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.

John Albert (NPI 1861428070)

Field	Value
Entity Type	Individual
Organization	John Albert
Address	7080 N Port Washington Rd
City	Glendale
State	WI
ZIP	53217
Taxonomy	Rheumatology Physician
NPI Enumerated	June 23, 2006

Payer Source	Total Paid
Medicare	$1.2M
Medicaid	$0

Key Findings

This provider’s Medicare footprint is the dominant payer relationship on file: total Medicare revenue is $1.2M and there is no Medicaid billing on file, so the practice is effectively single‑payer (Medicare) in scale. The absence of Medicaid activity should be treated as a substantive gap in payer mix rather than a small portion of revenue.

Revenue is highly concentrated in a small set of biologic infusion codes: the precomputed top‑3 Medicare codes by revenue account for 75.3% of this provider’s total Medicare revenue, driven primarily by J1745, J0129, and J1602. Those three codes—J1745 ($443.8K, 38.0%), J0129 ($317.6K, 27.2%), and J1602 ($119K, 10.2%)—constitute the bulk of billings and should be the focus for service‑line and reimbursement reviews.

The code mix and dominant revenue sources point to an infusion‑center model within a rheumatology practice: J1745 (infliximab), J0129 (abatacept), and J1602 (golimumab) are all biologic injectable therapies commonly administered in office or infusion settings, and substantial reimbursement for these codes indicates that drug administration—not office visits—is the primary revenue driver. Supplemental support services appear present: chemotherapy/infusion administration codes such as 96413 ($44.5K, 3.8%) and 96415 ($7.4K, 0.6%) are billed as well, consistent with prolonged or repeated infusion sessions.

Competitive standing is mixed across codes: the provider is a national outlier on J1745, ranking #20 of 1352 providers and listed at the 99th percentile as an "extreme outlier," which indicates unusually high national volume for infliximab relative to peers. By contrast, J0129 (rank #504 of 1221, 59th percentile) and J1602 (rank #576 of 1041, 44th percentile) are described as typical or unremarkable volumes, so dominance is concentrated specifically in the infliximab line rather than across all biologics.

Operational intensity for infusion services is further suggested by elevated add‑on infusion reporting: 96415 is ranked at the 97th percentile and described as "notably above typical national volume," signaling a higher-than-typical use of extended infusion time billing compared with national peers. Combined with the high J1745 volume, this pattern aligns with recurrent multi‑hour infusion sessions being a core part of practice operations.

Laboratory and monitoring activity is prominent and appears integrated with biologic treatment management: multiple lab panel and analytics codes are reported at high percentile ranks (for example, 86140 rank #338 at the 92th percentile, 85025 rank #3424 at the 90th percentile, 82565 rank #264 at the 95th percentile, and 85651 rank #135 at the 95th percentile). These elevated lab volumes support ongoing disease monitoring and safety labs commonly required for patients receiving biologic DMARDs.

Clinical evaluation and management (E/M) visits represent a relatively small share of reported Medicare revenue compared with drug administration: 99213 accounts for $23.7K (2.0%) and 99214 for $6.7K (0.6%) of Medicare revenue, indicating that reimbursement flows are concentrated in procedural/drug administration codes rather than office visit volume. This split suggests a practice model where patient encounters are driven primarily by infusion appointments rather than traditional office visit billing.

The provider has an established enrollment history, enumerated on 2006-06-23 (~20 years ago), which combined with the concentrated biologic infusion activity implies a long‑standing, infusion‑focused rheumatology practice. The longevity of enumeration alongside the concentrated top‑code profile supports interpreting observed patterns as sustained operational focus rather than a short‑term anomaly.

Medicare: Complete Services Breakdown

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

39 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J1745	Injection, infliximab, excludes biosimilar, 10 mg	17,070	$30	$443.8K
J0129	Injection, abatacept, 10 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)	9,630	$30	$317.6K
J1602	Injection, golimumab, 1 mg, for intravenous use	11,900	$10	$119K
J3111	Injection, romosozumab-aqqg, 1 mg	11,760	$10	$94.1K
J0897	Injection, denosumab, 1 mg	3,540	$20	$63.7K
96413	Chemotherapy is a therapeutic procedure used for the treatment of cancer via the use of chemical agents. These chemical agents (drugs) work on the cancerous cells of the body to destroy them. These…	460	$100	$44.5K
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…	380	$60	$23.7K
96365	The provider administers the initial intravenous infusion of a medication or other substance for a period up to one hour to prevent, treat, or diagnose a condition or disease.	200	$50	$9.8K
96415	In this add on procedure, the provider continues administration of a chemotherapy drug into a vein using an infusion technique. He uses this code to report each additional hour of infusion beyond the…	370	$20	$7.4K
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…	80	$90	$6.7K

Showing 1–10 of 39

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 39 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Wisconsin Distribution

John Albert — 9 of 25 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

39 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0129	5	10	8,170	$30	$286.2K
J1602	7	10	11,900	$10	$206.3K
J3111	9	10	15,120	$10	$206.2K
J1745	1	20	6,060	$30	$168.9K
J0897	16	60	2,220	$20	$69.3K
82306	30	120	20	$30	$13.1K
96413	2	80	110	$90	$12.7K
86480	10	10	20	$60	$12.2K
86235	9	20	110	$20	$10.7K
99214	4,997	9,800	80	$70	$9.2K

Showing 1–10 of 39

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Rheumatic Disease Center	WI	Rheumatology Physician	$0	$3M
Kurt Oelke	WI	Rheumatology Physician	$794.2K	$0
Farrukh Pasha	WI	Rheumatology Physician	$314.9K	$0
Suhail Hameed	WI	Rheumatology Physician	$302.5K	$0
Steven Bergquist	WI	Rheumatology Physician	$90.3K	$0
Jonathan Kushi	WI	Rheumatology Physician	$66.8K	$0
Katherine Finn	WI	Rheumatology Physician	$31.5K	$0
Juliana Shah	WI	Adult Health Nurse Practitioner	$15.5K	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
St. Francis Children's Center	WI	Rehabilitation Clinic/Center	$0	$6.1M
Great Lakes Hospice LLC	WI	Community Based Hospice Care Agency	$0	$1.9M
Rahul Sawlani	WI	Diagnostic Radiology Physician	$329.3K	$29.7K
Melissa High	WI	Physical Therapist	$115.4K	$0
Sharon Schulman	WI	Psychologist	$84.8K	$0
Cathy Perkins	WI	Psychosomatic Medicine Physician	$82.4K	$0
James Berman	WI	Dermatology Physician	$77.8K	$0
Paul Smerz	WI	Clinical Psychologist	$45.6K	$0
David Schulz	WI	Psychiatry Physician	$16.9K	$0
Christina Petrou	WI	Optometrist	$12.7K	$0

John Albert — 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