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

Why is the Medicaid comparison limited to West Virginia 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. West Virginia (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.

James Spychalski (NPI 1689630741)

Field	Value
Entity Type	Individual
Organization	James Spychalski
Address	1212 Garfield Ave Ste 202
City	Parkersburg
State	WV
ZIP	26101
Taxonomy	Family Medicine Physician
NPI Enumerated	April 26, 2006

Payer Source	Total Paid
Medicare	$405.3K
Medicaid	$0

Key Findings

This provider’s billing is effectively single‑payer: total Medicare revenue is $405.3K and there is no Medicaid billing on file, so Medicaid does not appear in this provider’s payer mix. That concentration means the provider’s reported business activity and revenue are driven entirely by Medicare fee‑for‑service claims in the available data.

Revenue concentration is meaningful at the top of the Medicare profile: the precomputed top three Medicare codes (99232, 99222, 99238) together account for 36.1% of this provider’s total Medicare revenue. Individually those codes generate $62.4K (16.0%), $48.9K (12.5%), and $29.5K (7.6%) respectively, so a little over one‑third of Medicare dollars come from a small group of inpatient E/M services.

The code mix indicates a hospital‑focused practice model: the top revenue drivers are inpatient and observation evaluation/management codes (99232, 99222, 99238) and the provider also bills 99235 (same‑day admission/discharge). High claim counts for those inpatient codes (99232: 1.1K claims; 99222: 532 claims; 99238: 518 claims) point to frequent hospital encounters rather than a purely office‑based primary care panel.

The provider is a national high‑volume outlier on several hospital E/M measures: 99222 is labeled an "extreme outlier" and ranks #204 of 117621 providers nationally (100th percentile), 99238 also ranks at the 100th percentile and is labeled "extreme outlier," and 99232 ranks in the 98th percentile and is described as "notably above typical". These rankings indicate this clinician bills these inpatient E/M codes at volumes well above the typical national provider.

Ancillary laboratory and specimen services form a second visible revenue stream: large volumes of blood draws and routine labs appear throughout the top codes (36415: 3K claims, $23.9K revenue; 84443: 1.5K claims, $24.6K revenue; 80061: 1.7K claims, $21.9K revenue; 82306: 723 claims, $21K revenue; 85025: 2K claims, $15.6K revenue). The combination of high specimen collection counts and multiple common panels suggests the provider either performs on‑site phlebotomy or regularly orders lab panels tied to ongoing inpatient and outpatient care.

Absence of Medicaid activity creates payer diversification risk: with $405.3K in Medicare revenue and "none" reported for Medicaid, the provider’s publicly reported revenue streams rely entirely on Medicare fee‑for‑service. That concentration could affect revenue stability and local contracting dynamics where Medicaid participation or dual‑eligible populations are material to competitive positioning.

The provider has an established billing tenure, with the NPI enumerated on 2006-04-26 (~20 years ago), indicating a long period of enrollment that aligns with sustained, high‑volume Medicare inpatient billing patterns. This longevity supports the interpretation that the inpatient and lab activity represent ongoing operations rather than a brief episodic pattern.

Other outpatient evaluation/management codes and care‑transition services are present but smaller contributors: 99214 and 99213 generate $22.6K (5.8%) and $17.7K (4.5%) respectively, while transitional care code 99496 appears with 24 claims and $4.4K revenue. Annual wellness visits are minimal (G0439: 20 claims, $2.3K revenue and a 15th percentile rank), suggesting preventive primary care visits are a relatively minor component of billed Medicare activity compared with inpatient management and lab services.

Medicare: Complete Services Breakdown

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

44 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
99232	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	1,110	$60	$62.4K
99222	The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	530	$90	$48.9K
99238	The provider sees a patient for hospital inpatient or observation discharge day management, involving evaluation and management (E/M). The provider spends 30 minutes or less on the service on the…	520	$60	$29.5K
84443	The lab analyst performs a test to measure the amount of thyroid–stimulating hormone (TSH), a hormone produced in the pituitary gland that helps regulate thyroid function. The typical specimen is the…	1,540	$20	$24.6K
36415	In this procedure, the provider inserts a needle into a vein to collect a blood sample.	2,980	$10	$23.9K
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…	330	$70	$22.6K
80061	The lab analyst performs a lipid panel test in which he measures the blood level of cholesterol and fats called triglycerides in the blood.	1,680	$10	$21.9K
82306	The lab analyst measures the vitamin D level, typically on a serum specimen. This analyte, commonly known as vitamin D, is not really a vitamin, but is an important steroid hormone that is produced…	720	$30	$21K
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…	350	$50	$17.6K
99231	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a straightforward or low level of medical…	500	$40	$17.4K

Showing 1–10 of 44

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 44 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. West Virginia Distribution

James Spychalski — 13 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — West Virginia

Full comparison — all codes billed, vs. state median

44 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99232	26	1,340	90	$60	$11.9K
99214	382	2,740	100	$70	$11.8K
G0439	471	560	60	$120	$9.3K
99213	272	2,860	80	$50	$7.5K
82306	4	40	40	$30	$6.1K
84443	4	60	70	$20	$4.7K
90662	274	310	50	$70	$4.6K
99222	1	1,080	30	$100	$4.5K
80053	13	70	100	$10	$4.3K
80061	4	60	60	$10	$4.3K

Showing 1–10 of 44

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Charleston Area Medical Center Inc	WV	General Acute Care Hospital	$0	$200.1M
Ohiohealth Corporation	OH	Family Medicine Physician	$0	$89.1M
Charleston Area Medical Center, Inc.	WV	General Acute Care Hospital	$0	$50.9M
Columbus Radiology Corp	OH	Diagnostic Radiology Physician	$0	$49.9M
Somc Medical Care Foundation, Inc.	OH	Family Medicine Physician	$0	$25.3M
Rainelle Medical Center Inc	WV	Federally Qualified Health Center (FQHC)	$0	$14.3M
Mark Le	FL	Diagnostic Radiology Physician	$10.7M	$0
Rajiv Khanna	WV	Medical Oncology Physician	$2M	$0
Pars Neurosurgical Associates, Inc	WV	Neurological Surgery Physician	$0	$1.5M
Charleston Area Medical Center, Inc.	WV	Hospitalist Physician	$0	$1.4M

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Rscr West Virginia, Inc.	WV	Developmental Disabilities Clinic/Center	$0	$153.6M
Camden Clark Memorial Hospital Corporation	WV	General Acute Care Hospital	$0	$56.2M
St. Joseph Recovery Center, LLC	WV	Substance Use Disorder Rehabilitation Clinic/Center	$0	$49.5M
Westbrook Health Services, Inc	WV	Community/Behavioral Health Agency	$0	$42.5M
Westbrook Health Services, Inc.	WV	Community/Behavioral Health Agency	$0	$32.6M
Camden-clark Physician Corporation	WV	Surgery Physician	$0	$19.8M
Wv Family Support And Rehabilitation Services	WV	Community/Behavioral Health Agency	$0	$19.4M
Clean & Clear Advantage, LLC	WV	Addiction (Substance Use Disorder) Counselor	$0	$18.3M
Mjs Enterprises Inc	WV	Land Ambulance	$960.2K	$8.7M
Camden Clark Memorial Hospital Corporation	WV	Land Ambulance	$874.9K	$5.3M

James Spychalski — 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