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    OpenPayerNPI Medicare & MedicaidNelson Gwinn
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    Nelson Gwinn — Billing Profile & Reimbursement Data

    NPI 1922087071 · Dothan, AL · Cardiovascular Disease Physician

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    Nelson Gwinn is a cardiovascular disease physician provider located in Dothan, Alabama. This profile covers 36 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
    OrganizationNelson Gwinn
    Address1150 Ross Clark Cir
    CityDothan
    StateAL
    ZIP36301
    TaxonomyCardiovascular Disease Physician
    NPI EnumeratedJanuary 16, 2006

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

    Payer SourceTotal Paid
    Medicare$1.3M
    Medicaid$0

    Key Findings

    NELSON GWINN (Cardiovascular Disease Physician) in DOTHAN, AL has an NPI enumerated 2006-01-16 (~20 years ago) and shows $1.3M in lifetime Medicare revenue while reporting none (no Medicaid billing on file), indicating an effectively single-payer Medicare practice footprint at this scale. The tenure suggests longstanding Medicare participation but no recorded Medicaid activity.

    Revenue is highly concentrated among a few Medicare codes: a precomputed 60.4% of this provider's Medicare revenue is generated by the top three codes. Those top three are 99490 ($337K, 26.1% of Medicare revenue), 99214 ($254.8K, 19.7%), and 93306 ($188.4K, 14.6%), which together dominate the revenue profile.

    The mix of high-volume codes indicates an operational focus on chronic care management, outpatient E/M, and diagnostic cardiac imaging. Specifically, extensive billing for 99490 (7.3K claims, $46 avg paid/claim, $337K) and 99439 (727 claims, $35 avg paid/claim, $25.4K) points to a structured chronic-care workflow, while 99214 (2.9K claims, $88 avg paid/claim, $254.8K) and echocardiography 93306 (1.6K claims, $117 avg paid/claim, $188.4K) reflect high-volume office-based cardiology and imaging services.

    On national comparative standing this provider is a major outlier for several services: 99490 ranks #18 of 16216 (100th percentile; notably above typical national volume), 99214 ranks #295 of 479517 (100th percentile; extreme outlier), and 93306 ranks #52 of 24624 (100th percentile; extreme outlier). These ranks indicate the provider is operating at much higher volumes than most peers for core cardiology outpatient and chronic-care services.

    Additional procedure-level signals reinforce a diagnostic and imaging-heavy practice: nuclear cardiology 78452 ($138K, 460 claims) ranks #128 of 14946 (99th percentile; extreme outlier), technetium A9500 ($79.6K, 915 claims) ranks #33 of 4099 (99th percentile; extreme outlier), and stress testing 93015 ($20.6K, 458 claims) ranks #148 of 7716 (98th percentile; notably above typical national volume). These placements suggest the provider delivers a high volume of advanced diagnostic tests relative to national peers.

    The payer mix is effectively single-payer Medicare: lifetime Medicare revenue is $1.3M while Medicaid revenue is none. This concentration implies limited Medicaid exposure and potential sensitivity to Medicare policy or reimbursement changes given the absence of Medicaid billing on file.

    Service setting appears weighted toward outpatient management and diagnostics rather than inpatient care: high revenue from outpatient E/M 99214 ($254.8K) and procedural imaging contrasts with comparatively small Medicare revenue from subsequent inpatient codes like 99232 ($29.7K) and initial hospital visits such as 99222 ($8.7K). This pattern is consistent with a predominantly ambulatory cardiology practice that also performs high-volume diagnostic procedures.

    The large claim volumes for chronic care and routine diagnostics suggest an established care-delivery program: 99490 (7.3K claims) combined with significant echo (93306, 1.6K claims) and ECG activity (93000, 2.9K claims, $29.2K; rank #32 of 71016, 100th percentile; extreme outlier) indicate systematic, recurring management of cardiac patients and capacity for longitudinal monitoring, which could align with value-based or population-health models even though only fee-for-service Medicare billing is recorded here.

