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    v1.0.28
    OpenPayerNPI Medicare & MedicaidSeth Kaplan
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    Seth Kaplan — Billing Profile & Reimbursement Data

    NPI 1518968775 · Raleigh, NC · Gastroenterology Physician

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    Seth Kaplan is a gastroenterology physician provider located in Raleigh, North Carolina. This profile covers 16 Medicare and 0 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.

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    Provider details (source: NPPES NPI Registry)

    FieldValue
    Entity TypeIndividual
    OrganizationSeth Kaplan
    Address3100 Blue Ridge Rd
    CityRaleigh
    StateNC
    ZIP27612
    TaxonomyGastroenterology Physician
    NPI EnumeratedAugust 9, 2005

    Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)

    Payer SourceTotal Paid
    Medicare$83.4K
    Medicaid$0

    Medicare: Total Revenue Breakdown by CPT/HCPCS Code

    Medicare revenue breakdown by CPT/HCPCS procedure code.

    View: Bar Chart1 / 2

    Medicare: Complete Services Breakdown

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

    16 rows

    CPT/HCPCS CodeDescriptionClaimsAvg PaidRevenue
    88305The physician, typically a pathologist, performs a level IV examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally…690$50$34K
    45385The provider examines the colon and rectum using a colonoscope, a long, thin flexible tubular instrument with a light source and camera. He removes one or more tumors, polyps, or other lesions with a…120$160$19.6K
    45380The provider examines the rectum and colon using a flexible colonoscope, a tubular instrument with a light source and camera, to look for the cause of a patient's symptoms, which may include…170$60$10K
    99214The 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…70$90$6.3K
    99213The 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…60$50$2.9K
    88312The lab analyst performs the technical lab steps to stain a specimen with a special stain. This code applies to Group I for microorganisms. A qualified provider, typically a pathologist, interprets…20$80$1.9K
    99204The provider sees a new 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 provider…20$100$1.8K
    43249The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum and dilates (widens) the esophagus with a balloon less than 30 mm in diameter.20$80$1.7K
    43239The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum where he removes one or more tissue biopsy specimens for diagnostic analysis.40$40$1.6K
    91065A hydrogen or methane breath test is a diagnostic procedure to find problems related to gastric functionality such as lactose deficiency, fructose intolerance, bacterial overgrowth, and oro–cecal…20$60$950

    Showing 1–10 of 16

    Medicare: Competitive Analysis & Benchmarks

    How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 16 CPT/HCPCS codes.

    View: State1 / 2

    Full comparison — all codes billed, vs. state median

    16 rows

    CPT/HCPCS CodeRankProvider CountMedian ClaimsAvg PaidAverage Revenue
    88305150440470$40$50.4K
    4538515556070$290$33.4K
    9921411,33818,060110$80$15.1K
    453804452040$180$13.7K
    4323936356060$120$11K
    4324910017030$270$9.7K
    8260723760030$10$8.7K
    850251,5311,92080$10$7.4K
    992138,79116,32070$50$7.1K
    8831213719040$50$6.5K

    Showing 1–10 of 16

    Nearby Providers

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

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    Bayada Home Health Care, Inc.NCHome Health Agency$0$15.9M
    Omni Family Of Services North Carolina Inc.NCCommunity/Behavioral Health Agency$0$10.7M
    Pacific Staffing IncNCIn Home Supportive Care Agency$0$10M
    Easter Seals Ucp North Carolina & Virginia, Inc.NCCommunity/Behavioral Health Agency$0$9.3M
    Community Connections Healthcare Services, LLCNCClinical Social Worker$0$9.2M
    Wp-raleigh Health Holdings, LLCNCAdult Care Home Facility$0$8.7M
    A. Silvia RossNCSpecialist$1.9M$0
    Orthopaedic Surgery Center Of Raleigh LLCNCOrthopaedic Surgery Physician$1.1M$0
    Sherry SinclairNCSpecialist$905.3K$0
    Priority Care Ambulance Inc.NCLand Ambulance$687.3K$154.3K

    Frequently Asked Questions

    References

    1. 1.Medicare Physician & Other Practitioner by Provider and Service. CMS.gov.Provider-level Medicare Part B utilization and payment data.
    2. 2.NPPES NPI Registry. CMS.gov.National Provider Identifier registry used for provider enumeration and taxonomy metadata.

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    Medicare Revenue by CPT/HCPCS Code
    Claims Volume vs. North Carolina Distribution
    Seth Kaplan — 0 of 16 codes billed far more than typical (above p95)
    p5–p95 (all providers)p25–p75MedianThis providerOutlier
    Rank Distribution — North Carolina