Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • NPI Medicare & Medicaid
    • Healthcare Providers
    • Health Insurance Payers
    • States
    • Service Lines
    • Taxonomy Codes
    Lookup tools
    • Billing Code Lookup
    • CPT Modifier Lookup
    • Provider Taxonomy Code Lookup
    • Healthcare Provider & Facility Lookup
    • Health Insurance Payer Lookup
    • Payer Contact Directory

    Policy & Benchmark Tools

    • Prior Authorization Lookup
    • Coverage Criteria Lookup
    • Timely Filing Lookup
    • Billing Code Reimbursement Rates
    • Payer Comparison Dashboard
    • Facility Comparison Dashboard
    • All tools

    Company

    • About OpenPayer
    • Data Sources
    • Trek Health
    OpenPayerby Trek Health
    LinkedInYouTube

    © 2026 Trek Health. All rights reserved.

    OpenPayer is built and maintained by Trek Health.

    v1.0.28
    OpenPayerNPI Medicare & MedicaidJames Dougherty
    Ask Trek AI about this page

    James Dougherty — Billing Profile & Reimbursement Data

    NPI 1629188750 · Williston, VT · Family Medicine Physician

    Customize your policy alerts

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

    Get alerted when relevant policies change without checking for updates manually.

    Monitor payer policy activity

    Receive email alerts as soon as relevant payer policies are published or updated.

    James Dougherty is a family medicine physician provider located in Williston, Vermont. This profile covers 26 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.

    Table of contents

    Progress1 / 9

    Explore openpayer tools

    • Billing CodesCPT, HCPCS, DRG & more
    • Reimbursement RatesCommercial vs. Medicare rate reports
    • ProvidersHospitals & facilities
    • PayersPlans & market footprint
    • Taxonomy CodesNUCC specialty codes
    • ModifiersCPT modifiers & usage
    • Prior AuthorizationPA policies by payer & drug
    • Timely FilingFiling deadlines by payer
    • Coverage CriteriaMedical necessity by payer
    • Payer ContactsClaims, PA & appeals contacts
    View all tools

    Provider details (source: NPPES NPI Registry)

    FieldValue
    Entity TypeIndividual
    OrganizationJames Dougherty
    Address28 Park Ave
    CityWilliston
    StateVT
    ZIP05495
    TaxonomyFamily Medicine Physician
    NPI EnumeratedAugust 30, 2006

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

    Payer SourceTotal Paid
    Medicare$154.9K
    Medicaid$0

    Key Findings

    This provider’s Medicare revenue stream is concentrated in core primary care evaluation-and-management and preventive visit codes: 99214 ($46.1K, 29.9%), G0439 ($25.6K, 16.6%), and 99213 ($18K, 11.6%). The dataset notes that the top three Medicare codes account for 58.1% of total Medicare revenue, which aligns with a typical family medicine practice focused on established-patient visits and annual wellness care.

    Total Medicare revenue is $154.9K while there is no Medicaid billing on file, so the provider is effectively single-payer from a claims perspective and relies entirely on Medicare for reported public-program reimbursement. This payer mix implies limited exposure to Medicaid-managed care streams and suggests a patient panel skewed toward Medicare beneficiaries.

    Competitive standing on key primary-care codes is above many peers nationally: 99214 ranks #37340 of 479517 (92th percentile), G0439 ranks #11263 of 105855 (89th percentile), and 99213 ranks #50165 of 457151 (89th percentile). Despite these upper-percentile ranks, the dataset characterizes volumes for these codes as "typical, unremarkable volume," indicating the provider operates above median activity but within the dataset’s normal operating band for family physicians.

    Preventive services and vaccine administration form a meaningful secondary revenue stream: 90677 (pneumococcal) generated $9K (5.8%), 90662 (influenza) $7.6K (4.9%), and 91320 (COVID vaccine) $5.5K (3.6%). Combined with G0444 (annual depression screening, $3.5K) and G0402 (initial preventive physical exam, $3.5K), the code mix indicates routine in‑office prevention and immunization workflows are in regular use.

    The practice shows a modest in-office laboratory and basic diagnostic footprint rather than a high-volume procedural or imaging clinic: 36415 ($3.1K), 80061 ($2.8K), 80048 ($1.5K), and 83036 ($1.5K) together produce relatively small shares of Medicare revenue and are described in the file as "typical, unremarkable volume." By contrast, imaging code 71046 and some low-volume codes (e.g., 0124A, 80305) appear at low national ranks, consistent with limited imaging/procedural services on site.

