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    OpenPayerNPI Medicare & MedicaidJames Gould
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    James Gould — Billing Profile & Reimbursement Data

    NPI 1912908161 · Festus, MO · Specialist

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    James Gould is a specialist provider located in Festus, Missouri. This profile covers 21 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.

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    Provider details (source: NPPES NPI Registry)

    FieldValue
    Entity TypeIndividual
    OrganizationJames Gould
    Address1390 Highway 61
    CityFestus
    StateMO
    ZIP63028
    TaxonomySpecialist
    NPI EnumeratedAugust 9, 2005

    Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)

    Payer SourceTotal Paid
    Medicare$1.6M
    Medicaid$0

    Key Findings

    This provider’s Medicare billing is concentrated in advanced endoscopic nasal and sinus procedures and related ENT interventions: high-revenue codes include 31298, 31295, and 69706 (balloon sinuplasty and endoscopic sinus/eustachian tube dilation), with supporting procedure lines such as 30117 (lesion excision), 30140 (inferior turbinate resection), and 30469 (nasal valve radiofrequency). The presence of CT imaging (70486) and multiple allergy testing and immunotherapy codes (95165, 95024, 95117) indicates a mix of procedural interventions and office-based diagnostic/allergy services rather than a pure primary-care panel.

    Revenue concentration is pronounced: 31298, 31295, and 69706 together account for 75.9% of this provider’s total Medicare revenue, and the provider’s lifetime Medicare revenue is $1.6M. Those three codes alone drive the majority of Medicare dollars for this NPI, so any changes in reimbursement or utilization for those specific procedures would materially affect the provider’s revenue.

    Payer mix is effectively single-payer Medicare: lifetime Medicare revenue is $1.6M while Medicaid revenue is none, meaning the provider has no Medicaid billing on file. This profile suggests a Medicare-dominant patient base or contracting footprint and limited exposure to Medicaid-managed care flows.

    For several of the top codes this provider is a national leader: 31298 ranks #2 of 175 providers nationally (99th percentile; extreme outlier), 31295 ranks #2 of 283 providers nationally (100th percentile; extreme outlier), and 69706 ranks #1 of 39 providers nationally (100th percentile; extreme outlier). Such rankings characterize the practice as a major national-volume outlier specifically for balloon dilation and endoscopic sinus procedures, rather than broadly high-volume across all ENT codes.

    Other procedure-level signals show consistently above-typical volumes for related ENT procedures: 30117 ($101K revenue, ranks #5 of 232, 98th percentile; extreme outlier), 30469 ($69.7K, ranks #4 of 84, 96th percentile; notably above typical), and 30140 ($30.9K, ranks #2 of 646, 100th percentile; extreme outlier). CT imaging (70486: 325 claims, $32.2K revenue, ranks #12 of 13305, 100th percentile; extreme outlier) further supports a high-throughput, procedure-focused practice with on-site or closely integrated imaging access.

    Non-procedural care and allergy services contribute meaningfully to visit volume but represent small shares of revenue: 95165 shows 1.5K claims and $16.4K revenue (1.0% of Medicare revenue), while E/M codes such as 99203 ($13.1K, 162 claims) and 99213 ($12.1K, 184 claims) are present but dwarfied by procedural income. This mix suggests front-end evaluation and allergy management support a procedure-driven business rather than being primary revenue drivers.

    The provider’s NPI tenure (enumerated 2005-08-09 (~21 years ago)) indicates an established practice history; combined with repeated extreme outlier rankings on key procedural codes, this tenure is consistent with long-standing specialization in sinus and eustachian tube interventions. For payers and network planners, the combination of long tenure and concentrated high-volume procedural billing signals a stable, specialty-focused asset for Medicare populations.

    High concentration in a small set of nationally outlier procedural codes creates both operational efficiency and risk: the practice’s Medicare revenue depends heavily on a few high-cost procedures (31298, 31295, 69706), which may make it sensitive to reimbursement policy, prior authorization, or competition in those niches. At the same time, the provider’s top national rankings for these procedures suggest potential leverage in contracting discussions for specialty procedural networks that prioritize endoscopic sinus and balloon dilation services.

    Medicare: Total Revenue Breakdown by CPT/HCPCS Code

    Medicare revenue breakdown by CPT/HCPCS procedure code.

