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NPI 1649292640 · St Thomas, VI · Nephrology Physician
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Walter Rohloff is a nephrology physician provider located in St Thomas, U.S. Virgin Islands. This profile covers 4 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 | Walter Rohloff |
| Address | 9149 Estate Thomas Ste 209a |
| City | St Thomas |
| State | VI |
| ZIP | 00802 |
| Taxonomy | Nephrology Physician |
| NPI Enumerated | July 25, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $100.3K |
| Medicare | $85.2K |
Provider is a dual-payer outpatient nephrology practice with comparable lifetime Medicare and Medicaid scale: Total Medicare revenue is $85.2K while total Medicaid revenue is $100.3K, indicating modestly higher Medicaid activity but overall similar magnitude across the two payers. Both payers drive practice volume through a narrow set of services rather than broad primary-care billing.
Revenue is highly concentrated in a small set of services for each payer: the top 3 Medicare codes account for 97.1% of this provider's total Medicare revenue, and the top 3 Medicaid codes account for 100.0% of this provider's total Medicaid revenue. This concentration suggests the clinic’s financial performance is tightly dependent on a few high-yield nephrology/E/M codes rather than a wide mix of low-value items.
Clinical mix shows an ESRD/outpatient dialysis management focus: code 90960 (monthly ESRD management) is the single largest revenue driver with $49K (57.4% of Medicare revenue) and $69K (68.6% of Medicaid revenue), while E/M codes 99214 and 99205 together make up the balance of billed visits. The presence of 90960 as the dominant code, together with E/M visits, indicates the provider primarily manages chronic end-stage renal disease patients with regular face-to-face monthly care.
Procedural hemodialysis activity is present but limited: Medicare billing includes 90937 with 33 claims and $2.5K revenue (2.9% of Medicare revenue), and ranks #165 of 280 providers nationally with a characterization of typical, unremarkable volume. The small share of revenue from 90937 relative to 90960 implies the provider’s role may emphasize ESRD care coordination and E/M visits more than performing the bulk of dialysis procedures.
Competitive standing on Medicare is modest: 90960 ranks #2440 of 6549 providers nationally (62th percentile; typical, unremarkable volume), 99214 ranks #84985 of 479517 (82th percentile; typical, unremarkable volume), and 99205 ranks #14960 of 66257 (77th percentile; typical, unremarkable volume). These percentiles indicate respectable but not dominant national positioning for the provider’s top billing codes — the provider is a typical volume participant rather than a high-volume leader.
State-level Medicaid presence appears limited and sensitive to small peer counts: 90960 ranks #4 of 4 providers in-state (0th percentile; typical, unremarkable volume) while 99214 ranks #26 of 43 providers in-state (40th percentile; typical, unremarkable volume). The in-state ranking for 90960 should be interpreted cautiously because the listed peer set is very small, and the provider does not appear to dominate the statewide market for ESRD management.
Payment patterns differ by payer at the claim level: for 90960 the avg paid/claim is $254 on Medicare versus $162 on Medicaid, and for 99214 the avg paid/claim is $79 on Medicare versus $71 on Medicaid (99205 averages $142 on Medicare). These per-claim differences show Medicare pays materially more per 90960 encounter than Medicaid, which will affect revenue mix even when visit volume is similar.
Provider tenure is long-standing: NPI was enumerated 2006-07-25 (~20 years ago), indicating stable enrollment and a prolonged presence in the Medicare/Medicaid systems. That tenure supports interpretation of the observed code mix as an established practice pattern rather than a transient billing profile.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
4 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 90960 | The provider manages all the services associated with the monthly care of a patient who is 20 years old or older and has a condition known as end stage renal disease or ESRD. For this service, the… | 190 | $250 | $49K |
| 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… | 340 | $80 | $27.2K |
| 99205 | The provider sees a new 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 provider… | 50 | $140 | $6.7K |
| 90937 | Hemodialysis is a procedure that involves drawing blood via an intraarterial or intravenous catheter, then sieving it through a semipermeable membrane to remove the impurities and finally transfusing… | 30 | $80 | $2.5K |
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 4 CPT/HCPCS codes.
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 |
|---|---|---|---|---|
| 90960 | The provider manages all the services associated with the monthly care of a patient who is 20 years old or older and has a condition known as end stage renal disease or ESRD. For this service, the… | 430 | $160 | $69K |
| 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… | 450 | $70 | $31.6K |
How this provider's Medicaid billing volume and revenue compare to other U.S. Virgin Islands providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. U.S. Virgin Islands median
2 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average 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… | 26 | 40 | 560 | $140 | $322K |
| 90960 | The provider manages all the services associated with the monthly care of a patient who is 20 years old or older and has a condition known as end stage renal disease or ESRD. For this service, the… | 4 | 10 | 1,020 | $150 | $136.9K |
Other providers in the same ZIP code as Walter Rohloff, ranked by combined Medicare and Medicaid revenue.
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