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

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

Andrew James (NPI 1871586321)

Field	Value
Entity Type	Individual
Organization	Andrew James
Address	1 S Keene St
City	Columbia
State	MO
ZIP	65201
Taxonomy	Medical-Surgical Clinical Nurse Specialist
NPI Enumerated	August 30, 2005

Payer Source	Total Paid
Medicare	$1.6M
Medicaid	$0

Key Findings

This provider’s billed activity is effectively single‑payer: lifetime Medicare revenue is $1.6M while Medicaid billing is listed as none, so all documented public-payer revenue comes from Medicare. The absence of Medicaid claims on file suggests limited or no engagement with Medicaid-managed patient populations or billing under that program.

Revenue is extremely concentrated in a very small set of drug and office‑visit codes: the top three Medicare codes by revenue (J0897, J3111, and 99213) account for 98.2% of this provider’s Medicare revenue, with J0897 at $1M (64.8%), J3111 at $462K (29.8%), and 99213 at $55.7K (3.6%). This concentration implies a narrow service mix where a few high‑cost items dominate billing and financial performance.

The procedure mix points to a specialty, infusion‑oriented outpatient practice focused on bone‑health biologics: J0897 and J3111 are high‑volume injectable osteoporosis agents (J0897 $1M, 55.7K claims; J3111 $462K, 57.8K claims), and the presence of 96372 (1.2K claims, $10.8K) supports frequent in‑office injection activity. These code patterns are consistent with an operation that administers physician‑supervised biologic injections rather than primarily providing general primary‑care services.

For J0897 this provider is a dominant national outlier: J0897 ranks #16 of 10057 providers nationally and is labeled an "extreme outlier," indicating far higher-than-typical volume for this code while generating $1M in Medicare revenue. That ranking and volume position the provider as a major national participant specifically in denosumab administration, not just a routine prescriber.

J3111 shows a different competitive signal: although the provider bills substantial volume (57.8K claims, $462K revenue), J3111 ranks #52 of 970 providers (95th percentile) and is described as "typical, unremarkable volume for this code," which suggests strong participation but not the same level of exceptional dominance seen for J0897. In other words, the provider is a significant user of romosozumab in absolute terms but more comparable to high‑volume peers.

Office visit E/M activity generates only a small portion of revenue versus the drugs, but certain E/M metrics are notable. 99213 produced $55.7K from 1.1K claims and ranks #4668 of 457151 providers (99th percentile; described as an "extreme outlier"), while 99214 produced $15.3K from 225 claims (72th percentile; typical). These figures indicate relatively high encounter volume for established‑patient visits alongside the drug administration business, but E/M still represents a minor share of total Medicare revenue.

High ancillary injection coding reinforces a procedure‑focused throughput model: 96372 is reported with 1.2K claims and $10.8K revenue and ranks #253 of 58224 providers (100th percentile; "extreme outlier"). The combination of frequent 96372 use plus the dominant J0897 and J3111 billing pattern is consistent with an office that regularly delivers and documents injections, likely relying on nursing staff and clinical support to deliver therapies.

The provider has long tenure in Medicare billing—NPI enumerated on 2005-08-30 (~21 years ago)—which suggests an established practice footprint and experience with Medicare workflows. Given the long tenure paired with a highly concentrated Medicare revenue stream and no Medicaid billing on file, the entity appears to operate a stable, specialized service line focused on in‑office biologic injections for bone health rather than broad multispecialty or safety‑net care.

Medicare: Complete Services Breakdown

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

6 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J0897	Injection, denosumab, 1 mg	55,680	$20	$1M
J3111	Injection, romosozumab-aqqg, 1 mg	57,750	$10	$462K
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…	1,140	$50	$55.7K
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…	230	$70	$15.3K
96372	A therapeutic, prophylactic, or diagnostic substance (a fluid, a drug, etc.) is injected via intramuscular or subcutaneous route into the patient's body. The procedure is performed by the physician…	1,200	$10	$10.8K
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…	30	$50	$1.8K

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 6 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Missouri Distribution

Andrew James — 4 of 6 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Missouri

Full comparison — all codes billed, vs. state median

6 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J3111	1	20	9,240	$10	$122.5K
J0897	1	210	2,400	$20	$82.4K
99214	2,366	8,960	100	$80	$13.9K
99213	59	8,730	70	$50	$7K
99203	1,303	2,950	30	$70	$3.2K
96372	3	850	50	$10	$860

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Michael Friedman	IL	Diagnostic Radiology Physician	$145.5K	$436.8K
James Newton	MO	Interventional Pain Medicine Physician	$536.3K	$0
Bradford Noble	MO	Interventional Pain Medicine Physician	$449K	$0
Alan Anz	MO	Adult Reconstructive Orthopaedic Surgery Physician	$414.9K	$0
Thomas Aleto	MO	Adult Reconstructive Orthopaedic Surgery Physician	$370.1K	$0
Samuel Thompson	MO	Adult Reconstructive Orthopaedic Surgery Physician	$328K	$0
Steven Meyer	MO	Orthopaedic Surgery of the Spine Physician	$308.2K	$0
Christopher Farmer	MO	Sports Medicine (Family Medicine) Physician	$299.6K	$0
Kurt Bormann	MO	Orthopaedic Surgery Physician	$273.8K	$0
Neal Meyer	MO	Diagnostic Radiology Physician	$273.3K	$450

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Woodhaven	MO	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$88.3M
Palmer's Home Care, LLC	MO	Intellectual and/or Developmental Disabilities Residential Treatment Facility	$0	$82.3M
Oats, Inc.	MO	Non-emergency Medical Transport (VAN)	$0	$23.4M
Independent Living Center Of Mid-missouri Inc.	MO	Specialist	$0	$14.2M
Ch Allied Services, Inc.	MO	General Acute Care Hospital	$0	$8.6M
Central Missouri Area Agency On Aging	MO	Voluntary or Charitable Agency	$0	$8.4M
Life Christain Outreach	MO	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$7.1M
Surgical Center At Columbia Orthopaedic Group LLC	MO	Ambulatory Surgical Clinic/Center	$6.2M	$0
Mid-missouri Supported Living	MO	Intellectual and/or Developmental Disabilities Residential Treatment Facility	$0	$5.3M
Woodhaven Learning Center	MO	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$5.1M

Andrew James — 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