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

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

Monique Jones (NPI 1861902322)

Field	Value
Entity Type	Individual
Organization	Monique Jones
Address	30920 Southfield Rd
City	Southfield
State	MI
ZIP	48076
Taxonomy	Family Nurse Practitioner
NPI Enumerated	October 10, 2017

Payer Source	Total Paid
Medicare	$1.6M
Medicaid	$0

Key Findings

This provider is effectively single‑payer at the claims level: total Medicare revenue is $1.6M while Medicaid revenue is none on file, so observed billing activity is concentrated in the Medicare program rather than split across Medicare and Medicaid. Analysts should treat this profile as Medicare‑driven when modeling payer mix, access, or payment sensitivity for this NPI.

Revenue is extremely concentrated: the precomputed top 3 Medicare codes by revenue account for 98.8% of this provider's total Medicare revenue, and a single code, Q4262, alone represents $1.5M of the $1.6M total (95.6% of this provider's total Medicare revenue). Such heavy reliance on a very small set of codes means overall revenue moves closely with utilization and reimbursement for those specific items.

The code mix points to a focused wound‑care and procedure‑oriented practice model: Q4262 (dual layer impax membrane) drives the vast majority of revenue (1.6K claims, $957 avg paid/claim, $1.5M revenue), supported by debridement (11042: 383 claims, $88 avg paid/claim, $33.7K revenue) and home/residence E/M visits (99348: 362 claims, $51 avg paid/claim, $18.5K revenue). The presence of 15271 (skin substitute, trunk/arms/legs) further reinforces that the operation bills for advanced wound coverings and related procedural work rather than a high volume of routine office E/M.

Competitive standing is mixed across code lines: for its largest revenue driver Q4262 the provider ranks #60 of 141 nationally (58th percentile; typical, unremarkable volume for this code), indicating the provider is not a dominant national leader in that specific code despite deriving most of its Medicare revenue from it. By contrast, 11042 ranks #1088 of 10712 (90th percentile; typical, unremarkable volume for this code) and 99348 ranks #1041 of 11547 (91th percentile; typical, unremarkable volume for this code), showing relatively stronger national presence in debridement and home visit E/M categories versus peers.

Operational and reimbursement sensitivity should be expected given that Q4262 is an add‑on, per‑square‑centimeter code: because $957 avg paid/claim and per‑unit billing drive $1.5M of revenue, shifts in payer coverage policy, pricing per unit, or documented unit counts could produce outsized changes in topline Medicare revenue. This structure suggests revenue is more dependent on per‑unit product utilization than on high volumes of traditional office visit E/M services.

Absence of Medicaid billing (none below) indicates limited or no participation in Medicaid programs under this NPI; this narrows the provider's payer diversification and may reflect patient panel composition, contractual arrangements with commercial payers or facilities, or administrative choices to not bill Medicaid. For payers and network planners, the lack of Medicaid activity means competitor comparisons and access evaluations should be weighted toward Medicare and commercial markets rather than state Medicaid volumes.

The provider has a relatively recent but established enrollment date — NPI enumerated on 2017-10-10 (~9 years ago) — which gives enough tenure to observe stable billing patterns but suggests the current concentrated service mix has developed within the last decade. Analysts assessing trend changes should look for earlier shifts around this enrollment period and watch for concentration persistence or diversification over subsequent reporting periods.

Medicare: Complete Services Breakdown

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

8 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
Q4262	Dual layer impax membrane, per square centimeter (add-on, list separately in addition to primary procedure)	1,590	$960	$1.5M
11042	The provider uses surgical instruments to remove the dead tissue in skin down to the subcutaneous layer and including the epidermis and dermis, up to the first 20 cm2.	380	$90	$33.7K
99348	The provider sees an established patient for a home or residence visit involving evaluation and management (E/M). The visit involves low medical decision making or the provider spends at least 30…	360	$50	$18.5K
15271	The provider uses a skin substitute, such as an allograft or xenograft, to cover wounds on the patient’s trunk, arms, and/or legs up to an area of 100 cm2. This code covers up to the first 25 cm2.	130	$110	$13.3K
99342	The provider sees a new patient for a home or residence visit involving evaluation and management (E/M). The visit involves a low level of medical decision making or the provider spends at least 30…	50	$50	$2.4K
99304	The provider sees a patient for an initial nursing facility care visit involving evaluation and management (E/M). The visit involves straightforward or low medical decision making or the provider…	30	$60	$1.7K
11000	The provider uses surgical instruments to debride the dead tissue in skin for up to 10 percent of the body surface.	30	$30	$700
11721	The provider surgically debrides (debulks or removes) 6 or more abnormal, diseased, or infected nails.	10	$30	$280

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 8 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Michigan Distribution

Monique Jones — 1 of 8 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Michigan

Full comparison — all codes billed, vs. state median

8 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
Q4262	2	10	1,780	$960	$1.7M
11721	548	550	270	$30	$12.7K
11042	14	360	80	$60	$6.7K
99348	32	470	60	$50	$6.5K
15271	4	20	60	$80	$6.1K
99304	49	110	30	$60	$3K
99342	31	120	20	$60	$2.6K
11000	8	20	30	$40	$2.2K

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Richard Park	CA	Internal Medicine Physician	$31.7M	$0
Nyrie Austin	NJ	Family Nurse Practitioner	$15.9M	$8.8K
Patrick Black	CA	Physical Therapist	$14M	$0
Owen Ellington	TX	Hematology & Oncology Physician	$11.5M	$0
Joseph Palumbo	WV	Emergency Medicine Physician	$7.9M	$44.3K
Shelita Jones	TX	Family Nurse Practitioner	$6.7M	$0
Kellie King	TX	Family Nurse Practitioner	$5.3M	$0
Jamie Kate Adoc	CA	Family Nurse Practitioner	$4.7M	$0
Raymond Wawrowski	OH	Physician Assistant	$4.7M	$0
Thuy Vo	CA	Family Nurse Practitioner	$4.4M	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Gesher Human Services	MI	Adult Mental Health Clinic/Center	$0	$12.6M
Personalize Home Care Services, LLC.	MI	Home Health Agency	$0	$7.2M
Cita Angels Homecare Inc	MI	Attendant Care Provider	$0	$5.5M
Riyadh Kasmikha	MI	Internal Medicine Physician	$158.3K	$1.8M
Southfield Surgery Center LLC	MI	Ambulatory Surgical Clinic/Center	$1.1M	$0
Carolyn Nicholson	MI	Clinical Social Worker	$520.4K	$0
Neil Gilbert	MI	Neurology Physician	$422.5K	$0
Zakari Tata	MI	Family Medicine Physician	$398K	$0
Peter Lipson	MI	Internal Medicine Physician	$270.9K	$0
Abiola Adisa-obayan	MI	Pain Medicine (Physical Medicine & Rehabilitation) Physician	$250.2K	$0

Monique Jones — 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