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

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

David James (NPI 1780667204)

Field	Value
Entity Type	Individual
Organization	David James
Address	185 W Netherwood Rd
City	Oregon
State	WI
ZIP	53575
Taxonomy	Optometrist
NPI Enumerated	November 29, 2005

Payer Source	Total Paid
Medicare	$22.1K
Medicaid	$0

Medicare: Complete Services Breakdown

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

6 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	190	$80	$15K
92273	The provider performs an electrophysiologic test of retinal function, which may be referred to as conventional, full–field or Ganzfeld (ffERG) or flash/focal (fERG) electroretinography to assess…	30	$90	$2.3K
99212	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,…	40	$40	$1.6K
92083	The provider may use one or more methods to determine the extent of a patient's visual field of one or both eyes; he interprets the results and prepares a report. Report this code for an extended…	40	$40	$1.3K
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…	20	$50	$990
92133	The provider performs computerized diagnostic imaging of the optic nerve in the posterior segment (back part) of the eye, interprets the data, and provides a report. The service may be on one or both…	30	$20	$780

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 6 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Wisconsin Distribution

David James — 0 of 6 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Wisconsin

Full comparison — all codes billed, vs. state median

6 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99214	2,003	9,800	80	$70	$9.2K
99213	7,855	9,380	60	$50	$4.7K
92273	9	20	30	$90	$2.5K
92083	292	530	40	$40	$2.4K
92133	323	560	40	$20	$1.5K
99212	519	2,000	30	$30	$1.3K

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
James Maloney	WI	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	$39.1K	$0
Max Melberg	WI	Optometrist	$38.6K	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Walgreen Co	WI	Pharmacy	$212.5K	$9.5K
Oregon Area Fire-ems District	WI	Land Ambulance	$137K	$0
James Dorrance	WI	Physician Assistant	$43.4K	$640

David James — Billing Profile & Reimbursement Data

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David James — Billing Profile & Reimbursement Data

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Medicare: Total Revenue Breakdown by CPT/HCPCS Code

Medicare: Complete Services Breakdown

Medicare: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References