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.

James Williams (NPI 1518491307)

Field	Value
Entity Type	Individual
Organization	James Williams
Address	111 Franklin Health Cmns
City	Farmington
State	ME
ZIP	04938
Taxonomy	Emergency Medicine Physician
NPI Enumerated	April 18, 2017

Payer Source	Total Paid
Medicare	$41K
Medicaid	$0

Key Findings

This profile is clearly emergency-medicine–centered: the top paid services are ED E/M visits (99284 and 99285) and a critical care entry (99291), with the provider recording 245 claims for 99284 ($83 avg paid/claim, $20.3K revenue) and 104 claims for 99285 ($136 avg paid/claim, $14.1K revenue). The code mix (moderate- and high-level ED E/M plus some critical care) is consistent with hands-on emergency department practice rather than outpatient clinic work or procedural specialties.

Medicare revenue is modest in absolute terms at $41K, and the provider has no Medicaid billing on file; this is effectively a single-payer (Medicare) footprint. The lack of any Medicaid claims — "none below" — means the provider has limited exposure to Medicaid-managed care arrangements and state program flows.

Revenue concentration is high: the precomputed top-three Medicare codes account for 91.9% of Medicare revenue, driven by 99284 (49.7%), 99285 (34.6%), and 99291 (7.6%). In dollar terms those three codes correspond to $20.3K (99284), $14.1K (99285), and $3.1K (99291), which together dominate this provider’s Medicare book.

99284 is a national outlier for volume: it ranks #1041 of 64306 providers (98th percentile) and is explicitly described as "notably above typical national volume for this code," indicating unusually high utilization of moderate-level ED visits compared with peers. By contrast, 99285 (rank #30553 of 61347, 50th percentile) and 99291 (rank #58525 of 71290, 16th percentile) are described as "typical, unremarkable volume," so the provider’s competitive strength is concentrated on 99284 rather than across higher-acuity codes.

Although 99291 is present, the absolute activity is small (19 claims, $164 avg paid/claim, $3.1K revenue) and the national rank is low; the data label for 99291 is "typical, unremarkable volume," which, together with the 16th-percentile rank, signals limited critical-care billing relative to national peer groups. This suggests the provider occasionally delivers time-based critical care but does not have a substantial critical-care billing footprint.

Payment-per-claim patterns align with acuity: 99291 and 99285 have higher avg paid/claim ($164 and $136 respectively) compared with lower-acuity codes such as 99283 ($46 avg) and ECG interpretation 93010 ($6 avg). These per-claim differences underline that higher-acuity encounters (when billed) materially increase revenue despite lower claim counts.

Tenure is moderate: the NPI was enumerated on 2017-04-18 (~9 years ago), indicating roughly nine years of enrollment activity to generate the recorded Medicare revenue. That tenure supports interpretation of the observed code mix as an established practice pattern rather than a very recent change in specialty or location.

From a payer/product strategy viewpoint, the combination of small total Medicare revenue ($41K), near-absence of Medicaid activity, and high concentration in a single ED code (99284) presents both risk and clarity: revenue is heavily dependent on sustained ED visit volume for 99284 (49.7% of Medicare revenue), so shifts in site-of-service patterns or payer mix could disproportionately affect the provider’s Medicare receipts.

Medicare: Complete Services Breakdown

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

5 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
99284	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making.	250	$80	$20.3K
99285	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a high level of medical decision making.	100	$140	$14.1K
99291	Critical care services include the treatment of vital organ failure or prevention of further life–threatening conditions. Delivering medical care in a moment of crisis and in time of emergency is…	20	$160	$3.1K
99283	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a low level of medical decision making.	40	$50	$2K
93010	The provider interprets and reports on the results of a routine 12–lead (or more) electrocardiogram.	220	$10	$1.3K

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 5 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Maine Distribution

James Williams — 1 of 5 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

5 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99285	8	340	70	$130	$12.5K
99291	12	280	30	$170	$7.9K
99284	1	350	70	$90	$6.5K
99283	4	250	30	$50	$1.9K
93010	3	300	100	$10	$1.5K

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Eddie Lares	CA	Emergency Medicine Physician	$353.5K	$0
Simon Chi	CA	Critical Care Medicine (Internal Medicine) Physician	$198.4K	$0
John How	CA	General Practice Physician	$197.2K	$0
Christopher Mccabe	AZ	Emergency Medicine Physician	$191.8K	$0
Daymon Peterson	MS	Emergency Medicine Physician	$175K	$0
Ariel Marks	CA	Emergency Medicine Physician	$142.6K	$0
Nicholas Schulack	NV	Emergency Medicine Physician	$130.9K	$0
Kenneth Filbeck	HI	General Practice Physician	$130.5K	$0
Karolina Deaugustinis	MD	Emergency Medicine Physician	$129.4K	$0
Samantha Wong	MI	Emergency Medicine Physician	$117.3K	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Mainehealth	ME	General Acute Care Hospital	$0	$22.7M
Mainehealth	ME	Rural Health Clinic/Center	$0	$16.7M
Work First, Inc.	ME	Developmentally Disabled Services Day Training Agency	$0	$7.2M
Mainehealth	ME	Rural Health Clinic/Center	$0	$2.4M
R.s.u. #9	ME	Local Education Agency (LEA)	$0	$2.3M
Mainehealth	ME	General Acute Care Hospital	$0	$1.4M
Wilson Stream Family Practice LLC PA	ME	Family Medicine Physician	$0	$1.2M
Farmington Oral & Facial Surgery P A	ME	Oral and Maxillofacial Surgery (Dentist)	$0	$1.2M
Troy A Norton Od, Inc.	ME	Optometrist	$0	$481.5K
Mainehealth	ME	Critical Access Hospital	$0	$433.3K

James Williams — Billing Profile & Reimbursement Data

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James Williams — 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