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

Why is the Medicaid comparison limited to Rhode Island 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. Rhode Island (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.

Claudia Wheeler (NPI 1518154079)

Field	Value
Entity Type	Individual
Organization	Claudia Wheeler
Address	765 Allens Ave
City	Providence
State	RI
ZIP	02905
Taxonomy	Physical Medicine & Rehabilitation Physician
NPI Enumerated	September 28, 2007

Payer Source	Total Paid
Medicare	$244.6K
Medicaid	$0

Key Findings

CLAUDIA WHEELER’s billed activity is effectively single-payer: total Medicare revenue is $244.6K and there is no Medicaid billing on file. This means the provider’s revenue base in our dataset is concentrated entirely in Medicare, which has implications for network negotiations and exposure to Medicare policy changes.

Revenue concentration is extreme: the precomputed top 3 Medicare codes account for 82.9% of this provider’s total Medicare revenue, indicating that a very small set of procedures drives the large majority of receipts. Such concentration can make the practice financially sensitive to reimbursement or utilization changes for those specific codes.

The practice appears to be procedure-driven and focused on chemodenervation/therapeutic botulinum toxin use: J0585 (Injection, onabotulinumtoxina, 1 unit) alone accounts for $167.8K in revenue (74.8% of total Medicare revenue). This dominant share, combined with multiple CPTs for chemodenervation (64642, 64644, 64643, 64646, 64616) on the roster, suggests the office workflow is centered on injection sessions rather than high-volume E/M visits.

Procedural support and localization techniques are prominent: the provider billed 95873 (electrical stimulation to identify nerves) for 142 claims and $8.2K revenue (3.7% of Medicare revenue), and this code is noted as ranks #3 of 58 providers nationally (96th percentile; notably above typical national volume for this code). High use of 95873 indicates routine use of electrophysiologic nerve localization to guide injections, implying investment in equipment and staff trained for targeted chemodenervation.

Competitive standing is mixed by code: for the dominant drug code J0585 the provider ranks #117 of 3636 providers nationally (97th percentile; typical, unremarkable volume for this code), which places them among higher-volume national billers of onabotulinumtoxina even though the available descriptor labels the volume as typical. For other injection CPTs such as 64642 the provider ranks #45 of 473 (90th percentile; typical, unremarkable volume for this code), indicating above-average activity in specific chemodenervation procedures relative to peers.

Office visit (E/M) billing is secondary to procedures: 99213 is the top E/M code with 146 claims and $9.6K revenue (4.3% of Medicare revenue) and ranks #135654 of 457151 providers nationally (70th percentile; typical, unremarkable volume for this code). The modest share of revenue from E/M codes versus injection-related codes suggests the business model prioritizes procedure sessions over routine clinic visit volume.

Tenure data show this provider’s NPI was enumerated on 2007-09-28 (~19 years ago), indicating an established practice presence. Combined with the concentrated procedural profile, long tenure may reflect a stable referral network or niche specialization in neuromuscular chemodenervation therapies.

The absence of any Medicaid billing on file means in-state Medicaid exposure is zero in our dataset, so payers and network planners should treat this entity as essentially Medicare-only for contracting and access analyses. If expansion into Medicaid populations is of strategic interest, this provider would represent a clear pathway to increase Medicaid capacity in the state because they are not currently reporting Medicaid activity.

Medicare: Complete Services Breakdown

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

12 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J0585	Injection, onabotulinumtoxina, 1 unit	41,950	$1	$167.8K
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…	150	$70	$9.6K
64642	The provider injects a chemical, such as Botox®, into one to four muscles of one extremity to relieve a patient's pain and spasms.	90	$100	$8.7K
95873	In this procedure, the provider uses electrical stimulation to identify specific nerves to inject with medication to control various disorders.	140	$60	$8.2K
64644	The provider injects a chemical, such as Botox®, into 5 or more muscles of one extremity to relieve a patient's pain and spasms.	60	$130	$8.2K
64643	The provider injects a chemical, such as Botox®, into one to four muscles of an additional extremity after the first to relieve a patient's pain and spasms.	90	$70	$6.4K
64646	The provider injects a chemical, such as Botox®, into one to five muscles in the trunk to relieve a patient's pain and spasms.	60	$90	$5K
64616	The provider administers a chemical compound to the neck muscles on one side, avoiding the laryngeal muscles. The goal of this procedure is to paralyze the muscles. Providers may treat cervical…	30	$140	$4.5K
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…	20	$100	$2.3K
99203	The provider sees a new 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 provider…	20	$80	$1.5K

Showing 1–10 of 12

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 12 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Rhode Island Distribution

Claudia Wheeler — 4 of 12 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Rhode Island

Full comparison — all codes billed, vs. state median

12 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0585	1	10	6,400	$1	$49.4K
99214	1,683	1,950	100	$80	$11.7K
64644	1	10	60	$130	$8.2K
99213	502	1,950	70	$60	$7.4K
64642	1	10	60	$100	$6.3K
95873	1	10	90	$60	$5K
64646	1	10	60	$90	$4.9K
64616	1	10	30	$140	$4.5K
64643	1	10	60	$70	$4.3K
99203	421	580	30	$70	$3.6K

Showing 1–10 of 12

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Rhode Island Hospital	RI	General Acute Care Hospital	$0	$380.8M
Kent County Memorial Hospital	RI	General Acute Care Hospital	$0	$90.8M
Affinity Physicians LLC.	RI	Internal Medicine Physician	$0	$41.8M
Newport Hospital	RI	General Acute Care Hospital	$0	$15.8M
Christiana Care Health Services Inc	DE	Hospitalist Physician	$0	$13.6M
Rhode Island Hospital	RI	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$13.2M
Rhode Island Hospital	RI	Pediatrics Physician	$0	$5.3M
Zobeida Diaz	RI	Psychiatry Physician	$0	$4M
Rhode Island Hospital	RI	Multi-Specialty Clinic/Center	$0	$4M
Richard Lim	RI	Internal Medicine Physician	$52.2K	$3.4M

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Women & Infants Hospital Of Rhode Island	RI	General Acute Care Hospital	$0	$132.1M
Elmwood Home Care, Inc.	RI	Home Health Agency	$0	$38.6M
H&t Medicals, Inc	RI	Home Health Agency	$0	$14.8M
R.i.s.a.t., LLC	RI	Methadone Clinic	$321.1K	$14M
Meeting Street Center	RI	Early Intervention Provider Agency	$0	$13.8M
The Providence Community Health Centers, Inc.	RI	Federally Qualified Health Center (FQHC)	$0	$13.4M
Women And Infants Hospital	RI	General Acute Care Hospital	$0	$12.6M
The Providence Community Health Centers, Inc.	RI	Federally Qualified Health Center (FQHC)	$0	$8.3M
Renaissance Adhc, LLC	RI	Adult Day Care Clinic/Center	$0	$7.4M
Catherine Allen	RI	Mental Health Counselor	$0	$7.4M

Claudia Wheeler — 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