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    OpenPayerNPI Medicare & MedicaidKalpesh Mistry
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    Kalpesh Mistry — Billing Profile & Reimbursement Data

    NPI 1740717669 · Toccoa, GA · Family Medicine Physician

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    Kalpesh Mistry is a family medicine physician provider located in Toccoa, Georgia. This profile covers 17 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
    OrganizationKalpesh Mistry
    Address115 Rock Quarry Rd
    CityToccoa
    StateGA
    ZIP30577
    TaxonomyFamily Medicine Physician
    NPI EnumeratedMay 23, 2017

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

    Payer SourceTotal Paid
    Medicare$65.8K
    Medicaid$0

    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.

    17 rows

    CPT/HCPCS CodeDescriptionClaimsAvg PaidRevenue
    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…240$50$12.8K
    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,…490$30$12.7K
    11044The provider uses surgical instruments to remove the dead, infected tissue in bone, also including the epidermis, dermis, subcutaneous tissue, muscle, and/or fascia as needed. This code covers the…40$170$6.2K
    97598After debriding the initial 20 cm2 at the same encounter, the provider excises devitalized (dead) tissue from an open wound. He may use a variety of techniques that include sharp debridement with…290$20$5.5K
    99203The provider sees a new 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 provider…70$70$5.2K
    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…60$80$4.3K
    99205The 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…30$130$4.3K
    87635Using an amplified nucleic acid probe technique, the lab analyst performs the necessary steps to identify the nucleic acids from the severe acute respiratory syndrome coronavirus 2 (SARS–COV–2) virus…70$50$3.6K
    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 cm2.80$40$3.5K
    99204The provider sees a new 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 provider…20$110$2.7K

    Showing 1–10 of 17

    Medicare: Competitive Analysis & Benchmarks

    How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 17 CPT/HCPCS codes.

    View: State1 / 2

    Full comparison — all codes billed, vs. state median

    17 rows

    CPT/HCPCS CodeRankProvider CountMedian ClaimsAvg PaidAverage Revenue
    1104491070$200$36K
    992149,46513,640120$80$17.8K
    992132,63413,36080$60$9.2K
    1104210424070$70$8.3K
    992152,0663,27030$120$7.7K
    992055881,58030$150$5.4K
    992044,5397,26030$110$5.1K
    97597415050$50$4.5K
    992039375,35030$70$3.3K
    9759831080$20$2.8K

    Showing 1–10 of 17

    Related Providers

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

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    Stephens County Hospital Physician Group LLCGAInternal Medicine Physician$0$562.4K
    Marc CoanGAInternal Medicine Physician$261.3K$0
    Allison DupontGAInterventional Cardiology Physician$246.6K$0
    Pradyumna TummalaGAInterventional Cardiology Physician$166K$0
    Mark LeimbachGAInterventional Cardiology Physician$135K$0
    Oguguo OkoyeGAEmergency Medicine Physician$134.3K$0
    Mary RichardsonSCAnatomic Pathology & Clinical Pathology Physician$83.9K$690
    David HurrayMTDermatopathology (Pathology) Physician$84.3K$0
    Farah BrownKYDiagnostic Radiology Physician$76.5K$0
    Merrie HambyGAFamily Nurse Practitioner$74.4K$0

    Nearby Providers

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

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    Pittard Clinic LLCGAMethadone Clinic$279.9K$0
    Muhammad AliGANephrology Physician$232.5K$0
    Lori HefferGAClinical Social Worker$0$222.7K
    Lenka NovotnaGAFamily Medicine Physician$159.7K$0
    Robin SweatGAFamily Nurse Practitioner$103.2K$0
    Joseph DeboskeyGAPodiatrist$71.5K$0
    Kandi WillisGAPhysician Assistant$41.6K$0

    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. Georgia Distribution
    Kalpesh Mistry — 1 of 15 codes billed far more than typical (above p95)
    p5–p95 (all providers)p25–p75MedianThis providerOutlier
    Rank Distribution — Georgia