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NPI 1598873382 · Ogden, UT · Hematology & Oncology Physician
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Carl Gray is a hematology & oncology physician provider located in Ogden, Utah. This profile covers 58 Medicare and 2 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.
Provider details (source: NPPES NPI Registry)
| Field | Value |
|---|---|
| Entity Type | Individual |
| Organization | Carl Gray |
| Address | 5405 S 500 E Ste 202 |
| City | Ogden |
| State | UT |
| ZIP | 84405 |
| Taxonomy | Hematology & Oncology Physician |
| NPI Enumerated | August 29, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $3.9M |
| Medicaid | $1.7M |
CARL GRAY is a hematology & oncology physician with a long-established Medicare/Medicaid billing presence; the NPI was enumerated on 2006-08-29 (~20 years ago), indicating roughly two decades of active enrollment that supports sustained treatment volume and payer relationships. The specialty and long tenure align with the mix of high-volume oncology biologic infusions and chemotherapy administration seen in the code set.
Medicare revenue ($3.9M) materially exceeds Medicaid revenue ($1.7M), indicating a Medicare-weighted practice footprint rather than a Medicaid-dependent operation. The provider is not single-payer — both payers contribute meaningful revenue — but Medicare accounts for the larger share of lifetime billed revenue.
Revenue concentration on Medicare is high: the precomputed top 3 Medicare codes by revenue account for 68.8% of the provider's total Medicare revenue. Those top drugs/procedures (notably J9299 and J9271 among others) show the practice is materially dependent on a small set of high-revenue biologic/oncology agents, which has implications for payer negotiations, drug-acquisition strategy, and exposure to pricing or utilization changes for those agents.
On Medicaid, the top 3 codes account for 100.0% of the provider's total Medicaid revenue, indicating extreme concentration of Medicaid billing into a tiny set of services. Specifically, 99214 drives 81.1% of Medicaid revenue and 85025 drives the remaining 18.9%, which suggests Medicaid activity is focused on office-based established patient visits and associated lab testing rather than the high-cost biologic infusions that dominate Medicare.
The provider is a competitive outlier nationally on several Medicare codes. J9299 (nivolumab) accounts for $1.2M and ranks #17 of 505 providers nationally (97th percentile), and Q5126 (bevacizumab-maly, biosimilar) accounts for $538.6K and ranks #1 of 29 providers nationally (100th percentile). These rankings and the dataset labels (e.g., “notably above typical” and “extreme outlier”) indicate this clinician is a dominant national volume provider for certain expensive oncology injectables, which distinguishes the practice from typical peers.
Several other Medicare codes show unusually high volume compared to national peers: J0897 ranks in the 98th percentile and 96413 ranks in the 99th percentile, both described as “extreme outlier” or “notably above typical,” reinforcing that the practice delivers high volumes of oncology therapeutics and chemotherapy administration relative to most providers. This pattern suggests operational capability for infusion services and chemotherapy management at scale.
Not all high-ranking codes are concentrated: J9271 (pembrolizumab) produces $928.8K and sits at the 82nd percentile (rank #320 of 1841), which is high but not an extreme outlier, indicating the provider’s volume for some checkpoint inhibitors aligns more with an expanded but not unique market presence. Likewise, several common infusion and E/M codes (e.g., 99214, 96367) fall into high percentiles nationally but are characterized as “notably above typical” rather than extreme, suggesting a mix of both routine oncology office care and specialized infusion services.
The Medicaid billing profile contrasts with Medicare competitive standing: 99214 on Medicaid yields $1.4M and ranks #418 of 1340 in-state (69th percentile), which is an unremarkable in-state volume for office E/M visits; 85025 ranks at the 46th percentile in-state. This implies that while the provider is a national leader in specific Medicare infusion codes, their Medicaid activity is more modest and centered on office visits and labs rather than high-cost biologics.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
58 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J9299 | Injection, nivolumab, 1 mg | 48,000 | $20 | $1.2M |
| J9271 | Injection, pembrolizumab, 1 mg | 21,600 | $40 | $928.8K |
| Q5126 | Injection, bevacizumab-maly, biosimilar, (alymsys), 10 mg | 9,790 | $60 | $538.6K |
| J0897 | Injection, denosumab, 1 mg | 24,300 | $20 | $437.4K |
| Q5115 | Injection, rituximab-abbs, biosimilar, (truxima), 10 mg | 5,190 | $30 | $176.4K |
| Q5118 | Injection, bevacizumab-bvzr, biosimilar, (zirabev), 10 mg | 4,670 | $30 | $121.4K |
| 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… | 1,080 | $100 | $106.2K |
| 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… | 890 | $100 | $84.5K |
| J1627 | Injection, granisetron, extended-release, 0.1 mg | 11,300 | $10 | $56.5K |
| J0185 | Injection, aprepitant, 1 mg | 35,360 | $1 | $35.4K |
Showing 1–10 of 58
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 58 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
58 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J9299 | 1 | 10 | 48,000 | $20 | $1.1M |
| Q5126 | 1 | 10 | 9,790 | $50 | $534K |
| J9271 | 1 | 10 | 10,010 | $40 | $510.2K |
| Q5115 | 1 | 10 | 5,190 | $30 | $176.5K |
| Q5118 | 1 | 10 | 4,670 | $30 | $120.6K |
| J0897 | 1 | 70 | 1,920 | $20 | $67.2K |
| J1437 | 2 | 10 | 2,100 | $20 | $35.2K |
| J1627 | 1 | 10 | 3,600 | $1 | $20.1K |
| 96413 | 1 | 50 | 100 | $90 | $13.8K |
| 96401 | 9 | 20 | 140 | $50 | $13.7K |
Showing 1–10 of 58
Medicaid revenue breakdown by year and by CPT/HCPCS procedure code, including monthly billing trends and the top codes driving revenue.
View: By Year1 / 3
Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.
2 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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… | 630 | $2,220 | $1.4M |
| 85025 | A complete blood count (better known as a CBC) is a blood test request by a doctor that provides detailed information about various types of cells in a patient's blood. Usually a pathologist or a… | 690 | $470 | $324.5K |
How this provider's Medicaid billing volume and revenue compare to other Utah providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Utah median
2 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 85025 | A complete blood count (better known as a CBC) is a blood test request by a doctor that provides detailed information about various types of cells in a patient's blood. Usually a pathologist or a… | 66 | 120 | 1,100 | $30 | $186.6K |
| 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… | 418 | 1,340 | 200 | $80 | $144K |
Other providers in the same ZIP code as Carl Gray, ranked by combined Medicare and Medicaid revenue.
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