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

Why is the Medicaid comparison limited to South Dakota 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. South Dakota (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.

Michael Adler (NPI 1851314124)

Field	Value
Entity Type	Individual
Organization	Michael Adler
Address	2120 Live Stronger St
City	Tea
State	SD
ZIP	57064
Taxonomy	Orthopaedic Surgery Physician
NPI Enumerated	July 26, 2006

Payer Source	Total Paid
Medicare	$407.3K
Medicaid	$0

Key Findings

This provider’s lifetime Medicare footprint is modest but concentrated: total Medicare revenue is $407.3K and there is no Medicaid billing on file, so the practice is effectively single‑payer (Medicare) in the claims data. The NPI was enumerated on 2006-07-26 (~20 years ago), indicating long-tenure practice activity in TEA, SD.

Revenue is highly concentrated in a narrow surgical mix: the precomputed top‑3 Medicare codes account for 84.3% of this provider’s Medicare revenue, with 27447 ($211.1K, 51.8%), 27130 ($107.8K, 26.5%), and 99213 ($24.9K, 6.1%) listed as the principal contributors. This concentration signals that a small set of procedures—primarily joint arthroplasty and related evaluation—drive most of the billing.

The practice appears to be a high‑volume arthroplasty operation based on code mix: 27447 (total knee arthroplasty) and 27130 (total hip arthroplasty) together dominate revenue, and the presence of high counts of consult/new patient visits (99203: 220 claims, $14.7K) and established visit codes (99213: 415 claims, $24.9K) supports a surgical referral and perioperative clinic workflow. Imaging and basic injections (e.g., 73502: 381 claims, $11.4K; 73564: 361 claims, $11.2K; J3301: 801 claims, $801) appear as ancillary services consistent with an orthopaedic surgical practice.

Competitive standing is especially strong for knee replacement: 27447 ranks #67 of 12089 providers nationally (99th percentile; extreme outlier), indicating procedural volume far above typical national providers for that code. Hip replacement volume is also prominent—27130 ranks #132 of 8062 (98th percentile; notably above typical)—so the provider is a notable national outlier on core arthroplasty procedures even though overall Medicare revenue is $407.3K.

Not all service lines are outsized: routine evaluation-and-management coding shows mixed positioning—99213 ranks #36920 of 457151 providers (92th percentile; typical, unremarkable volume) while 99203 ranks #3196 of 161519 (98th percentile; notably above typical). This pattern suggests the practice receives a steady stream of new surgical consults at higher-than-typical rates while routine office follow-up volumes are more in line with broad national peers.

Imaging and minor procedure volumes reinforce the surgical orientation but do not dominate revenue: multiple X‑ray codes (73502: $11.4K, 73564: $11.2K, 73562: $8.5K) and a joint injection code (20610: 128 claims, $4.6K) appear with substantial claim counts and percentile positions described as typically unremarkable to notably above typical. These ancillary revenues supplement arthroplasty income but represent a small share of total Medicare receipts.

Given the extreme concentration in a few high‑revenue procedures, the practice’s financial performance is materially dependent on arthroplasty volume—operational or market changes that affect knee and hip replacement referrals could disproportionately impact overall Medicare revenue. The absence of Medicaid billing on file further concentrates payor exposure to Medicare beneficiaries and the elective surgical market.

Location and tenure context: listed as an Orthopaedic Surgery Physician in TEA, SD with NPI enumeration ~20 years ago, the provider combines long tenure with outlier national procedural rankings for core codes. That mix suggests an established surgeon with a practice profile heavily weighted toward joint replacement services and a referral pipeline that supports unusually high national volumes for 27447 and 27130.

