intravenous administration services and associated monitoring rather than procedural surgery or inpatient care.

Revenue concentration is high: the precomputed top-3 Medicare codes account for 79.5% of the provider’s total Medicare revenue, signaling dependency on a very small set of services for the majority of Medicare income. Given the total Medicare revenue of $266.6K, this concentration suggests limited revenue diversification within this payer.

Payer mix is effectively single-payer: the profile shows $266.6K in lifetime Medicare revenue and no Medicaid billing on file, so the provider operates as a Medicare-focused biller and would be considered single-payer in this dataset. Analysts should treat Medicaid exposure as nil based on available claims.

Competitive standing on the large, dominant code is modest nationally: J1602 generated $163.4K (59.5% of the provider’s Medicare revenue) and the provider ranks #463 of 1041 nationally (55th percentile), which the data labels as typical and unremarkable volume. This indicates the provider is neither a national leader nor a low-volume outlier for golimumab infusion — it sits near the middle of peer activity for this specific drug.

Other high-revenue codes show varying competitive positions: J0897 (denosumab) produced $28.1K and ranks in the 27th percentile (#7234 of 10057), indicating lower relative volume for that monoclonal antibody, while 99214 office visits generated $26.6K and rank in the 80th percentile (#95625 of 479517), showing comparatively stronger activity for moderate-complexity outpatient evaluation and management. Together these ranks suggest stronger performance on outpatient E/M relative to some other injectable drugs.

Tenure on file is long: the provider’s NPI was enumerated on 2007-04-26 (approximately 19 years ago), indicating a longstanding presence in Medicare billing that supports the observed accumulation of lifetime revenue and steady practice patterns. This tenure increases confidence that the observed code mix reflects an established practice model rather than a short-term anomaly.

Operational implications: high volume of J1602 claims (14.9K claims) with low average paid per claim ($11) and substantial total revenue implies many low-paid administrations aggregated into significant revenue; operationally this suggests throughput- and infusion-capacity are central to the business model (staffing, infusion chairs, supply management). Supporting lab and monitoring codes (80053, 36415, 85025, 82306) further indicate routine pre- and post-infusion clinical work.

Risk/variability signals: several infusion-related add-on and chemotherapy codes (96413, 96415, 96365, 96375) appear at typical national percentiles, with some at lower national standing (96415 at the 14th percentile), implying that while infusion services are core, certain extended-infusion or multi-hour services are less commonly billed by this provider compared with peers. This mixed percentile profile suggests the practice focuses on standard-length infusions rather than longer continuous infusions.

Medicare: Complete Services Breakdown

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

25 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J1602	Injection, golimumab, 1 mg, for intravenous use	14,850	$10	$163.3K
J0897	Injection, denosumab, 1 mg	1,560	$20	$28.1K
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…	310	$90	$26.6K
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…	150	$100	$14.7K
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…	180	$50	$9.4K
96365	The provider administers the initial intravenous infusion of a medication or other substance for a period up to one hour to prevent, treat, or diagnose a condition or disease.	180	$50	$8.5K
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…	30	$130	$3.7K
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.	340	$10	$3.4K
36415	In this procedure, the provider inserts a needle into a vein to collect a blood sample.	410	$10	$3.3K
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…	340	$10	$2.7K

Showing 1–10 of 25

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 25 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Maine Distribution

Edward Fels — 0 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Maine

Full comparison — all codes billed, vs. state median

25 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J1602	3	10	14,850	$10	$163.5K
J0897	15	20	2,730	$20	$86.4K
96413	15	30	170	$100	$20.6K
99214	135	2,500	70	$70	$7.2K
96365	7	30	90	$50	$5.6K
99215	383	780	30	$100	$4.8K
99213	256	2,350	50	$50	$4.3K
99204	619	810	30	$100	$3.6K
96375	17	20	230	$10	$3.1K
20610	126	180	40	$40	$2.9K

Showing 1–10 of 25

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Columbus Radiology Corp	OH	Diagnostic Radiology Physician	$0	$49.9M
York Hospital	PA	Family Medicine Physician	$0	$6.2M
York Hospital	ME	General Acute Care Hospital	$0	$5.8M
Brian Daikh	ME	Specialist	$1.2M	$0
Kenneth Orourke	ME	Specialist	$381.7K	$0
Rheumatology Associates P.A.	ME	Specialist	$0	$381.2K
George Gentchos	NJ	Diagnostic Radiology Physician	$335.4K	$0
Brian Keroack	ME	Specialist	$326.6K	$0
Peter Dourdoufis	NH	Cardiovascular Disease Physician	$254.4K	$0
Jeffrey Colnes	ME	Cardiovascular Disease Physician	$226K	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Mainehealth	ME	General Acute Care Hospital	$0	$142.6M
Shalom House, Inc.	ME	Mental Illness Community Based Residential Treatment Facility	$0	$81.9M
Mercy Hospital	ME	General Acute Care Hospital	$0	$35.5M
Maxim Healthcare Services, Inc.	ME	Home Health Agency	$0	$28.1M
Quality Care Access, LLC	ME	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$17.2M
Portland Community Health Center	ME	Federally Qualified Health Center (FQHC)	$0	$12.9M
Al-shawk Home Healthcare, LLC	ME	Personal Care Attendant	$0	$7M
Maine Eye Center, PA	ME	Ophthalmology Physician	$0	$6.1M
Hand Of Mercy Health Care, LLC	ME	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$6.1M
Mainehealth	ME	General Acute Care Hospital	$0	$5.5M

Edward Fels — 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