Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • NPI Medicare & Medicaid
    • Healthcare Providers
    • Health Insurance Payers
    • States
    • Service Lines
    • Taxonomy Codes
    Lookup tools
    • Billing Code Lookup
    • CPT Modifier Lookup
    • Provider Taxonomy Code Lookup
    • Healthcare Provider & Facility Lookup
    • Health Insurance Payer Lookup
    • Payer Contact Directory

    Policy & Benchmark Tools

    • Prior Authorization Lookup
    • Coverage Criteria Lookup
    • Timely Filing Lookup
    • Billing Code Reimbursement Rates
    • Payer Comparison Dashboard
    • Facility Comparison Dashboard
    • All tools

    Company

    • About OpenPayer
    • Data Sources
    • Trek Health
    OpenPayerby Trek Health
    LinkedInYouTube

    © 2026 Trek Health. All rights reserved.

    OpenPayer is built and maintained by Trek Health.

    v1.0.28
    OpenPayerNPI Medicare & MedicaidJames Whalen
    Ask Trek AI about this page

    James Whalen — Billing Profile & Reimbursement Data

    NPI 1780681064 · Cromwell, CT · MOHS-Micrographic Surgery Physician

    Customize your policy alerts

    Sign up for James Whalen — Billing Profile & Reimbursement Data policy alerts

    Get alerted when relevant policies change without checking for updates manually.

    Monitor payer policy activity

    Receive email alerts as soon as relevant payer policies are published or updated.

    James Whalen is a mohs-micrographic surgery physician provider located in Cromwell, Connecticut. This profile covers 18 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.

    Table of contents

    Progress1 / 8

    Explore openpayer tools

    • Billing CodesCPT, HCPCS, DRG & more
    • Reimbursement RatesCommercial vs. Medicare rate reports
    • ProvidersHospitals & facilities
    • PayersPlans & market footprint
    • Taxonomy CodesNUCC specialty codes
    • ModifiersCPT modifiers & usage
    • Prior AuthorizationPA policies by payer & drug
    • Timely FilingFiling deadlines by payer
    • Coverage CriteriaMedical necessity by payer
    • Payer ContactsClaims, PA & appeals contacts
    View all tools

    Provider details (source: NPPES NPI Registry)

    FieldValue
    Entity TypeIndividual
    OrganizationJames Whalen
    Address1 Willowbrook Rd Ste 2
    CityCromwell
    StateCT
    ZIP06416
    TaxonomyMOHS-Micrographic Surgery Physician
    NPI EnumeratedJuly 1, 2005

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

    Payer SourceTotal Paid
    Medicare$440.6K
    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.

    18 rows

    CPT/HCPCS CodeDescriptionClaimsAvg PaidRevenue
    17311Mohs surgery is a multi–staged procedure that is performed to excise a malignant lesion layer by layer, along with histo–pathological assessment. The assessment is performed to ensure that the…410$560$232.7K
    17312Mohs surgery is a multi–staged method of excising a malignant lesion layer by layer, along with histo–pathological assessment, to ensure negative malignancy of the margins.190$350$67.8K
    12032This CPT® code is used for the intermediate repair of wounds to the scalp, axillae, trunk and/or extremities (excluding hands and feet) that are 2.6 to 7.5 cm in size.120$200$23.6K
    17313Mohs surgery is a multi–staged method of excising a malignant lesion layer by layer, along with histo–pathological assessment, to ensure negative malignancy of the margins.40$530$21.3K
    12052This CPT® code is used for the intermediate repair of wounds to the face, ears, eyelids, nose, lips and/or mucous membranes that are 2.6 to 5.0 cm in size.140$140$19.5K
    99212The 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,…340$50$15.3K
    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…130$90$11.5K
    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…120$70$8.2K
    12042This CPT® code is used for the intermediate repair of superficial wounds to the neck, hands, feet, and/or external genitalia that are 2.6 to 7.5 cm in size.30$170$5.3K
    12051This CPT® code is used for the intermediate repair of wounds to the face, ears, eyelids, nose, lips, and/or mucous membranes that are 2.5 cm or less in size.40$120$5.2K

    Showing 1–10 of 18

    Medicare: Competitive Analysis & Benchmarks

    How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 18 CPT/HCPCS codes.

    View: State1 / 2

    Full comparison — all codes billed, vs. state median

    18 rows

    CPT/HCPCS CodeRankProvider CountMedian ClaimsAvg PaidAverage Revenue
    17311930300$490$149.1K
    173121030150$350$59.2K
    17313183070$500$37.8K
    13132193050$210$15.5K
    13121172060$210$13.7K
    1203257030$210$9.2K
    1205222050$150$8.8K
    992132,1516,44070$60$8.1K
    1205131020$140$5.5K
    1203421020$250$4.5K

    Showing 1–10 of 18

    Related Providers

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

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    University Of Connecticut Health CenterCTGeneral Practice Physician$0$34.8M
    University DentistsCTDental Clinic/Center$0$13.8M
    Michael RuddatCTOphthalmology Physician$2.7M$0
    Asad NasirFLNuclear Medicine Physician$2.2M$0
    Jonathan MoseleyCTInternal Medicine Physician$740$1.2M
    Hanspaul MakkarCTMOHS-Micrographic Surgery Physician$1M$0
    Pareen MehtaCADiagnostic Radiology Physician$1M$0
    University Of Connecticut Health CenterCTClinical Medical Laboratory$396.3K$580.4K
    Yale UniversityCTClinical Medical Laboratory$946.4K$390
    Walter OsiasCADiagnostic Radiology Physician$759.8K$0

    Nearby Providers

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

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    Professional Home Care Services,incCTOxygen Equipment & Supplies (DME)$0$7.8M
    Professional Home Care Services, Inc.CTHome Infusion Therapy Pharmacy$0$4.4M
    Northeast Medical Equipment IncCTDurable Medical Equipment & Medical Supplies$0$3.1M
    Apria Healthcare LLCCTDurable Medical Equipment & Medical Supplies$0$2.8M
    Loveland Eyecare, LLCCTOptometrist$0$1.9M
    Cromwell Fire DistrictCTLand Ambulance$217.9K$681.6K
    Matthew MoyerCTPrimary Care Nurse Practitioner$220.7K$0
    Amy ChenCTDermatology Physician$124.4K$0
    Stephen SiegelCTFamily Medicine Physician$86.2K$0
    Kayla CurtisCTNurse Practitioner$76K$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. Connecticut Distribution
    James Whalen — 2 of 18 codes billed far more than typical (above p95)
    p5–p95 (all providers)p25–p75MedianThis providerOutlier
    Rank Distribution — Connecticut