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.

James Simon (NPI 1538477708)

Field	Value
Entity Type	Individual
Organization	James Simon
Address	1130 Ten Rod Rd
City	North Kingstown
State	RI
ZIP	02852
Taxonomy	Clinical Social Worker
NPI Enumerated	September 21, 2010

Payer Source	Total Paid
Medicaid	$1.7M
Medicare	$0

Medicaid: Complete Services Breakdown

Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.

7 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
H0046	Mental health services, not otherwise specified	4,050	$130	$509.9K
T1019	Personal care services, per 15 minutes, not for an inpatient or resident of a hospital, nursing facility, icf/mr or imd, part of the individualized plan of treatment (code may not be used to identify…	2,550	$170	$441.8K
T1024	Evaluation and treatment by an integrated, specialty team contracted to provide coordinated care to multiple or severely handicapped children, per encounter	2,220	$140	$319K
T1016	Case management, each 15 minutes	6,120	$40	$263.2K
H2014	Skills training and development, per 15 minutes	960	$90	$86K
H2016	Comprehensive community support services, per diem	10,940	$10	$54.7K
T1027	Family training and counseling for child development, per 15 minutes	850	$50	$41.6K

Medicaid: Competitive Analysis & Benchmarks

How this provider's Medicaid billing volume and revenue compare to other Rhode Island providers billing the same CPT/HCPCS codes.

Claims Volume vs. Rhode Island Distribution

James Simon — 0 of 7 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. Rhode Island median

7 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1019	Personal care services, per 15 minutes, not for an inpatient or resident of a hospital, nursing facility, icf/mr or imd, part of the individualized plan of treatment (code may not be used to identify…	24	30	9,040	$150	$5.7M
T1024	Evaluation and treatment by an integrated, specialty team contracted to provide coordinated care to multiple or severely handicapped children, per encounter	32	90	510	$160	$975K
H0046	Mental health services, not otherwise specified	26	70	2,310	$70	$698K
T1027	Family training and counseling for child development, per 15 minutes	34	90	350	$100	$363.8K
H2014	Skills training and development, per 15 minutes	21	30	1,420	$90	$300.3K
T1016	Case management, each 15 minutes	45	180	400	$20	$230.7K
H2016	Comprehensive community support services, per diem	18	40	10,150	$10	$230.4K

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Perspectives Corporation	RI	Mental Health Counselor	$0	$13.3M
Perspectives Corporation	RI	Behavior Analyst	$0	$6.6M

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Dominion Diagnostics, LLC	RI	Clinical Medical Laboratory	$4.8M	$249.1M
Perspectives Corporation	RI	Developmentally Disabled Services Day Training Agency	$0	$182.9M
Perspectives Corporation	RI	Developmentally Disabled Services Day Training Agency	$0	$18.1M
Perspectives Corporation	RI	Community/Behavioral Health Agency	$0	$13.2M
The Sensational Child, Inc.	RI	Durable Medical Equipment & Medical Supplies	$0	$5.4M
Easter Seals Rhode Island	RI	Early Intervention Provider Agency	$0	$5.2M
Community Care Nurses, Inc.	RI	Durable Medical Equipment & Medical Supplies	$0	$1.8M
South County Psychiatry LLC	RI	Psychiatry Physician	$0	$1.6M
Melissa Graswald	RI	General Practice Dentistry	$0	$1.5M
Teresa Jacob	RI	General Practice Dentistry	$0	$1.5M

James Simon — Billing Profile & Reimbursement Data

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James Simon — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References