    Tenure data show the provider’s NPI was enumerated on 2006-08-30 (~20 years ago), indicating a long-established enrollment in Medicare which supports continuity of care claims patterns and accumulation of routine preventive visit volume over time. This longevity is consistent with the steady mix of established-patient E/M and preventive codes observed.

    Although several E/M and preventive codes sit in upper national percentiles, the overall Medicare revenue scale ($154.9K) is modest in absolute terms and concentrated: reliance on a small set of visit and prevention codes suggests limited diversification of revenue streams within public payers. For payer or network strategy, this profile signals a primarily outpatient, longitudinal primary care practice with constrained procedural or Medicaid-facing activity.

    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.

    26 rows

    CPT/HCPCS CodeDescriptionClaimsAvg PaidRevenue
    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…580$80$46.1K
    G0439Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit200$130$25.6K
    99213The 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…340$50$18K
    99215The 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…120$120$15.4K
    90677This code represents a vaccine product administered intramuscularly to protect against pneumococcal disease, a bacterial infection. This is a 20–valent vaccine, protecting against 20 strains of the…30$270$9K
    90662This code represents a flu vaccine product that is a split virus type, contains no preservatives, and has enhanced effectiveness due to a higher antigen content. It is administered as an injection…110$70$7.6K
    91320This code represents a SARS–CoV–2 vaccine product (tris–sucrose formulation) administered by intramuscular injection to reduce the patient’s risk of contracting COVID–19. The dosage is 30 mcg/0.3 mL.40$130$5.5K
    G0402Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment20$160$3.5K
    G0444Annual depression screening, 5 to 15 minutes190$20$3.5K
    G0008Administration of influenza virus vaccine110$30$3.4K

    Showing 1–10 of 26

    Medicare: Competitive Analysis & Benchmarks

    How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 26 CPT/HCPCS codes.

    View: State1 / 2

    Full comparison — all codes billed, vs. state median

    26 rows

    CPT/HCPCS CodeRankProvider CountMedian ClaimsAvg PaidAverage Revenue
    91320316040$130$18.1K
    992142796090$70$10.6K
    G0439624050$120$8.3K
    9048077110130$40$7.8K
    170003440170$30$7.7K
    992155441040$110$7.2K
    90677178020$270$6.8K
    992137891080$50$6.7K
    906623714050$70$6.1K
    G00086917070$20$3.5K

    Showing 1–10 of 26

    Related Providers

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

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    Evergreen Family Health PartnersVTFamily Medicine Physician$0$626.1K
    Scott PaluskaVTSports Medicine (Family Medicine) Physician$120.7K$3.1K
    Melisa GibsonVTFamily Medicine Physician$90.2K$0
    Tina D'amatoVTFamily Medicine Physician$82.6K$0
    Michael JohnsonVTFamily Medicine Physician$81.1K$0
    Paul ReissVTFamily Medicine Physician$76.3K$0
    Jason LippmanVTSports Medicine (Family Medicine) Physician$68.1K$0
    Rebecca JoyceVTFamily Medicine Physician$64.5K$0
    Preston GrahamVTFamily Medicine Physician$62.5K$0
    Jan FerrisVTFamily Medicine Physician$62.3K$0

    Nearby Providers

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

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    Primary Care Health Partners - Vermont LLPVTFamily Medicine Physician$0$2.8M
    Brian Ashley, Ma, PlcVTPsychologist$0$1M
    Healthdirect Institutional Pharmacy Services, Inc.VTLong Term Care Pharmacy$411.2K$503.7K
    Town Of WillistonVTAmbulance$160.7K$234.6K
    Lisa AngstmanVTClinical Psychologist$116.1K$261.4K
    Benjamin Physical Medicine, PlcVTMedical Specialty Clinic/Center$0$307.8K
    Thomas Chittenden Health Center, PlcVTFamily Medicine Physician$0$288.9K
    Beth MorelliVTMental Health Counselor$0$288.7K
    Sawyer LecompteVTMental Health Counselor$0$284.7K
    Kathleen KelleyVTMental Health Counselor$0$242.3K

    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. Vermont Distribution
    James Dougherty — 8 of 25 codes billed far more than typical (above p95)
    p5–p95 (all providers)p25–p75MedianThis providerOutlier
    Rank Distribution — Vermont