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

Why is the Medicaid comparison limited to Georgia 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. Georgia (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 Splichal (NPI 1588619142)

Field	Value
Entity Type	Individual
Organization	James Splichal
Address	3320 Old Jefferson Rd Bldg 700
City	Athens
State	GA
ZIP	30607
Taxonomy	Hematology & Oncology Physician
NPI Enumerated	May 23, 2006

Payer Source	Total Paid
Medicare	$1.9M
Medicaid	$0

Key Findings

This provider’s Medicare footprint dominates their billed activity: lifetime Medicare revenue is $1.9M while there is no Medicaid billing on file, so JAMES SPLICHAL is effectively a single-payer (Medicare-focused) billing profile in the available data. The absence of Medicaid claims suggests limited exposure to state-program reimbursement and a patient mix concentrated in Medicare beneficiaries.

Revenue is highly concentrated in a small set of biologic/infusion drugs: the precomputed top-three codes account for 70.2% of the provider’s total Medicare revenue, led by J9271 ($832K, 46.2%), followed by J0897 ($290.7K, 16.1%) and Q5123 ($142.1K, 7.9%). This concentration indicates that a large share of overall revenue is driven by high-volume administration of specific oncology biologics rather than diversified office-based procedures.

The code mix and highest-revenue items identify a hematology/oncology infusion practice model: J9271 (pembrolizumab), Q5123 (rituximab-arrx biosimilar), and J0897 (denosumab) are the dominant drivers, and chemotherapy administration codes such as 96413 (422 claims, $38K) and add-on infusion code 96417 (170 claims, $7.8K) are present. These patterns point to on-site infusion services, supportive care agents (e.g., J0885 epoetin alfa; J1437 ferric derisomaltose), and integrated lab/phlebotomy workflows supporting oncology treatment.

Competitive standing is mixed across the top drugs: J9271 ranks #358 of 1841 (80th percentile) and is characterized as typical volume for that code nationally, whereas J0897 ranks #407 of 10057 (96th percentile; notably above typical) and Q5123 ranks #2 of 40 (97th percentile; notably above typical). In plain terms, the provider is a relatively routine national participant for pembrolizumab but is a high-volume outlier for denosumab and an especially concentrated national provider of the rituximab biosimilar compared with peers.

Office visit E/M activity is substantial and well above typical peer levels: 99214 appears as an extreme outlier with 1.6K claims, $137.1K revenue (7.6% of Medicare revenue), ranking #3138 of 479517 providers (99th percentile). Additional high-level visit codes (99215 and 99205) also sit at elevated percentiles, which together imply a large established-patient panel and significant outpatient visit throughput supporting the infusion practice.

Several ancillary service lines support the infusion-centric model: high counts of phlebotomy and lab codes (36415, 85025, 80053) and frequent injection/infusion administration codes (96367, 96365) are reported. Notably, 96372 is flagged as an extreme outlier (891 claims, $8.9K), indicating unusually high volume of separate therapeutic/prophylactic injections beyond primary chemotherapy sessions, consistent with an active supportive-care regimen.

The provider’s longer tenure in the NPI registry (enumerated 2006-05-23, ~20 years ago) suggests an established practice and potential stability in referral and payer relationships over time. This longevity, combined with concentrated biologic administration, may make the provider a reliable source for certain high-use oncology drugs in the regional Medicare network.

From a payer/contracting perspective, the absence of Medicaid billing and the concentration in costly Medicare-administered biologics create both opportunities and considerations: payers negotiating networks or site-of-care policies should note the provider’s outsized use of J0897 and Q5123 (high national percentiles) and the heavy reliance on J9271 for nearly half of Medicare revenue. Network access, specialty drug coverage terms, and site-of-care cost-management strategies are likely the most relevant levers given this provider’s Medicare-centered, infusion-heavy profile.

Medicare: Complete Services Breakdown

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

77 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J9271	Injection, pembrolizumab, 1 mg	20,800	$40	$832K
J0897	Injection, denosumab, 1 mg	17,100	$20	$290.7K
Q5123	Injection, rituximab-arrx, biosimilar, (riabni), 10 mg	4,180	$30	$142.1K
99214	The 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…	1,580	$90	$137.1K
J0885	Injection, epoetin alfa, (for non-esrd use), 1000 units	14,460	$10	$72.3K
99215	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the…	410	$130	$52.5K
J1454	Injection, fosnetupitant 235 mg and palonosetron 0.25 mg	120	$330	$40.3K
96413	Chemotherapy is a therapeutic procedure used for the treatment of cancer via the use of chemical agents. These chemical agents (drugs) work on the cancerous cells of the body to destroy them. These…	420	$90	$38K
J1437	Injection, ferric derisomaltose, 10 mg	2,100	$20	$31.5K
99213	The 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…	440	$60	$26.1K

Showing 1–10 of 77

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 77 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Georgia Distribution

James Splichal — 9 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Georgia

Full comparison — all codes billed, vs. state median

77 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J9271	14	40	15,200	$40	$767.3K
Q5123	1	10	3,410	$30	$120.5K
J0897	15	290	2,460	$20	$90.2K
J1437	23	30	2,850	$20	$56.4K
J0885	2	30	3,970	$10	$26.6K
J1454	2	20	80	$330	$25.9K
96413	24	160	170	$90	$20.3K
J3490	16	50	50	$320	$19.8K
88185	9	10	530	$20	$18.5K
99214	69	13,640	120	$80	$17.8K

Showing 1–10 of 77

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Petros Nikolinakos	GA	Hematology & Oncology Physician	$4.6M	$0
University Cancer & Blood Center LLC	GA	Hematology & Oncology Physician	$0	$3.2M
Charles Bodine	GA	Hematology & Oncology Physician	$2.3M	$0
Gustavo Westin	FL	Medical Oncology Physician	$2M	$0
Kuang Chang	GA	Hematology & Oncology Physician	$1.8M	$0
Jeffrey Thomas	GA	Hematology & Oncology Physician	$1.7M	$0
Cynthia Shepherd	GA	Hematology & Oncology Physician	$1.6M	$0
Barry Charnick	FL	Nuclear Radiology Physician	$1.3M	$0
Frederick Flynt	GA	Hematology & Oncology Physician	$1M	$0
Gordon Schoenfeld	GA	Radiation Oncology Physician	$834K	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Mohan Iyer	GA	Retina Specialist (Ophthalmology) Physician	$1.6M	$0
Victor Copeland	GA	Retina Specialist (Ophthalmology) Physician	$1.5M	$0
Athens Eye Surgery Center,llc	GA	Ambulatory Surgical Clinic/Center	$1.2M	$0
Athens Radiology Associates PC	GA	Diagnostic Radiology Physician	$0	$863K
Tzu-chuan Huang	GA	Hematology & Oncology Physician	$469.2K	$0
Jeffrey Williams	GA	Gastroenterology Physician	$385.8K	$0
Athens Gastroenterology Endoscopy Center Inc	GA	Endoscopy Clinic/Center	$375.9K	$0
Walter Sams	GA	Ophthalmology Physician	$358.3K	$0
Emory Patterson	GA	Ophthalmology Physician	$326.1K	$0
Addie Hill	GA	Hematology & Oncology Physician	$298.2K	$0

James Splichal — Billing Profile & Reimbursement Data

Sign up for James Splichal — Billing Profile & Reimbursement Data policy alerts

James Splichal — Billing Profile & Reimbursement Data

Sign up for James Splichal — Billing Profile & Reimbursement Data policy alerts

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