    View: Bar Chart1 / 2

    Medicare: Complete Services Breakdown

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

    21 rows

    CPT/HCPCS CodeDescriptionClaimsAvg PaidRevenue
    31298The provider passes an endoscope into the nasal cavity of the patient through which he passes a balloon–tipped catheter and dilates the ostium (opening) of the frontal and sphenoid sinuses.180$3,640$640.3K
    31295The provider passes an endoscope into the nasal cavity of the patient. He also dilates the ostium, or opening, of the maxillary sinus. The approach is either through the nose or via a depression on…180$1,710$314.8K
    69706Surgical nasal endoscopy consists of the use of a medical device that has a thin rigid or a flexible tube to view the sinuses and nasal passages. In this procedure, the endoscopy provides an approach…130$2,050$272.6K
    30117In this procedure, the provider excises or destroys a lesion in the nose through an internal approach, in which the provider places the surgical instruments into the nose to perform the procedure.270$380$101K
    30469The provider applies radiofrequency energy to reshape the nasal valve in both nostrils.70$970$69.7K
    31237In this procedure, the provider inserts an endoscope into the nasal cavity. She examines the nasal contents. The provider then performs a nasal biopsy, polypectomy, or debridement.120$290$33.4K
    70486The provider uses computed tomography, or CT, to examine the maxillofacial area, such as the upper jaw or face structures. The provider does not administer contrast for this exam.330$100$32.2K
    30140This CPT code is for a submucous resection of the inferior turbinate (partial or complete by any method).180$170$30.9K
    31231In this procedure, the provider inserts an endoscope into the nasal cavity to examine the structures of the nasal cavity on one or both sides.210$140$30.7K
    31296The provider passes an endoscope through the nasal cavity of the patient to bring about dilation of the ostium, or opening, of the frontal sinus.10$1,820$23.7K

    Showing 1–10 of 21

    Medicare: Competitive Analysis & Benchmarks

    How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 21 CPT/HCPCS codes.

    View: State1 / 2

    Full comparison — all codes billed, vs. state median

    21 rows

    CPT/HCPCS CodeRankProvider CountMedian ClaimsAvg PaidAverage Revenue
    69706110130$2,050$272.6K
    3129811020$3,630$254K
    3129511020$1,680$99.3K
    3046911050$1,220$58.6K
    3011711050$360$40.8K
    3129611010$1,820$23.7K
    9516519801,020$10$14.3K
    3123712030$260$9.8K
    3014011030$210$8.7K
    992131,7688,73070$50$7K

    Showing 1–10 of 21

    Related Providers

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

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    Claude YarboroughSCGastroenterology Physician$132.8K$0
    Stephen BrackbillSCGastroenterology Physician$128.4K$0
    Matthew BarnesSCGastroenterology Physician$102.6K$0
    David PalmaSCGastroenterology Physician$99.1K$0
    Lance HudsonSCCertified Registered Nurse Anesthetist$94K$0
    Lisa RiddleSCCertified Registered Nurse Anesthetist$82.2K$0
    Michael FlynnSCCertified Registered Nurse Anesthetist$69.4K$0
    Ronald EslickSCCertified Registered Nurse Anesthetist$68K$0
    Ellen NormanSCMedical Physician Assistant$62.1K$0
    Matthew StroudSCCertified Registered Nurse Anesthetist$47.9K$0

    Nearby Providers

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

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    Compass Health, IncMOCommunity/Behavioral Health Agency$0$44M
    Mercy Hospital JeffersonMOGeneral Acute Care Hospital$0$27.8M
    Joachim Plattin Townships Ambulance DistrictMOLand Ambulance$762.9K$3.5M
    Ccpartners LLCMOPediatric Adolescent Medicine Physician$0$3.8M
    My Place Residential CareMOCustodial Care Facility$0$3.8M
    Omar AlmousalliMOCardiovascular Disease Physician$338.9K$346.8K
    Twin Cities Ambulatory Surgery Center LPMOAmbulatory Surgical Clinic/Center$283.8K$9.7K
    Laishang ZhangMOPsychiatry Physician$221.3K$6.5K
    Tariq AlamMONeurology Physician$223.8K$3.2K
    Bassam RoukozMOInterventional Cardiology Physician$193.8K$220

    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.

    Medicare Revenue by CPT/HCPCS Code
    Claims Volume vs. Missouri Distribution
    James Gould — 10 of 21 codes billed far more than typical (above p95)
    p5–p95 (all providers)p25–p75MedianThis providerOutlier
    Rank Distribution — Missouri