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 U.S. Virgin Islands for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to U.S. Virgin Islands 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. U.S. Virgin Islands (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.

Adam Shapiro (NPI 1780688606)

Key Findings

Field	Value
Entity Type	Individual
Organization	Adam Shapiro
Address	9149 Estate Thomas
City	St Thomas
State	VI
ZIP	00802
Taxonomy	Facial Plastic Surgery Physician
NPI Enumerated	June 9, 2005

Payer Source	Total Paid
Medicare	$81.4K
Medicaid	$0

This profile is effectively single‑payer in the claims on file: Total Medicare revenue is $81.4K and there is no Medicaid billing on file, so Medicaid does not appear in this provider’s claim mix. That concentration means analyses of payer mix should treat this entity as Medicare‑driven rather than balanced across public payers.

Revenue concentration is high within a narrow set of services: the precomputed top 3 Medicare codes by revenue account for 46.6% of this provider's total Medicare revenue, driven by 99213, 95810, and 95811. Those three codes indicate that nearly half of Medicare dollars come from routine outpatient evaluation/management visits (99213) plus polysomnography sleep studies (95810, 95811).

The procedural and diagnostic mix suggests an outpatient ENT/sleep‑focused practice footprint despite a Facial Plastic Surgery Physician taxonomy. High‑revenue codes combine office E/M (99213; $17.1K, 276 claims) with sleep testing (95810 $11.4K, 24 claims; 95811 $9.4K, 19 claims) and ENT diagnostics such as flexible laryngoscopy (31575 $6.9K, 75 claims) and nasal endoscopy (31231 $4.4K, 33 claims). This pattern points to a practice that bills both evaluation visits and a range of diagnostic procedures and lab services.

Several high‑volume lab and diagnostic codes indicate a reliance on many low‑paid, high‑count services: for example 86003 appears 955 times for $4.8K in revenue at an average $5 paid/claim, and 83013 appears 65 times for $4.1K. These entries show revenue driven in part by frequent, low‑unit tests (allergy and H. pylori testing) that supplement visits and procedure revenue.

Competitive standing on core E/M codes is above median but described as ordinary in national context: 99213 ranks #66798 of 457151 (85th percentile) and 99203 ranks #13495 of 161519 (92th percentile), yet both are labeled "typical, unremarkable volume for this code." In other words, the provider has a stronger‑than‑median footprint on routine office visit codes but is not flagged as an extreme outlier nationally.

Sleep diagnostics generate a material share of Medicare dollars but do not show outlier national volume: 95810 and 95811 together contribute $20.8K of revenue and are described as "typical, unremarkable volume for this code" (rank percentiles in the low tens to low thirties). This implies meaningful local demand for polysomnography without an unusually large national presence in sleep testing.

The provider’s NPI tenure is long: NPI enumerated 2005-06-09 (~21 years ago), indicating an established billing history in the Medicare program. That tenure supports using multi‑year trend analysis if additional year‑by‑year claims data are available for follow‑up.

No top Medicare codes are flagged as statistical outliers in the supplied labels; most top codes are explicitly described as "typical, unremarkable volume for this code." From a risk or variation perspective, the profile exhibits routine utilization patterns rather than extreme deviations on the supplied measures.

Medicare: Complete Services Breakdown

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

22 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	280	$60	$17.1K
95810	Polysomnography refers to the continuous and simultaneous monitoring and recording of various physiological and pathophysiological parameters of sleep for six or more hours with physician review,…	20	$480	$11.4K
95811	During the study, the physician monitors the sleep pattern of the patient, along with different bodily functions during the sleep cycle extending over a period of six hours or more.	20	$490	$9.4K
99203	The 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…	120	$60	$7.9K
31575	The provider uses a flexible laryngoscope to look inside the larynx, or voice box, to detect the presence of any abnormalities. This code applies to diagnostic services.	80	$90	$6.9K
86003	The lab analyst performs the technical lab test to analyze a specimen such as serum for allergen–specific immunoglobulin E (IgE), using a crude allergen extract. The test result is quantitative or…	960	$10	$4.8K
31231	In this procedure, the provider inserts an endoscope into the nasal cavity to examine the structures of the nasal cavity on one or both sides.	30	$130	$4.4K
83013	The lab analyst tests multiple breath samples for the presence of an isotope that indicates the presence of the H. pylori bacteria. This organism can cause irritation and ulcers of the stomach lining.	70	$60	$4.1K
99204	The 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…	30	$100	$3.4K
92512	The provider uses this diagnostic test to evaluate the respiratory function of the nose by measuring the airflow during inhalation and exhalation as well as the air pressure in the nose.	60	$40	$2.5K

Showing 1–10 of 22

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Duanne Jones	VI	Public Health Dentistry	$0	$33.2M
Vi Government Hospital And Health Facilities Corp	VI	General Acute Care Hospital	$0	$23.6M
The St Thomas East End Medical Center Corporation	VI	Federal Public Health Clinic/Center	$0	$12.8M
Aac-air Ambulance Caribbean Inc.	VI	Air Ambulance	$2M	$8.6M
Vi Relocation Services And Rentals LLC	VI	Land Ambulance	$0	$6.8M
Alicia Prentice	VI	Home Health Aide	$0	$3.9M
Stretcher Plus, LLC	VI	Non-emergency Medical Transport (VAN)	$0	$2.8M
Cog Restore, LLC	VI	Rehabilitation Clinic/Center	$0	$2.1M
Dept Of Health, Govt Of Vi Ems St Thomas	VI	Land Ambulance	$0	$1.5M
Vi Oral Surgery, Inc	VI	Oral and Maxillofacial Surgery (Dentist)	$0	$1.4M

Adam Shapiro — Billing Profile & Reimbursement Data

Sign up for Adam Shapiro — Billing Profile & Reimbursement Data policy alerts

Adam Shapiro — Billing Profile & Reimbursement Data

Sign up for Adam Shapiro — Billing Profile & Reimbursement Data policy alerts

Key Findings

Medicare: Total Revenue Breakdown by CPT/HCPCS Code

Medicare: Complete Services Breakdown

Medicare: Competitive Analysis & Benchmarks

Nearby Providers

Frequently Asked Questions

References

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99214	61	80	100	$80	$15.5K
95810	2	10	20	$460	$12.1K
95811	2	10	20	$470	$10.9K
31575	2	10	80	$90	$8.1K
99213	14	80	100	$50	$7.6K
83013	2	10	70	$60	$4.4K
99204	20	40	40	$100	$4.4K
86003	1	10	790	$1	$3.9K
99203	4	30	50	$60	$3.8K
31231	1	10	20	$140	$3.5K