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NPI 1760879217 · Granada Hills, CA · Geriatric Medicine (Family Medicine) Physician
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James Michail is a geriatric medicine (family medicine) physician provider located in Granada Hills, California. This profile covers 43 Medicare and 10 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 | James Michail |
| Address | 10515 Balboa Blvd Ste 290 |
| City | Granada Hills |
| State | CA |
| ZIP | 91344 |
| Taxonomy | Geriatric Medicine (Family Medicine) Physician |
| NPI Enumerated | April 22, 2015 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $20.4M |
| Medicaid | $86.8K |
This provider’s billing is overwhelmingly Medicare-driven: total Medicare revenue is $20.4M versus total Medicaid revenue of $86.8K, indicating the practice is effectively Medicare-focused rather than balanced across payers. The NPI was enumerated 2015-04-22 (~11 years ago), consistent with an established practice that has built a Medicare-centric service line over multiple years.
Medicare revenue is highly concentrated in a small set of product and procedure codes: the precomputed top 3 Medicare codes (Q4236, Q4253, Q4188) account for 89.6% of total Medicare revenue, with Q4236 alone representing $12.4M. All three top codes are amniotic membrane/skin-substitute add-on products, which—together with documented use of skin substitute codes (15271, 15275) and debridement codes (11043, 11042, 11046)—points to a specialized wound-care operation that bills advanced biologic grafts and procedural wound services.
The provider’s code mix shows integrated wound-care workflows: high-volume use of amniotic membrane products (Q4236, Q4253, Q4188), procedural debridement (11043, 11042), and adjunctive device therapy (97610) suggests the practice delivers debridement, biologic coverage, and device-based healing interventions in a coordinated manner. These services are complemented by frequent post-procedure follow-up in facility and home settings, indicating continuity of care across inpatient, nursing facility, and home/residence encounters.
Several Medicare codes identify the provider as a national-level user of specific wound-care technologies and products. Q4236 ranks #5 of 79 nationally (95th percentile; notably above typical national volume) and generated $12.4M in revenue, while 97610 ranks #3 of 320 (99th percentile; extreme outlier) and 15271 ranks #6 of 1157 (100th percentile; extreme outlier), together signaling unusually high utilization of specialized wound therapies compared with national peers.
Beyond device/product dominance, the provider shows unusually high volumes for facility- and home-based E/M services on Medicare: 99349 (home/residence established patient, $336.9K) ranks #22 of 14284 (100th percentile; extreme outlier) and 99232 (subsequent inpatient care, $101.4K) ranks #2245 of 177383 (99th percentile; extreme outlier). These rankings indicate substantial clinical activity in nursing facilities, inpatient settings, and home visits that supports the reported wound-care procedural throughput.
Medicaid activity is small and concentrated but largely typical within-state: the precomputed top 3 Medicaid codes account for 72.3% of Medicaid revenue, led by 99497 ($30.4K, 35.1% of Medicaid revenue) and followed by 99308 ($18.2K) and 99233 ($14.1K). All three Medicaid top codes rank in the middle percentiles in-state (73rd, 60th, 68th percentiles respectively), characterizing the provider as a modest, typical participant in California Medicaid for these services rather than a dominant in-state provider.
The contrast between Medicare and Medicaid suggests reimbursement and utilization patterns differ by payer: high-value Medicare reimbursement for amniotic membrane products and adjunctive wound devices appears to drive the provider’s revenue model, while Medicaid involvement is numerically limited and concentrated in time-based care planning and facility E/M codes. For payers and network planners, this implies the provider’s business case and referral patterns are tightly coupled to Medicare-covered wound products and related follow-up care.
