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    OpenPayerNPI Medicare & MedicaidDouglas Toole
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    Douglas Toole — Billing Profile & Reimbursement Data

    NPI 1740543834 · Salt Lake City, UT · Foot & Ankle Surgery Podiatrist

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    Douglas Toole is a foot & ankle surgery podiatrist provider located in Salt Lake City, Utah. This profile covers 12 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.

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    Provider details (source: NPPES NPI Registry)

    FieldValue
    Entity TypeIndividual
    OrganizationDouglas Toole
    Address6405 S 3000 E Ste 201
    CitySalt Lake City
    StateUT
    ZIP84121
    TaxonomyFoot & Ankle Surgery Podiatrist
    NPI EnumeratedJune 22, 2012

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

    Payer SourceTotal Paid
    Medicare$1.6M
    Medicaid$0

    Key Findings

    This Salt Lake City Foot & Ankle Surgery Podiatrist has generated $1.6M in total Medicare revenue and shows no Medicaid billing on file, making the practice effectively single-payer (Medicare) from a claims perspective. The provider’s NPI was enumerated 2012-06-22 (~14 years ago), indicating an established tenure in the Medicare program that aligns with a focused specialty practice rather than a new entrant.

    Revenue is extremely concentrated in wound-care/skin-substitute add-on products: Q4248 accounts for $1.1M (69.1% of Medicare revenue), Q4204 accounts for $356.8K (22.3%), and 97610 accounts for $81.4K (5.1%). Precomputed figures show these top three codes together make up 96.5% of the provider’s Medicare revenue, signaling high dependence on a very small set of procedure codes for the practice’s income.

    Service-line implications from the code mix point to a practice built around advanced wound care and biologic skin-substitute use rather than routine office-based E/M encounters. The dominance of Q4248 (Dermacyte amniotic membrane) and Q4204 (Xwrap) — both add-on, per-square-centimeter graft products — plus 97610 (low-frequency ultrasound for wound healing) indicates procedural throughput focused on treating complex lower-extremity wounds, consistent with podiatric wound-management services.

    Competitive standing on Medicare is mixed: Q4248 ranks #7 of 18 nationally (65th percentile) and is labeled a typical, unremarkable volume for that code, suggesting the provider is a visible but not dominant national participant in Dermacyte use. Q4204 ranks #6 of 7 nationally (17th percentile) with typical, unremarkable volume, implying limited peer presence for Xwrap nationally and that the provider’s high dollar share is more a function of price/volume concentration than broad market dominance.

    For 97610 (low-frequency ultrasound), the provider ranks #113 of 320 nationally (64th percentile) and is described as typical, unremarkable volume, indicating a moderate footprint in the noninvasive wound-therapy space. Other billed codes (e.g., 11042, 15275, 15271) contribute only modest amounts of revenue individually and also show percentile placements that are generally in the typical range, reinforcing the view that the practice’s Medicare profile is concentrated and specialized rather than broadly diversified.

    Payer-mix and exposure implications: with no Medicaid billing on file, the provider has virtually all recorded public-payer revenue tied to Medicare. This single-payer concentration increases operational sensitivity to Medicare policy, reimbursement changes, or utilization shifts for high-revenue add-on graft codes (Q4248 and Q4204), because those two codes alone represent a combined majority of the $1.6M Medicare revenue.

    Ancillary/local-service footprint is small relative to the specialty-driven revenue: E/M and home-visit codes such as 99213, 99348, and 99347 appear with minimal revenue (hundreds to low thousands of dollars) and low claim counts, confirming that office-based evaluation and management is not a primary revenue driver. Low-revenue, low-volume items like 0640T also appear but do not materially affect the provider’s overall Medicare revenue profile.

    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.

