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

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

William Hogan (NPI 1861427411)

Field	Value
Entity Type	Individual
Organization	William Hogan
Address	235lakemont Rd
City	Newport
State	VT
ZIP	05855
Taxonomy	Physical Therapist
NPI Enumerated	July 12, 2006

Payer Source	Total Paid
Medicare	$178K
Medicaid	$0

Key Findings

This provider’s billings are effectively single-payer Medicare: total Medicare revenue is $178K and there is no Medicaid billing on file, so Medicaid contributes $0 to the recorded lifetime revenue and the provider appears to operate without recorded Medicaid participation. The NPI was enumerated 2006-07-12 (~20 years ago), indicating a long-enumerated practitioner with an established billing history concentrated in Medicare.

Revenue is highly concentrated in a narrow set of PT services: the precomputed top-3 Medicare codes account for 83.8% of this provider’s total Medicare revenue, driven by 97140 ($85.3K, 47.5%), 97110 ($37.9K, 21.1%), and 97164 ($27.4K, 15.2%). That concentration signals that a small number of procedure types dominate the financial profile rather than a broad mix of services.

The code mix and utilization pattern point to a hands-on, high-frequency outpatient physical therapy practice: 97140 (manual therapy) shows 4.7K claims at $18 avg paid/claim and 97110 (therapeutic exercise) shows 1.9K claims at $20 avg paid/claim, while 97164 (PT re-evaluation) appears 547 times at $50 avg paid/claim. High claim counts with relatively low per-claim payments are consistent with repeated, brief treatment visits focused on manual therapy and exercise with periodic re-evaluations.

Competitive standing is uneven by code: the provider is a national outlier on several high-revenue procedures—97140 ranks #134 of 65133 providers nationally (100th percentile; extreme outlier) and 97164 ranks #6 of 9023 providers nationally (100th percentile; extreme outlier)—indicating exceptionally high national volume for those specific services despite modest total Medicare revenue. At the same time, other common PT codes show ordinary participation: for example, 97110 ranks #7305 of 79999 providers nationally (91th percentile; typical, unremarkable volume).

Beyond the two extreme outlier codes, a mix of above-average and typical standings suggests specialization rather than across-the-board high utilization: 97035 ranks #32 of 5010 providers nationally (99th percentile; extreme outlier) and 97163 ranks #161 of 6562 providers nationally (98th percentile; notably above typical), while 97112 ranks #31724 of 61940 providers nationally (49th percentile; typical, unremarkable volume). This pattern indicates pockets of exceptional activity in manual modalities and higher-complexity re-evaluations alongside otherwise typical PT coding.

From a payer/contracting perspective, the combination of concentrated revenue (83.8% from top-3 codes) and national outlier ranks on specific manual-therapy and re-evaluation codes suggests these CPTs warrant targeted utilization review or peer-comparison monitoring rather than a broad-based audit: focused checks on frequency, session duration, and documented medical necessity for repeated 97140 sessions and frequent 97164 re-evaluations would be the most data-directed approach.

The absence of any Medicaid billing on file has network and access implications in Vermont: with $178K in Medicare revenue and no recorded Medicaid activity, this provider is effectively not contributing to Medicaid capacity in Newport, VT according to the available billing records, which may reflect contracting choices, credentialing status, or a patient mix concentrated in Medicare and commercial payers.

Provider tenure (NPI enumerated 2006-07-12, ~20 years ago) combined with concentrated, high-volume billing on a few procedure codes suggests an established, niche service profile—an experienced practitioner operating a focused manual-therapy and therapeutic-exercise practice that consistently bills high volumes of a small set of PT CPTs.

Medicare: Complete Services Breakdown

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

7 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
97140	Manual therapy is a form of physical therapy which uses the controlled movement and pressure of hands to treat various disorders of soft tissues and joints, eg, chronic back pain. Manual therapy…	4,740	$20	$85.3K
97110	Therapeutic exercise is a form of physical therapy that utilizes specially designed exercises and activities to help patients gain better mobility and fitness levels. Normally used on patients with…	1,890	$20	$37.9K
97164	The provider, typically a physical therapist, conducts a physical therapy re–evaluation that includes history review and standardized tests and measures to assess body structure and function; she…	550	$50	$27.4K
97035	Physical therapists use different treatment modalities that can help strengthen, relax, and heal muscles from their strained conditions.	1,730	$10	$13.9K
97163	The provider, typically a physical therapist, conducts a physical therapy evaluation that includes history of a patient with three or more personal factors that may affect care, assess a clinical…	100	$70	$7.1K
97112	Neuromuscular reeducation is a therapeutic treatment (exercise) performed by a physician in an attempt to reduce impairments and restore function through the application of clinical skills and/or…	280	$30	$7K
97535	A healthcare provider is required to give proper instruction to a person especially in cases of recovery from acute disease.	60	$20	$1K

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 7 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Vermont Distribution

William Hogan — 5 of 7 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Vermont

Full comparison — all codes billed, vs. state median

7 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
97110	5	230	400	$20	$9.2K
97112	66	180	200	$20	$6.8K
97140	1	210	250	$20	$6.1K
97164	1	40	20	$50	$2.4K
97163	1	10	20	$70	$1.8K
97535	21	50	60	$20	$1.5K
97035	1	40	90	$10	$1.1K

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Northeast Kingdom Physical Therapy PC	VT	Physical Therapy Clinic/Center	$0	$358.3K
Julie Guerette	VT	Psychologist	$0	$246.2K
Richard Grunert	VT	Urology Physician	$68.5K	$0
Kevin Haley	VT	Mental Health Counselor	$0	$50.5K
Peter Gunther	VT	Internal Medicine Physician	$8.7K	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Northeast Kingdom Human Services Inc Ds Waiver	VT	Developmental Disabilities Clinic/Center	$0	$204.7M
Baart Behavioral Health Services, Inc.	VT	Substance Use Disorder Rehabilitation Clinic/Center	$85.8K	$17.6M
Northeast Kingdom Human Services Inc Sbs	VT	Adolescent and Children Mental Health Clinic/Center	$0	$8.3M
Autism Advocacy And Intervention, LLC	VT	Behavior Analyst	$0	$7.8M
Newport Ambulance Service Inc.	VT	Land Ambulance	$743.2K	$2.9M
North Country Hospital & Health Center Inc	VT	Internal Medicine Physician	$0	$3.2M
North East Kingdom Community Action, Inc.	VT	Public Health or Welfare Agency	$0	$2.8M
Northeast Kingdom Human Services Inc Mh Children	VT	Adolescent and Children Mental Health Clinic/Center	$0	$2.7M
North Country Hospital & Health Center Inc	VT	Pediatrics Physician	$0	$2.2M
James V. Wyllie, Dds P.C.	VT	General Practice Dentistry	$0	$1.8M

William Hogan — Billing Profile & Reimbursement Data

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William Hogan — 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