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.

John Toole (NPI 1609803121)

Field	Value
Entity Type	Individual
Organization	John Toole
Address	316 Calhoun St
City	Charleston
State	SC
ZIP	29401
Taxonomy	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
NPI Enumerated	June 28, 2006

Payer Source	Total Paid
Medicare	$79.6K
Medicaid	$0

Medicare: Complete Services Breakdown

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

8 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
33533	Coronary artery bypass, using arterial graft(s); single arterial graft	50	$1,320	$62.2K
33519	The provider diverts blood flow from damaged vessels in the heart by grafting three vein segments taken from another location, such as the leg, while the patient is undergoing a coronary artery…	20	$410	$6.1K
33518	The provider diverts blood flow from damaged vessels in the heart by grafting two vein segments taken from another location, such as the leg, while the patient is undergoing a coronary artery bypass…	10	$310	$4.3K
99204	The 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…	20	$110	$2.3K
99203	The provider sees a new 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 provider…	20	$80	$1.7K
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…	10	$120	$1.4K
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…	20	$60	$1K
33508	The provider employs surgical endoscopy to visualize structures surrounding the vein he harvests for a coronary artery bypass procedure.	50	$10	$560

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 8 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. South Carolina Distribution

John Toole — 0 of 8 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

8 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
33533	4	70	20	$920	$24K
99213	7,105	7,690	100	$60	$10.8K
99215	2,218	2,360	40	$120	$9.3K
99204	3,395	4,520	40	$110	$6.4K
33519	7	20	10	$280	$4.5K
99203	1,995	2,970	30	$70	$3.9K
33518	15	30	10	$240	$3.8K
33508	4	50	30	$10	$250

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Roper Saint Francis Physicians Network	SC	Family Medicine Physician	$0	$2.9M
Roper Saint Francis Physicians Network	SC	Family Medicine Physician	$0	$2.8M
Susan Yonce	SC	Family Nurse Practitioner	$2.3M	$0
Danyel Mcevoy	SC	Anatomic Pathology & Clinical Pathology Physician	$2.3M	$0
Roper Saint Francis Physicians Network	SC	Family Medicine Physician	$0	$1.7M
Roper Saint Francis Physicians Network	SC	Clinical Medical Laboratory	$40.4K	$1.3M
Kathryn Conner	SC	Medical Physician Assistant	$904.3K	$0
Stephen Ramey	SC	Radiation Oncology Physician	$608K	$0
Jeffrey Rieder	SC	Interventional Cardiology Physician	$554.1K	$0
John Mccrosson	SC	Adult Reconstructive Orthopaedic Surgery Physician	$510.8K	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Roper Hospital, Inc	SC	General Acute Care Hospital	$0	$22.1M
Charleston County School District	SC	Local Education Agency (LEA)	$0	$12.7M
Michael Spandorfer	SC	Pulmonary Disease Physician	$246.4K	$0
James Carswell	SC	Critical Care Medicine (Internal Medicine) Physician	$222K	$0
Johnny Campbell	SC	Diagnostic Radiology Physician	$213.4K	$0
Jeffery Bennett	SC	Diagnostic Radiology Physician	$201.7K	$0
Robert Lowery	SC	Orthopaedic Surgery Physician	$197.6K	$0
Edward Butler	SC	Procedural Dermatology Physician	$184.7K	$0
Catherine Johnson-gough	SC	Diagnostic Radiology Physician	$179.4K	$0
Andrew Barnes	SC	Neuroradiology Physician	$178.9K	$0

John Toole — Billing Profile & Reimbursement Data

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John Toole — Billing Profile & Reimbursement Data

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Medicare: Total Revenue Breakdown by CPT/HCPCS Code

Medicare: Complete Services Breakdown

Medicare: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References