    12 rows

    CPT/HCPCS CodeDescriptionClaimsAvg PaidRevenue
    Q4248Dermacyte amniotic membrane allograft, per square centimeter (add-on, list separately in addition to primary procedure)1,340$830$1.1M
    Q4204Xwrap, per square centimeter (add-on, list separately in addition to primary procedure)380$950$356.8K
    97610The provider uses a low–frequency ultrasound device to try to improve wound healing.240$340$81.4K
    11042The provider uses surgical instruments to remove the dead tissue in skin down to the subcutaneous layer and including the epidermis and dermis, up to the first 20 cm2.190$90$17.8K
    15275The provider uses a skin substitute, such as an allograft or xenograft, to cover wounds on the face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, up to…100$120$11.5K
    99348The provider sees an established patient for a home or residence visit involving evaluation and management (E/M). The visit involves low medical decision making or the provider spends at least 30…190$60$11.2K
    15271The provider uses a skin substitute, such as an allograft or xenograft, to cover wounds on the patient’s trunk, arms, and/or legs up to an area of 100 cm2. This code covers up to the first 25 cm2.90$110$10.1K
    97597The provider excises devitalized (dead) tissue from an open wound, choosing from a variety of techniques; treatment may include topical application of medicine or materials, wound assessment,…40$80$3.1K
    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…20$60$1.4K
    99342The provider sees a new patient for a home or residence visit involving evaluation and management (E/M). The visit involves a low level of medical decision making or the provider spends at least 30…20$50$970

    Showing 1–10 of 12

    Medicare: Competitive Analysis & Benchmarks

    How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 12 CPT/HCPCS codes.

    View: State1 / 2

    Full comparison — all codes billed, vs. state median

    12 rows

    CPT/HCPCS CodeRankProvider CountMedian ClaimsAvg PaidAverage Revenue
    Q4248110860$820$760.7K
    Q4204210540$1,020$551.7K
    97610110100$310$41.1K
    15275710100$110$9.8K
    110422612090$70$9.1K
    1527172080$100$9.1K
    992133,0563,68060$50$6.4K
    99348159070$50$5K
    97597225040$60$4K
    99342102020$50$2.3K

    Showing 1–10 of 12

    Related Providers

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

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    Jacqueline WalkerNVNurse Practitioner$3.4M$0
    Nicholas HugentoblerCOFoot & Ankle Surgery Podiatrist$1.9M$0
    Michelle WilliamsUTNurse Practitioner$1.1M$0
    Innovation Medical Group PCUTPodiatrist$0$741.2K
    Shawn IsaeffUTVascular & Interventional Radiology Physician$668K$0
    Aaron FrodshamUTVascular & Interventional Radiology Physician$484K$0
    Christopher WarnerCOVascular & Interventional Radiology Physician$448.8K$0
    Sloane SterlingUTPhysician Assistant$303.1K$0
    Howard SillMDVascular & Interventional Radiology Physician$216.3K$170
    Jeremy JoyalUTPain Medicine (Anesthesiology) Physician$179.5K$3.4K

    Nearby Providers

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

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    Evolve Emod LLCUTHome Modifications Contractor$0$23.9M
    Mountain Land Rehabilitation LLCUTPhysical Therapist$0$4M
    Rosewood Assisted Care IncUTAssisted Living Facility$0$3.2M
    Bristol Hospice - Utah Ii, L.L.C.UTCommunity Based Hospice Care Agency$0$2.6M
    Journey Treatment CenterUTSubstance Abuse Rehabilitation Facility$0$1.9M
    Big Smiles Utah P.C.UTDentist$0$1.3M
    J Q Medical Supply, LLCUTDurable Medical Equipment & Medical Supplies$0$1.2M
    Transport Connection, IncUTPrivate Vehicle$0$806.7K
    Utah Gastroenterology LLCUTGastroenterology Physician$0$613.8K
    Spencer ClarkUTPhysical Therapist$494K$13.7K

    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. Utah Distribution
    Douglas Toole — 2 of 12 codes billed far more than typical (above p95)
    p5–p95 (all providers)p25–p75MedianThis providerOutlier
    Rank Distribution — Utah