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

Why is the Medicaid comparison limited to Montana 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. Montana (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.

Melody Nelsen (NPI 1669519930)

Field	Value
Entity Type	Individual
Organization	Melody Nelsen
Address	500 W. Broadway
City	Missoula
State	MT
ZIP	59802
Taxonomy	Rheumatology Physician
NPI Enumerated	January 30, 2007

Payer Source	Total Paid
Medicare	$2M
Medicaid	$0

Key Findings

MELODY NELSEN’s billing mix is consistent with a rheumatology practice that delivers in-office biologic therapy and procedural care: the top revenue drivers are injectable biologics (J1602, J0129, J3262) and the portfolio includes infusion-administration codes (96365, 96413, 96415) plus joint injection codes (20610, 20600, 20605). This pattern indicates the operation is organized to provide supervised infusions and on-site administration rather than being limited to office consults only.

Revenue concentration is high: the precomputed top‑3 Medicare codes account for 68.4% of this provider’s total Medicare revenue, with J1602 contributing $601.5K (30.8%), J0129 $375.7K (19.3%), and J3262 $358.4K (18.4%) of the $2M Medicare lifetime revenue. Those three biologic drugs therefore represent the majority of reported Medicare income and drive the practice’s overall financial profile.

Payer mix is effectively single‑payer Medicare: total Medicare revenue is $2M while Medicaid shows none (no Medicaid billing on file). The absence of Medicaid activity means the provider’s public‑program exposure and reimbursement mix are concentrated in Medicare, which has implications for patient access and reimbursement negotiation.

Competitive standing is uneven across drugs: J1602 ranks #25 of 1041 providers nationally (98th percentile) and is described as notably above typical national volume, signaling a national‑level outlier or major participant for golimumab administration. By contrast, J0129 (rank #419 of 1221, 66th percentile) and J3262 (rank #124 of 618, 80th percentile) sit in more typical national bands, indicating high specialization around J1602 but more modest market positions for other biologics.

Operational throughput is supported by high relative volumes of infusion and E/M activity: 96365 has 653 claims and $33.3K revenue (1.7% of total) and ranks in the 97th percentile (notably above typical), while 99214 has 772 claims and $64.8K revenue (3.3% of total) and ranks in the 96th percentile (notably above typical). These elevated percentiles for both an infusion administration code and a mid‑level E/M code suggest the practice runs frequent infusion sessions accompanied by substantial established‑patient follow‑up.

Despite biologics dominating revenue, direct clinical encounters and procedures contribute only a small share of Medicare revenue; for example, 99214 accounts for $64.8K (3.3%) and 96365 $33.3K (1.7%) of the $2M total. This split indicates that pharmaceutical reimbursement is the primary income source while office visits and procedures are secondary revenue streams.

The provider has long tenure in the Medicare program, with an NPI enumerated on 2007-01-30 (~19 years ago), which supports the likelihood of an established referral base and operational stability necessary to sustain high biologic infusion volumes. Longevity combined with the J1602 outlier position suggests these patterns are not new or solely transient.

The lack of any Medicaid billing on file points to minimal engagement with state Medicaid programs and creates payer concentration risk: the practice’s revenue and access strategy appear tied to Medicare beneficiaries and commercially insured patients who receive infused biologics. For payers and network planners, this profile highlights a provider with concentrated Medicare exposure and limited demonstrated experience with Medicaid populations.

Medicare: Complete Services Breakdown

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

28 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J1602	Injection, golimumab, 1 mg, for intravenous use	60,150	$10	$601.5K
J0129	Injection, abatacept, 10 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)	11,050	$30	$375.7K
J3262	Injection, tocilizumab, 1 mg	71,680	$10	$358.4K
J9312	Injection, rituximab, 10 mg	4,000	$60	$252K
J1745	Injection, infliximab, excludes biosimilar, 10 mg	3,080	$30	$80.1K
J0717	Injection, certolizumab pegol, 1 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)	20,000	$1	$80K
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…	770	$80	$64.8K
96365	The provider administers the initial intravenous infusion of a medication or other substance for a period up to one hour to prevent, treat, or diagnose a condition or disease.	650	$50	$33.3K
J0897	Injection, denosumab, 1 mg	1,680	$20	$30.2K
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…	250	$70	$18.1K

Showing 1–10 of 28

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 28 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Montana Distribution

Melody Nelsen — 7 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Montana

Full comparison — all codes billed, vs. state median

28 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J1602	1	10	17,870	$10	$287.4K
J3262	2	10	51,720	$1	$272.3K
J0129	1	10	6,880	$30	$252.9K
J9312	1	10	3,730	$60	$233.5K
J1745	2	10	3,080	$30	$122.5K
J0717	1	10	20,000	$1	$77.6K
J0897	4	10	1,200	$20	$27.2K
99214	40	1,810	100	$70	$12.4K
96413	2	10	60	$100	$11.3K
99215	265	780	40	$100	$7.9K

Showing 1–10 of 28

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Western Montana Clinic PC	MT	Multi-Specialty Clinic/Center	$0	$8.7M
Providence Health & Services Mt	MT	Emergency Medicine Physician	$0	$8.2M
Providence Health & Services Mt	MT	Family Medicine Physician	$0	$5.7M
Providence Health & Services Mt	MT	Family Medicine Physician	$0	$4.9M
Scott Guess	MT	Ophthalmology Physician	$2.7M	$72.4K
Providence Health & Services Mt	MT	General Acute Care Hospital	$0	$2.4M
Western Montana Clinic PC	MT	Clinical Medical Laboratory	$668.9K	$1.7M
Providence Health & Services Mt	MT	Psychiatric/Mental Health Nurse Practitioner	$0	$1.8M
Rebecca Belsom	MT	Rheumatology Physician	$1.4M	$0
Ann Corsi	MT	Rheumatology Physician	$656.8K	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Consumer Direct District Of Columbia	MT	In Home Supportive Care Agency	$0	$393.2M
Youth Homes	MT	Emotionally Disturbed Childrens' Residential Treatment Facility	$0	$9.7M
Providence Surgery Center	MT	Ambulatory Surgical Clinic/Center	$1.6M	$3.5M
Partnership For Children	MT	Emotionally Disturbed Childrens' Residential Treatment Facility	$0	$4.7M
Gary Wingfield	MT	Assisted Living Facility	$0	$4.7M
Blue Mountain Clinic, Inc.	MT	Family Medicine Physician	$0	$1.4M
Youth Homes	MT	Community/Behavioral Health Agency	$0	$972.2K
Partnership For Children	MT	Community/Behavioral Health Agency	$0	$937.8K
County Of Missoula	MT	Public Health or Welfare Agency	$81.3K	$657.1K
Missoula Alf Operations, LLC	MT	Assisted Living Facility	$0	$675.4K

Melody Nelsen — Billing Profile & Reimbursement Data

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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