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

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

Kenneth Lawlor (NPI 1902917289)

Field	Value
Entity Type	Individual
Organization	Kenneth Lawlor
Address	3111 Clearwater Dr Ste A
City	Prescott
State	AZ
ZIP	86305
Taxonomy	Rheumatology Physician
NPI Enumerated	August 31, 2006

Payer Source	Total Paid
Medicare	$2.3M
Medicaid	$0

Key Findings

This provider bills almost exclusively to Medicare with total Medicare revenue of $2.3M and no Medicaid billing on file, so the practice is effectively single-payer from a public-program perspective. Absence of any Medicaid activity means Medicaid-related network access, supplemental payments, or state-driven reimbursement changes are not material to this provider's reported revenue base.

Revenue is highly concentrated in a few biologic drug codes: the precomputed top 3 codes account for 82.9% of this provider's total Medicare revenue. Those three codes are J0129 ($1.1M revenue, 48.8% of Medicare), J1602 ($523.1K revenue, 23.1% of Medicare), and J3262 ($246.8K revenue, 10.9% of Medicare), indicating a dominant share of income is tied to administered specialty drugs.

The code mix and top revenue drivers indicate an infusion-focused rheumatology practice: high-revenue biologic medication codes (J0129, J1602, J3262, J1745) combined with infusion administration and supportive codes (96365, J7050, 96374) point to on-site infusion services rather than only office-based consults or procedures. This suggests the practice operates an infusion suite or otherwise delivers IV/subcutaneous biologic therapies as a core service line.

For specific drugs the provider shows unusually high national volume: J0129 ranks #38 of 1221 providers nationally (97th percentile; notably above typical national volume for this code) and J1602 ranks #43 of 1041 providers nationally (96th percentile; notably above typical national volume for this code). By contrast, J3262 sits at #235 of 618 providers nationally (62th percentile; typical, unremarkable volume), so the practice is a national-scale outlier for certain biologics but not for all targeted agents.

Office evaluation-and-management billing is also an outlier relative to peers: 99214 generated $133.2K (5.9% of Medicare revenue) and ranks #4154 of 479517 providers nationally (99th percentile; extreme outlier). Coupled with elevated counts for new-patient levels like 99204 ($22.4K, 1.0% of Medicare; ranks notably above typical national volume) this pattern signals both high patient throughput and substantial face-to-face management in addition to infusion services.

Several infusion-administration and chemotherapy/infusion-related codes show notable volume: 96365 (initial IV infusion) produced $44.2K (2.0% of Medicare) and ranks #114 of 8873 providers nationally (99th percentile; notably above typical national volume), and 96415 add-on hours appear in the claims list. These entries corroborate that drug administration capacity, not just drug acquisition, is a material operational capability and revenue center.

The business profile implies concentration risk because nearly half of Medicare revenue is tied to a single code (J0129) and the top three codes together drive 82.9% of Medicare revenue. Any changes in coverage, reimbursement, or utilization for those specific biologics would disproportionately impact the provider's revenue given the lack of Medicaid diversification.

The provider has long tenure in Medicare billing (NPI enumerated 2006-08-31 (~20 years ago)), which supports experience in managing chronic rheumatologic care and infusion services over time. The presence of procedure codes such as 20610 and 20600 alongside the infusion and E/M activity indicates a blended practice that delivers both procedural joint care and ongoing biologic management to Medicare beneficiaries.

Medicare: Complete Services Breakdown

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

20 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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)	32,480	$30	$1.1M
J1602	Injection, golimumab, 1 mg, for intravenous use	52,310	$10	$523.1K
J3262	Injection, tocilizumab, 1 mg	49,360	$10	$246.8K
J1745	Injection, infliximab, excludes biosimilar, 10 mg	5,130	$30	$133.4K
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…	1,430	$90	$133.2K
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.	880	$50	$44.2K
99204	The provider sees a new 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 provider…	180	$120	$22.4K
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…	170	$100	$17.6K
99215	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the…	110	$130	$14.1K
20610	In 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…	100	$60	$5.4K

Showing 1–10 of 20

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 20 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Arizona Distribution

Kenneth Lawlor — 3 of 20 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Arizona

Full comparison — all codes billed, vs. state median

20 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0129	2	30	14,700	$30	$494.5K
J3262	15	20	74,500	$1	$367.2K
J1602	6	30	24,040	$10	$316.2K
J1745	10	40	2,980	$30	$103.9K
96413	122	230	190	$100	$24.8K
99214	192	10,410	120	$80	$20.6K
99215	849	3,270	50	$120	$11.9K
99213	8,121	9,600	80	$60	$9.6K
99204	338	5,790	40	$110	$6.7K
99205	852	1,730	30	$150	$6.6K

Showing 1–10 of 20

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Tammy Tunis	AZ	Family Nurse Practitioner	$160.9K	$0
Adam Roberts	AZ	Physician Assistant	$67.9K	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Life Line Ambulance Service Inc	AZ	Land Ambulance	$2.1M	$33.9M
West Yavapai Guidance Clinic, Inc.	AZ	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$15.6M
West Yavapai Guidance Clinic	AZ	Substance Abuse Rehabilitation Facility	$0	$6.6M
Donn Davis	AZ	Radiation Oncology Physician	$1.2M	$0
Roscoe Chan	AZ	Radiation Oncology Physician	$738.6K	$0
Keith Mackenzie	AZ	Procedural Dermatology Physician	$693.8K	$0
Richard Cirelli	AZ	Dermatology Physician	$559.8K	$0
Robert Wolfe	AZ	Family Nurse Practitioner	$552.9K	$0
Kimberly Stover	AZ	Nurse Practitioner	$518K	$0
Ketan Jani	AZ	Pulmonary Disease Physician	$486.9K	$10.6K

Kenneth Lawlor — 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