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    v1.0.28
    OpenPayerNPI Medicare & MedicaidNPI 1861462095
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    NPI 1861462095 — Billing Profile & Reimbursement Data

    NPI 1861462095 · XX · healthcare

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    NPI 1861462095 is a healthcare provider located in Unspecified Location. This profile covers 19 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. Note: "XX" is a placeholder CMS uses when a provider's practice-location state wasn't reported — not a traditional US state; claims coded under it are grouped and benchmarked here the same way a traditional state would be.

    Provider details (source: NPPES NPI Registry)

    FieldValue
    Entity TypeIndividual
    OrganizationNPI 1861462095
    Address
    City
    StateXX (Unspecified Location)
    ZIP
    TaxonomyN/A
    NPI Enumerated
    NPI DeactivatedJuly 23, 2026

    (source: CMS Medicare & Medicaid claims data)

    Medicare: Total Revenue Breakdown by CPT/HCPCS Code

    Medicare revenue breakdown by CPT/HCPCS procedure code.

    View: Bar Chart1 / 2

    Medicare Revenue by CPT/HCPCS Code

    Medicare: Complete Services Breakdown

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

    19 rows

    CPT/HCPCS CodeDescriptionClaimsAvg PaidRevenue
    27447In 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…30$980$27.5K
    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…330$60$20.7K
    27130In 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…20$960$20.2K
    20610In 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…220$50$10.6K
    29827The provider examines the tissue inside the shoulder joint with an arthroscope. She inserts additional instruments to repair a torn rotator cuff, the grouping of muscles and tendons that surround and…10$810$8.9K
    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…90$70$6.5K
    99214The 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…70$90$5.9K
    73564In 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.120$30$4K
    J7323Hyaluronan or derivative, euflexxa, for intra-articular injection, per dose40$90$3.7K
    73030This particular procedure is for a minimum of 2 X–ray views of the complete shoulder.90$30$2.3K

    Showing 1–10 of 19

    Medicare: Competitive Analysis & Benchmarks

    How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 19 CPT/HCPCS codes. Note: this provider's state, "XX," is a placeholder CMS uses when a provider's practice-location state wasn't reported — not a traditional US state; the State panel below benchmarks against other providers coded under the same designation.

    View: State1 / 2

    Claims Volume vs. Unspecified Location Distribution
    NPI 1861462095 — 3 of 8 codes billed far more than typical (above p95)
    p5–p95 (all providers)p25–p75MedianThis providerOutlier
    Rank Distribution — Unspecified Location

    Full comparison — all codes billed, vs. state median

    19 rows

    CPT/HCPCS CodeRankProvider CountMedian ClaimsAvg PaidAverage Revenue
    9921312710140$60$18.8K
    992149541080$90$15.8K
    992037410140$90$12.2K
    73221231010$50$530
    73502581060$10$480
    73030421060$10$380
    73562741050$10$320
    72110561020$10$200
    20610160N/A$N/A$N/A
    27130380N/A$N/A$N/A

    Showing 1–10 of 19

    Related Providers

    Other providers that share a Tax Identification Number (TIN) with NPI 1861462095, ranked by combined Medicare and Medicaid revenue.

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    Black Hills Orthopedic & Spine Center, Inc.SDMulti-Specialty Clinic/Center$0$1.7M
    Rebecca LinquistSDOphthalmology Physician$904.5K$0
    Gregory WittenbergSDDermatology Physician$816K$0
    Black Hills Surgical Hospital, LLCSD

    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.

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    Lifetime revenue by payer source
    Payer SourceTotal Paid
    Medicare$122K
    Medicaid$0
    Urgent Care Clinic/Center
    $0
    $698.5K
    Bradley ClarkMODiagnostic Radiology Physician$570.8K$0
    Gail BernardSDOphthalmology Physician$487.7K$0
    Ryan BereckyORDiagnostic Radiology Physician$250.2K$0
    Stephen LoosNVDiagnostic Radiology Physician$247.8K$0
    Jeffrey MarrsSDOrthopaedic Surgery Physician$247.5K$0
    Nathan JaquaSDGastroenterology Physician$237.3K$0