Operationally, the combination of high counts for debridement (11043, 11042), skin substitutes (15271, 15275), device therapy (97610), and frequent post-procedure facility/home visits (99349, 99308, 99309) is consistent with an end-to-end wound-management practice that performs procedural intervention plus longitudinal management. This pattern is reinforced by multiple codes flagged as "extreme outlier" or "notably above typical" versus national peers, which should be interpreted as indicators of unusually high service volumes in these clinical areas rather than indicators of other non-clinical attributes.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
43 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| Q4236 | Carepatch, per square centimeter (add-on, list separately in addition to primary procedure) | 12,840 | $970 | $12.4M |
| Q4253 | Zenith amniotic membrane, per square centimeter (add-on, list separately in addition to primary procedure) | 5,520 | $740 | $4.1M |
| Q4188 | Amnioarmor, per square centimeter (add-on, list separately in addition to primary procedure) | 2,180 | $780 | $1.7M |
| 97610 | The provider uses a low–frequency ultrasound device to try to improve wound healing. | 2,010 | $390 | $780.7K |
| 99349 | The provider sees an established patient for a home or residence visit involving evaluation and management (E/M). The visit involves moderate medical decision making or the provider spends at least… | 3,300 | $100 | $336.9K |
| 11043 | The provider uses surgical instruments to remove the dead tissue in muscle and/or fascia, including any debridement of the epidermis, dermis, and subcutaneous tissue, for the first or only 20 cm2 or… | 1,190 | $190 | $225.1K |
| 99308 | The provider sees a patient for a subsequent nursing facility care visit involving evaluation and management (E/M). The visit involves a low level of medical decision making and/or the provider… | 2,490 | $60 | $146.9K |
| 15271 | The 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. | 910 | $130 | $113.3K |
| 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… | 1,540 | $70 | $101.4K |
| 15275 | The 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… | 460 | $130 | $59.7K |
Showing 1–10 of 43
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 43 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
43 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| Q4236 | 5 | 20 | 3,950 | $960 | $6.2M |
| Q4253 | 2 | 10 | 3,110 | $670 | $2.3M |
| Q4188 | 4 | 30 | 1,120 | $750 | $1.1M |
| 97610 | 3 | 50 | 260 | $390 | $182.8K |
| 11043 | 22 | 370 | 120 | $170 | $52.1K |
| 99309 | 445 | 1,790 | 210 | $80 | $48.1K |
| 99308 | 96 | 1,640 | 190 | $60 | $35.5K |
| 99349 | 7 | 870 | 110 | $90 | $31.7K |
| 11044 | 60 | 110 | 60 | $240 | $29.1K |
| 99233 | 2,743 | 11,530 | 120 | $100 | $26.2K |
Showing 1–10 of 43
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.
10 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 99497 | The provider discusses and shares planning with a patient, his family, or an individual representing the patient, regarding the future health care needs of the patient. Use this code for the first 30… | 520 | $60 | $30.4K |
| 99308 | The provider sees a patient for a subsequent nursing facility care visit involving evaluation and management (E/M). The visit involves a low level of medical decision making and/or the provider… | 670 | $30 | $18.2K |
| 99233 | The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the… | 1,560 | $10 | $14.1K |
| 99309 | The provider sees a patient for a subsequent nursing facility care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or the provider… | 290 | $30 | $7.2K |
| 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… | 90 | $70 | $5.7K |
| 99223 | The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the… | 270 | $20 | $4.6K |
| 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… | 240 | $20 | $3.5K |
| 99306 | The provider sees a patient for an initial nursing facility care visit involving evaluation and management (E/M). The visit involves high medical decision making, and/or the provider spends at least… | 50 | $60 | $2.6K |
| 99239 | The provider sees a patient for hospital inpatient or observation discharge day management, involving evaluation and management (E/M). The provider spends more than 30 minutes on the service on the… | 80 | $1 | $330 |
| 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… | 10 | $10 | $130 |
How this provider's Medicaid billing volume and revenue compare to other California providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. California median
10 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 99233 | The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the… | 864 | 2,670 | 540 | $40 | $183.4K |
| 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… | 1,746 | 2,840 | 490 | $40 | $139.6K |
| 99223 | The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the… | 1,199 | 2,730 | 190 | $90 | $100.3K |
| 99239 | The provider sees a patient for hospital inpatient or observation discharge day management, involving evaluation and management (E/M). The provider spends more than 30 minutes on the service on the… | 541 | 910 | 160 | $50 | $73.4K |
| 99309 | The provider sees a patient for a subsequent nursing facility care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or the provider… | 572 | 1,000 | 440 | $30 | $72K |
| 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… | 707 | 1,280 | 120 | $90 | $56.6K |
| 99308 | The provider sees a patient for a subsequent nursing facility care visit involving evaluation and management (E/M). The visit involves a low level of medical decision making and/or the provider… | 463 | 1,150 | 400 | $20 | $42K |
| 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… | 953 | 1,060 | 140 | $30 | $29.6K |
| 99497 | The provider discusses and shares planning with a patient, his family, or an individual representing the patient, regarding the future health care needs of the patient. Use this code for the first 30… | 165 | 610 | 130 | $40 | $24.9K |
| 99306 | The provider sees a patient for an initial nursing facility care visit involving evaluation and management (E/M). The visit involves high medical decision making, and/or the provider spends at least… | 275 | 430 | 80 | $50 | $22.5K |
Other providers in the same ZIP code as James Michail, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Los Angeles County Department Of Mental Health | CA | Mental Health Clinic/Center (Including Community Mental Health Center) | $0 | $78.6M |
| Richard Park | CA | Internal Medicine Physician | $31.7M | $0 |
| Jacob Offenberger | CA | Allergy & Immunology Physician | $360.6K | $1.5M |
| Sharis Karapetian | CA | Optometrist | $556K | $0 |
| Evelyn Jankowski | CA | Dermatology Physician | $439.5K | $0 |
| Carla Kazimir | CA | Physical Therapist | $157.4K | $0 |
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