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

Why is the Medicaid comparison limited to Wyoming 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. Wyoming (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 Wilson (NPI 1518087154)

Field	Value
Entity Type	Individual
Organization	Douglas Wilson
Address	1217 S Greeley Hwy Ste A
City	Cheyenne
State	WY
ZIP	82007
Taxonomy	Physical Therapist
NPI Enumerated	March 29, 2007

Payer Source	Total Paid
Medicare	$376.9K
Medicaid	$0

Key Findings

This profile is effectively single-payer: Total Medicare revenue: $376.9K and there is no Medicaid billing on file, so payer mix is concentrated entirely in Medicare rather than split between Medicare and Medicaid. That lack of Medicaid activity means the provider’s revenue exposure and growth opportunities are tied to Medicare patient volume and reimbursement trends.

The NPI was enumerated on 2007-03-29 (~19 years ago), indicating a long-tenured presence in the market. That tenure, combined with sustained Medicare billing, suggests an established outpatient physical therapy practice rather than a newly formed clinic.

Revenue is highly concentrated in a few procedure lines: the top 3 Medicare codes account for 58.7% of this provider’s total Medicare revenue. Those top drivers are 97530 ($85.9K, 22.9%), 97112 ($73.3K, 19.6%), and 97110 ($60.8K, 16.2%), indicating most revenue comes from functional activities, neuromuscular reeducation, and therapeutic exercise.

The code mix and claim counts point to a high-throughput, therapy-focused operation: 97530 shows 3.2K claims, 97112 shows 3.9K claims, and 97110 shows 3.6K claims. These are time-based, repeatable treatment codes (many billed in 15-minute units), so the practice appears oriented toward volume-driven outpatient therapy sessions and ongoing patient visits.

Competitive standing on several core PT codes is national outlier-level: 97112 ranks #224 of 61940 providers (100th percentile, labeled extreme outlier) and 97535 ranks #41 of 16743 providers (100th percentile, extreme outlier), while 97530 ranks #814 of 62717 providers (99th percentile, extreme outlier). These ranks indicate this provider bills these service codes at volumes far above typical national peers and functions as a major national volume outlier for multiple interventions.

There is a mix of extreme outlier intervention volumes and more typical evaluation patterns: 97162 (180 claims, $13.3K) is an extreme outlier nationally (99th percentile), whereas 97163 (14 claims, $1.1K) is at the 20th percentile and described as typical. This suggests the practice delivers many routine/moderate-complexity therapy visits but bills relatively fewer high-complexity initial evaluations.

Unit economics reflect low-to-moderate per-claim payments consistent with high-volume physical therapy: 97530 averages $27 avg paid/claim, 97112 $19 avg paid/claim, and 97110 $17 avg paid/claim. Those payment levels combined with thousands of claims for leading codes indicate reliance on volume of short-duration therapy units rather than a small number of high-dollar procedures.

The complete absence of Medicaid billing constrains payer diversification and concentrates reimbursement risk in Medicare policy and local Medicare patient demand. For payers and competitors evaluating market dynamics, the provider represents a concentrated, Medicare-focused therapy operation with outsized national volumes on several CPTs but limited engagement with Medicaid populations.

Medicare: Complete Services Breakdown

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

10 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
97530	The provider uses various activities during direct contact with the patient to improve the patient’s functional performance. Use this code for each 15 minutes of activity.	3,180	$30	$85.9K
97112	Neuromuscular reeducation is a therapeutic treatment (exercise) performed by a physician in an attempt to reduce impairments and restore function through the application of clinical skills and/or…	3,860	$20	$73.3K
97110	Therapeutic exercise is a form of physical therapy that utilizes specially designed exercises and activities to help patients gain better mobility and fitness levels. Normally used on patients with…	3,570	$20	$60.8K
97535	A healthcare provider is required to give proper instruction to a person especially in cases of recovery from acute disease.	3,140	$20	$59.6K
97116	The provider instructs the patient in the proper ways of practicing various exercises, including climbing stairs, focusing on one or more areas, that assist them in walking comfortably and without…	2,100	$20	$33.6K
97140	Manual therapy is a form of physical therapy which uses the controlled movement and pressure of hands to treat various disorders of soft tissues and joints, eg, chronic back pain. Manual therapy…	1,620	$20	$25.8K
97032	Electrical stimulation therapy uses electricity to stimulate the muscles for the treatment of pain and other disorders associated with muscles. Electrodes are placed on the affected muscle areas and…	1,820	$10	$16.4K
97162	The provider, typically a physical therapist, conducts a physical therapy evaluation that includes history to rule out any adverse factors that will affect care; observes whether the patient's…	180	$70	$13.3K
97164	The provider, typically a physical therapist, conducts a physical therapy re–evaluation that includes history review and standardized tests and measures to assess body structure and function; she…	90	$50	$4.7K
97163	The provider, typically a physical therapist, conducts a physical therapy evaluation that includes history of a patient with three or more personal factors that may affect care, assess a clinical…	10	$80	$1.1K

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 10 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Wyoming Distribution

Douglas Wilson — 7 of 10 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Wyoming

Full comparison — all codes billed, vs. state median

10 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
97110	7	350	690	$20	$17K
97530	2	270	330	$20	$13.5K
97112	1	280	370	$20	$10.6K
97140	26	340	490	$20	$10.4K
97535	1	40	70	$20	$3.6K
97116	1	70	100	$20	$3.3K
97162	3	190	30	$70	$2.7K
97164	3	40	30	$50	$2K
97163	25	30	20	$70	$1.7K
97032	1	40	70	$10	$1.4K

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Wyoming Physical Therapy PC	WY	Specialist	$0	$134.6K
Ty Parsons	WY	Physical Therapist	$78.8K	$0
Joseph Dobbins	CO	Physical Therapist	$53.2K	$0
Megan Jacobs	CO	Audiologist	$15.6K	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Cheyenne Health & Wellness Center	WY	Community Health Clinic/Center	$0	$2.8M
Lincare Inc.	WY	Durable Medical Equipment & Medical Supplies	$0	$1.5M
Respitech Home Health Care Inc	WY	Durable Medical Equipment & Medical Supplies	$0	$1.4M
Meals On Wheels Of Cheyenne Inc.	WY	Case Management Agency	$0	$1.1M
Cheyenne-laramie County Health Department	WY	Public Health or Welfare Agency	$93.1K	$534.5K
Stride Learning Center	WY	Clinic/Center	$0	$364.4K
Pain Consultants Of The Rockies, PC	WY	Pain Medicine (Anesthesiology) Physician	$0	$272.5K
Heather Roberts	WY	Family Nurse Practitioner	$237.6K	$0
Hope And Healing Counseling, LLC	WY	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$217.9K
Michelle Dowling	WY	Family Nurse Practitioner	$200.7K	$0

Douglas Wilson — Billing Profile & Reimbursement Data

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Douglas Wilson — 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