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

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

Mohsen Ghafouri (NPI 1912929233)

Field	Value
Entity Type	Individual
Organization	Mohsen Ghafouri
Address	8100 Ashton Ave
City	Manassas
State	VA
ZIP	20109
Taxonomy	Rheumatology Physician
NPI Enumerated	July 24, 2006

Payer Source	Total Paid
Medicare	$2.6M
Medicaid	$0

Key Findings

This provider’s billing is effectively single‑payer: Total Medicare revenue is $2.6M and there is no Medicaid billing on file, so Medicare drives this practice’s public-payer footprint and financial profile. Analysts should treat Medicaid exposure as negligible when modeling payer mix or risk for this NPI.

Revenue concentration is high and centered on specialty injectable agents: the precomputed top‑3 Medicare codes account for 64.5% of the provider’s Medicare revenue, with J0717 at $852.4K (32.7%), J0897 at $479.5K (18.4%), and J0129 at $350.4K (13.4%). This degree of concentration indicates the business is materially dependent on a small set of drug-administration services for Medicare revenue.

The code mix points to a rheumatology practice with substantial on‑site biologic and bone‑directed therapy administration: high-revenue codes include J0717, J0897, J0129 and J3111 (romosozumab) alongside multiple infusion/administration codes (96401, 96413, 96415, 96365). Together these codes are consistent with regular in-office administration of biologic agents and bone-health therapies rather than a purely clinic-visit–based model.

Competitive standing varies by code: J0897 is described as an "extreme outlier," ranking #133 of 10057 providers nationally (99th percentile), and J0717 ranks #28 of 848 (97th percentile; notably above typical national volume), indicating unusually high national activity in those specific drug administrations. By contrast, J0129 ranks #466 of 1221 (62th percentile; typical, unremarkable volume), so not all high-revenue drugs reflect outsized market share.

Evaluation-and-management activity shows a tilt toward high-acuity visits: 99215 produced $120.7K (4.6% of Medicare revenue) and ranks #383 of 145531 providers nationally (100th percentile; extreme outlier), while 99214 adds $99.7K (3.8%) and ranks #9876 of 479517 (98th percentile; notably above typical national volume). This pattern suggests the practice manages a meaningful panel of complex established Medicare patients in addition to delivering infused therapies.

Infusion/chemotherapy administration appears to be an important operational capability: 96401 generated $75.4K (2.9% of Medicare revenue) and ranks #27 of 3868 providers nationally (99th percentile; extreme outlier), and 96413 and 96415 are also present on the roster. These placements support the conclusion that the site is set up for frequent nurse‑administered drug infusions or injections.

Ancillary procedure mix is consistent with rheumatology subspecialty care but represents modest revenue outside the high-cost drugs: codes such as 20611 (arthrocentesis, $14.4K, 0.6%), 77080 (DXA, $8.8K, 0.3%), and J7326 (hyaluronan, $14.1K, 0.5%) appear at typical to unremarkable volumes. These services likely complement biologic therapy management and osteoporosis care rather than drive revenue independently.

The provider has a longstanding NPI (enumerated 2006-07-24, ~20 years ago), which aligns with the mature utilization profile and the facility to sustain high-volume drug administration and complex visit management. Tenure combined with extreme outlier ranks on several administration codes suggests an established clinical operation specialized in in-office biologic and bone‑health treatments.

Medicare: Complete Services Breakdown

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

34 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J0717	Injection, certolizumab pegol, 1 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)	213,110	$1	$852.4K
J0897	Injection, denosumab, 1 mg	26,640	$20	$479.5K
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)	10,310	$30	$350.4K
J3111	Injection, romosozumab-aqqg, 1 mg	37,800	$10	$302.4K
J1602	Injection, golimumab, 1 mg, for intravenous use	16,350	$10	$179.8K
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…	890	$140	$120.7K
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…	1,060	$90	$99.7K
96401	The provider administers nonhormonal, antineoplastic chemotherapy drugs subcutaneously or intramuscularly to the patient.	1,320	$60	$75.4K
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…	310	$100	$29.7K
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…	170	$120	$20.1K

Showing 1–10 of 34

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 34 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Virginia Distribution

Mohsen Ghafouri — 7 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Virginia

Full comparison — all codes billed, vs. state median

34 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0129	17	30	10,450	$30	$407.3K
J0717	4	30	74,500	$1	$361.7K
J3111	5	20	19,740	$10	$190.2K
J1602	10	20	13,430	$10	$176.7K
J0897	5	340	2,820	$20	$89.3K
96413	90	230	250	$100	$28.5K
99214	388	12,890	140	$80	$21K
J7326	24	50	30	$400	$17.8K
96401	4	180	110	$60	$11.5K
20611	47	230	60	$70	$10.5K

Showing 1–10 of 34

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Prince William County Community Services Board	VA	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$42.8M
Therapeutic Alliance LLC	VA	Community/Behavioral Health Agency	$0	$33.7M
Virginia Support Services, P.C.	VA	Mental Health Counselor	$0	$17.7M
Bridging The Gap Family Services	VA	Community/Behavioral Health Agency	$0	$9.1M
Virginia Home Based Counseling	VA	Mental Health Counselor	$0	$9M
Prince William County Early Intervention Program	VA	Rehabilitation Clinic/Center	$0	$8.3M
Jordana Fein	VA	Retina Specialist (Ophthalmology) Physician	$4.2M	$0
Notal Vision Inc	VA	Physiological Laboratory	$3M	$1.9K
Aec Medical Transport & Rapid Response LLC	VA	Land Ambulance	$1.2M	$1M
Behdad Aryavand	VA	Vascular Surgery Physician	$1.6M	$0

Mohsen Ghafouri — 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

Nearby Providers

Frequently Asked Questions

References