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

Why is the Medicaid comparison limited to South Carolina 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. South Carolina (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.

Durga Adhikari (NPI 1538319074)

Field	Value
Entity Type	Individual
Organization	Durga Adhikari
Address	2001 2nd Ave Ste 201
City	Summerville
State	SC
ZIP	29486
Taxonomy	Rheumatology Physician
NPI Enumerated	September 21, 2008

Payer Source	Total Paid
Medicare	$2.4M
Medicaid	$0

Key Findings

This provider’s Medicare footprint is the dominant payer relationship on file: reported total Medicare revenue is $2.4M while there is no Medicaid billing on file, so the practice is effectively single‑payer (Medicare) in the available data. Analytically, that concentration means Medicare reimbursement patterns will largely determine the provider’s revenue profile and competitive positioning.

Revenue is heavily concentrated in a small set of biologic drug codes: the precomputed top‑3 Medicare codes (J0129, J1602, J3262) account for 56.9% of this provider’s total Medicare revenue. Those three codes individually generate $670.7K (J0129), $404K (J1602), and $264K (J3262) of Medicare revenue as presented, indicating that a majority of dollars are tied to a narrow set of infused or physician‑administered biologics.

The code mix and volumes point to an on‑site infusion/infusion‑support business line: multiple high‑revenue J‑codes for physician‑administered biologics (J0129 abatacept; J1602 golimumab; J3262 tocilizumab; J0490 belimumab; Q5104 infliximab‑abda biosimilar) appear alongside infusion administration codes such as 96365, 96375 and the chemotherapy administration code 96413. This pattern is consistent with regular in‑office IV or infusion therapy for rheumatologic and autoimmune conditions rather than primarily self‑administered injectables.

Competitive standing is mixed but shows strong national participation on several key biologics: J1602 (golimumab) and Q5104 (infliximab‑abda biosimilar) both rank in the 93rd percentile nationally, and J0129 (abatacept) is at the 89th percentile, signaling above‑typical national volume for those products. By contrast, other biologics such as J9312 (rituximab) are at the 23rd percentile and J0717 (certolizumab pegol) sits at the 16th percentile, indicating variable strength across specific agents rather than uniform dominance across the therapeutic class.

Operationally, the provider reports very large claim counts for some infusion codes (for example, J3262 has 52.8K claims and J1602 has 40.4K claims) paired with relatively low average paid per claim for certain items, which suggests high‑throughput infusion operations where volume is a key driver of revenue. The presence of 96365 (521 claims, 96th percentile) further supports that the practice administers many initial IV infusions and is efficient at throughput for infusion encounters.

Clinical support services are present but represent a small share of revenue: office E/M entries such as 99214 (201 claims) and 99204 (95 claims) and laboratory tests like 85025 (267 claims), 82306 (53 claims) and 86235 (84 claims) appear in the top 25 but each contributes only fractional percentages of Medicare revenue. This indicates the practice is clinically comprehensive (office visits plus in‑house labs) but that the bulk of dollars come from biologic drug administration rather than face‑to‑face evaluation or diagnostics.

The concentration of revenue into a narrow set of physician‑administered biologics creates exposure to formulary shifts, biosimilar uptake, and payor coverage changes: with 56.9% of Medicare revenue tied to the top three codes, changes in reimbursement, utilization management, or migration to biosimilars could materially affect topline Medicare receipts. Monitoring changes in utilization and shifts toward biosimilars (e.g., presence of both Q5104 and J1745 infliximab codes) will be important for forecasting revenue stability.

The provider has an established presence in the NPI registry (enumerated 2008-09-21, listed as ~18 years ago), which suggests a sustained operating history and potentially stable referral patterns and patient base supporting the infusion‑oriented service line. That tenure, combined with concentrated biologic dispensing, indicates a mature specialty practice focused on long‑term management of rheumatologic conditions.

Medicare: Complete Services Breakdown

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

42 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J0129	Injection, abatacept, 10 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)	20,330	$30	$670.7K
J1602	Injection, golimumab, 1 mg, for intravenous use	40,400	$10	$404K
J3262	Injection, tocilizumab, 1 mg	52,800	$10	$264K
J0490	Injection, belimumab, 10 mg	6,070	$40	$236.7K
Q5104	Injection, infliximab-abda, biosimilar, (renflexis), 10 mg	5,370	$30	$161.1K
J9312	Injection, rituximab, 10 mg	2,100	$60	$134.4K
J0897	Injection, denosumab, 1 mg	5,460	$20	$98.3K
J3111	Injection, romosozumab-aqqg, 1 mg	12,180	$10	$97.4K
J0717	Injection, certolizumab pegol, 1 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)	22,400	$1	$89.6K
J1745	Injection, infliximab, excludes biosimilar, 10 mg	3,250	$30	$81.2K

Showing 1–10 of 42

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 42 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. South Carolina Distribution

Durga Adhikari — 1 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — South Carolina

Full comparison — all codes billed, vs. state median

42 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0129	8	40	9,640	$30	$424.2K
J0717	17	20	59,200	$1	$278.4K
J1602	7	40	23,560	$10	$264.5K
J3262	6	20	40,900	$1	$202.7K
J9312	15	20	2,340	$60	$193.7K
J0490	1	10	4,820	$40	$152K
J3111	19	40	12,390	$10	$129.4K
J1745	24	50	3,250	$30	$107K
Q5104	3	10	2,630	$30	$91.6K
J0897	58	250	2,400	$20	$91.2K

Showing 1–10 of 42

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
William Chafin	GA	Rheumatology Physician	$3.3M	$0
Taylor Mader	SC	Rheumatology Physician	$3.1M	$0
Dean Stephens	GA	Rheumatology Physician	$2.7M	$0
Charles Degenhardt	GA	Rheumatology Physician	$2.4M	$0
Paul Sutej	GA	Rheumatology Physician	$2.4M	$0
Marta Bognar	GA	Rheumatology Physician	$2.3M	$0
Brent Flickinger	GA	Rheumatology Physician	$2.3M	$0
Kathleen Flint	SC	Rheumatology Physician	$2.3M	$0
Colin Edgerton	SC	Rheumatology Physician	$1.9M	$0
John Brittis	SC	Rheumatology Physician	$1.9M	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Roper St Francis Hospital-berkeley Inc.	SC	General Acute Care Hospital	$0	$7.3M
Charleston Surgery Center Limited Partnership	SC	Ambulatory Surgical Clinic/Center	$2.6M	$2M
Broad River Physicians Group, LLC	SC	Emergency Medicine Physician	$0	$3M
Sfd Kids LLC	SC	Dentist	$0	$2.4M
Jennifer Murphy	SC	Rheumatology Physician	$1.4M	$0
Gregory Niemer	SC	Rheumatology Physician	$1.4M	$0
Low Country Endoscopy Center, LLC	SC	Ambulatory Surgical Clinic/Center	$524.9K	$93.6K
Michael Marte	SC	Hematology & Oncology Physician	$607.8K	$0
Nicholas Holdgate	SC	Rheumatology Physician	$557.8K	$0
Clarence Legerton	SC	Rheumatology Physician	$555.4K	$0

Durga Adhikari — 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