Medicare: Complete Services Breakdown

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

17 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
27447	In this procedure, the provider replaces the damaged weight bearing surfaces of both the medial and lateral compartments in the knee joint using implants of metal or other strong materials. The…	220	$950	$211.1K
27130	In this procedure, the provider surgically replaces the hip joint by prosthesis, or artificial hip joint. He replaces both the femoral and acetabular components with or without using an autograft or…	110	$950	$107.8K
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…	420	$60	$24.9K
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…	220	$70	$14.7K
73502	In this diagnostic procedure, the provider takes X–ray images of one hip, either left or right, from two or three projections (directions or angles) to check for any fracture, swelling, or other…	380	$30	$11.4K
73564	In this procedure, the provider takes four or more X–ray views of the knee joint to check for any fracture, swelling, or reason for pain in the knee area.	360	$30	$11.2K
73562	In this procedure, the provider takes three X–ray images of a patient’s knee joint to check for any fracture, swelling, or reason for pain in the knee area.	330	$30	$8.5K
20610	In this procedure, the provider inserts a needle through the skin of a patient and into a major joint or bursa and then uses the syringe attachment to the needle to remove fluid or he may inject a…	130	$40	$4.6K
29881	The provider examines the inside of the knee joint with an arthroscope. She repairs the joint by removing the meniscus, a crescent shaped cartilage cushion, from either the medial or lateral…	10	$370	$4K
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,…	80	$40	$3K

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

Claims Volume vs. South Dakota Distribution

Michael Adler — 7 of 17 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — South Dakota

Full comparison — all codes billed, vs. state median

17 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
27447	1	100	40	$550	$24.1K
27130	1	60	30	$520	$18.4K
99214	1,548	1,660	90	$70	$11.4K
29881	6	10	10	$500	$7K
99213	82	1,710	80	$50	$6.4K
20610	49	220	60	$40	$3.3K
99203	7	600	30	$60	$2.9K
73721	24	30	20	$60	$2.6K
99212	61	440	30	$30	$1.7K
72110	36	70	30	$30	$1.2K

Showing 1–10 of 17

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Nathan Steinle	CA	Retina Specialist (Ophthalmology) Physician	$9.5M	$0
Prema Abraham	SD	Retina Specialist (Ophthalmology) Physician	$7.1M	$0
Kyle Thompson	ID	Retina Specialist (Ophthalmology) Physician	$4.5M	$0
Douglas Holmes	WY	Retina Specialist (Ophthalmology) Physician	$4.1M	$0
Mitchell Goff	UT	Retina Specialist (Ophthalmology) Physician	$3.8M	$0
Brendan Girschek	AZ	Ophthalmology Physician	$3.2M	$0
Chad Laurich	SD	Vascular Surgery Physician	$3.2M	$0
NPI 1588636484	—	—	$3.2M	$0
Ryan Geraets	SD	Ophthalmology Physician	$3M	$0
John Bormes	SD	Ophthalmology Physician	$2.6M	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Orthopedic Institute PC	SD	Multi-Specialty Clinic/Center	$0	$567.1K
David Jones	SD	Orthopaedic Hand Surgery Physician	$323.9K	$0
Richard Curd	SD	Orthopaedic Hand Surgery Physician	$289.9K	$0
Matthew Mckenzie	SD	Orthopaedic Surgery Physician	$275.6K	$0
Corey Rothrock	SD	Adult Reconstructive Orthopaedic Surgery Physician	$273.3K	$0
Timothy Walker	SD	Orthopaedic Surgery Physician	$261.3K	$0
Jason Hurd	SD	Orthopaedic Surgery Physician	$214.6K	$0
Keith Baumgarten	SD	Orthopaedic Surgery Physician	$210K	$0
James Brunz	SD	Pain Medicine (Anesthesiology) Physician	$202.3K	$0
Matthew Wingate	SD	Orthopaedic Surgery of the Spine Physician	$176K	$0

Michael Adler — Billing Profile & Reimbursement Data

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Key Findings

Medicare: Total Revenue Breakdown by CPT/HCPCS Code

Medicare: Complete Services Breakdown

Medicare: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References