    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.

    36 rows

    CPT/HCPCS CodeDescriptionClaimsAvg PaidRevenue
    99490The clinical staff provides services directed by the provider to support and coordinate a patient’s care across multiple disciplines. The patient has two or more chronic conditions that place the…7,330$50$337K
    99214The 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…2,900$90$254.8K
    93306The provider uses transducers to obtain two–dimensional (2D) images of the heart structures through the chest wall. He evaluates the anatomy and function of all four heart chambers, valves, adjacent…1,610$120$188.4K
    78452In this procedure, the provider performs multiple SPECT studies of the heart to determine the areas of deficient blood flow. The goal of the procedure is to determine areas that have deficient blood…460$300$138K
    A9500Technetium tc-99m sestamibi, diagnostic, per study dose920$90$79.6K
    J2785Injection, regadenoson, 0.1 mg1,630$40$70K
    99232The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…500$60$29.7K
    93000The provider records the electrical conduction of the heart to examine any abnormality in its functioning, based on signals from at least 12 leads, wires that connect the recording device to…2,920$10$29.2K
    99204The 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…240$120$28K
    99439The clinical staff provides services directed by the provider to support and coordinate a patient’s care across multiple disciplines. The patient has two or more chronic conditions that place the…730$40$25.4K

    Showing 1–10 of 36

    Medicare: Competitive Analysis & Benchmarks

    How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 36 CPT/HCPCS codes.

    View: State1 / 2

    Full comparison — all codes billed, vs. state median

    36 rows

    CPT/HCPCS CodeRankProvider CountMedian ClaimsAvg PaidAverage Revenue
    933063440170$80$19.1K
    9921437,330120$80$16.8K
    78452325050$210$16.2K
    J27851160270$40$15K
    994901350150$40$14.1K
    992322742,530100$60$13.3K
    A950019080$90$12K
    92928749030$400$12K
    8388068030$40$8.9K
    934583517030$200$8.1K

    Showing 1–10 of 36

    Related Providers

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

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    Houston County Healthcare AuthorityALInternal Medicine Physician$0$9.6M
    Houston County Healthcare AuthorityALGeneral Acute Care Hospital$0$4.9M
    Houston County Healthcare AuthorityALClinical Medical Laboratory$591.7K$2.1M
    Jawaunna BlackmonALHematology & Oncology Physician$2.1M$0
    Adnan MallickNJOphthalmology Physician$1.6M$0
    Houston County Healthcare AuthorityALInternal Medicine Physician$0$1.5M
    Christopher CentafontALCardiovascular Disease Physician$688.3K$0
    Darius AliabadiALCardiovascular Disease Physician$679.1K$0
    Andreas MuenchALCardiovascular Disease Physician$636.8K$0
    Sai AvulaALInternal Medicine Physician$540.7K$0

    Nearby Providers

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

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    State Of Alabama Department Of Public HealthALHome Health Agency$0$6.9M
    Wiregrass Hospice, LLCALCommunity Based Hospice Care Agency$0$5.8M
    Dothan Ambulance ServiceALLand Ambulance$1.7M$3.9M
    Southeast Alabama Maternity Care ProgramALExclusive Provider Organization$0$5.1M
    Houston County Health Dept Fp ClinicALPublic Health or Welfare Agency$0$4.4M
    Southern Alabama Surgery Center LLCALAmbulatory Surgical Clinic/Center$3.8M$94.3K
    Edmund LacourALRheumatology Physician$3.7M$0
    Eye Partners, PCALOptometrist$0$2.4M
    Radiology Associates Of Dothan PCALDiagnostic Radiology Physician$0$1.7M
    Gut Endo, LLCALAmbulatory Surgical Clinic/Center$1.5M$2.4K

    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. Alabama Distribution
    Nelson Gwinn — 10 of 25 codes billed far more than typical (above p95)
    p5–p95 (all providers)p25–p75MedianThis providerOutlier
    Rank Distribution — Alabama