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    OpenPayerNPI Medicare & MedicaidCarmen Gota
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    Carmen Gota — Billing Profile & Reimbursement Data

    NPI 1568427052 · St. George, UT · Rheumatology Physician

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    Carmen Gota is a rheumatology physician provider located in St. George, Utah. This profile covers 30 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
    OrganizationCarmen Gota
    Address1060 South Main Street
    CitySt. George
    StateUT
    ZIP84770
    TaxonomyRheumatology Physician
    NPI EnumeratedApril 19, 2006

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

    Payer SourceTotal Paid
    Medicare$1.2M
    Medicaid$0

    Key Findings

    This provider’s Medicare business is the only payer activity on file: Total Medicare revenue is $1.2M while there is no Medicaid billing on file, so operational scale and payer mix are effectively single‑payer and concentrated in Medicare. Analysts should treat Medicaid as absent when modeling revenue diversification or contracting exposure for this NPI.

    Revenue concentration is extreme: the precomputed top‑3 Medicare codes account for 80.8% of the provider’s total Medicare revenue, with J0717 reported at $592K (49.4%), J0129 at $266.1K (22.2%), and 99214 at $111K (9.3%). This indicates the practice’s revenue is heavily dependent on a very small set of high‑earning codes rather than a broad mix of low‑value services.

    The code mix points to a rheumatology practice that combines high‑complexity office visits with in‑office biologic and parenteral drug administration. Top drug codes J0717 (certolizumab pegol; 148K claims, $592K) and J0129 (abatacept; 7.8K claims, $266.1K) together drive a majority of revenue, while J3262 (tocilizumab; 16.9K claims, $84.6K) and J1745 (infliximab; 2.3K claims, $57.3K) further reflect regular in‑office specialty drug administration.

    Clinical visit volume is unusually high: 99214 appears as a major E&M contributor (1.2K claims, $111K) and is labeled an "extreme outlier, far above typical national volume," ranking #6612 of 479517 (99th percentile). This suggests the provider treats a large panel of established patients with moderate complexity visits, supporting the high in‑office drug administration activity.

    Several administration and infusion codes also show above‑typical presence, reinforcing an infusion/administration service line beyond routine office care. For example, 96401 (744 claims, $40.2K; 3.4%) is described as "notably above typical national volume" and ranks #136 of 3868 (97th percentile), while 96365 (234 claims, $10.8K) and 96366 (57 claims, $855) further document IV infusion activity.

    Competitive standing is mixed by code: J0717 is ranked #64 of 848 (93th percentile) but labeled "typical, unremarkable volume for this code," indicating nationally notable placement without being characterized as exceptional by the data label; J0129 is mid‑pack (rank #646 of 1221, 47th percentile) and also labeled "typical, unremarkable volume." These rankings suggest the provider is an important but not uniformly dominant participant across biologic agents.

    Ancillary diagnostics and procedures are present but represent a small share of revenue, indicating they support clinical management rather than drive income. Examples include comprehensive metabolic panel 80053 (306 claims, $3.1K, 0.3%), CBC 85025 (305 claims, $2.4K, 0.2%), and basic imaging codes such as 73130 (38 claims, $1K, 0.1%), all of which appear in the top‑25 but contribute minimal dollars relative to J‑codes and E&M.

    The NPI tenure is long: NPI enumerated on 2006-04-19 (~20 years ago), indicating an established presence in the market that aligns with the observed high volume of established‑patient visits and in‑office biologic administration. This longevity should be considered when assessing referral patterns and local competitive relationships.

    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.

    30 rows

    CPT/HCPCS CodeDescriptionClaimsAvg PaidRevenue
    J0717Injection, 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)148,000$1$592K
    J0129Injection, 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)7,830$30$266.1K
    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…1,230$90$111K
    J3262Injection, tocilizumab, 1 mg16,920$10$84.6K
    J1745Injection, infliximab, excludes biosimilar, 10 mg2,290$30$57.3K
    96401The provider administers nonhormonal, antineoplastic chemotherapy drugs subcutaneously or intramuscularly to the patient.740$50$40.2K
    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…120$110$13.9K
    96365The provider administers the initial intravenous infusion of a medication or other substance for a period up to one hour to prevent, treat, or diagnose a condition or disease.230$50$10.8K
    86480The lab analyst performs a test to evaluate a cell mediated immunity gamma interferon antigen response to certain tuberculosis, or TB, antibodies.50$60$3.2K
    80053The lab analyst performs a comprehensive metabolic panel, or CMP test in which he measures the blood level of 14 chemicals the code descriptor lists for the panel.310$10$3.1K

    Showing 1–10 of 30

    Medicare: Competitive Analysis & Benchmarks

    How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 30 CPT/HCPCS codes.

    View: State1 / 2

    Full comparison — all codes billed, vs. state median

    30 rows

    CPT/HCPCS CodeRankProvider CountMedian ClaimsAvg PaidAverage Revenue
    J071731057,900$1$388K
    J326261070,740$1$328K
    J01295107,880$30$287.1K
    J17455104,400$30$137.1K
    96401220140$50$13.7K
    99214234,08080$80$11.6K
    992132,5593,68060$50$6.4K
    96365128090$40$5.2K
    99204751,79030$100$4.1K
    8648031050$60$3.8K

    Showing 1–10 of 30

    Related Providers

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

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    The Cleveland Clinic FoundationOHGeneral Acute Care Hospital$0$864.1M
    Ihc Health Services, Inc.UTChildren's Hospital$0$129.5M
    Ohiohealth CorporationOHFamily Medicine Physician$0$89.1M
    Ihc Health Services, Inc.UTGeneral Acute Care Hospital$0$68.7M
    Ihc Health Services, Inc.UTGeneral Acute Care Hospital$0$65.8M
    Ihc Health Services IncUTGeneral Acute Care Hospital$0$54.1M
    Columbus Radiology CorpOHDiagnostic Radiology Physician$0$49.9M
    Ihc Health Services, Inc.UTGeneral Acute Care Hospital$0$44.3M
    Ihc Health Services IncUTHome Infusion Therapy Pharmacy$0$38.1M
    Healthcare Partners Affiliates Medical GroupCAInternal Medicine Physician$0$37.7M

    Nearby Providers

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

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    American Logistics, LLC.UTTransportation Broker$0$299.6M
    Southwest CenterUTMental Health Clinic/Center (Including Community Mental Health Center)$0$58.3M
    Red Rock Healthcare, Inc.UTHome Health Agency$0$27.3M
    Virgin River Healthcare, Inc.UTIn Home Supportive Care Agency$0$13.3M
    Crimson Heights LLCUTCommunity/Behavioral Health Agency$0$7.8M
    Southwest CenterUTSubstance Use Disorder Rehabilitation Clinic/Center$0$7.7M
    Crimson Heights LLCUTBehavior Analyst$0$6.8M
    Washington County School DistrictUTLocal Education Agency (LEA)$0$6.8M
    Red Mesa Home CareUTHome Health Agency$0$4M
    The Learning Center For FamiliesUTDevelopmentally Disabled Services Day Training Agency$0$3.9M

    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.

    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

    Medicare Revenue by CPT/HCPCS Code
    Claims Volume vs. Utah Distribution
    Carmen Gota — 2 of 25 codes billed far more than typical (above p95)
    p5–p95 (all providers)p25–p75MedianThis providerOutlier
    Rank Distribution — Utah