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

Why is the Medicaid comparison limited to Unspecified Location 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. Unspecified Location (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.

Sam Spencer (NPI 1932274487)

Field	Value
Entity Type	Individual
Organization	Sam Spencer
Address	326 Encinitas Blvd
City	Encinitas
State	XX (Unspecified Location)
ZIP	92024
Taxonomy	Foot & Ankle Surgery Podiatrist
NPI Enumerated	November 21, 2006

Payer Source	Total Paid
Medicare	$199.7K
Medicaid	$0

Key Findings

SAM SPENCER is a Foot & Ankle Surgery Podiatrist in ENCINITAS with an NPI enumerated on 2006-11-21 (~20 years ago), indicating long-standing Medicare enrollment and continuity in outpatient podiatric practice. The taxonomy and tenure are consistent with a community-based podiatry clinician focused on procedural outpatient care rather than recent entrants or transient billers.

The provider’s Medicare portfolio is concentrated and modest in scale: total Medicare revenue is $199.7K and the provider has no Medicaid billing on file, making this effectively a single-payer (Medicare) practice from the available claims data. Because Medicaid revenue is listed as none, in-state Medicaid competitive comparisons are not applicable for this profile.

Revenue concentration is high among a small set of CPTs: the top 3 Medicare codes by revenue — 11056, 99213, and 11721 — account for 70.7% of this provider's total Medicare revenue. Those three codes individually represent $49.4K (11056), $48.6K (99213), and $43K (11721) of the $199.7K total, showing that a few procedures and E/M visits drive most of the practice’s Medicare receipts.

The code mix shows a procedural, clinic-based podiatry operation: 11056 (removal of 2 to 4 benign hyperkeratotic lesions) and 11721 (surgical debridement of 6 or more nails) are large revenue contributors, alongside high-volume established office visits with 99213. This combination signals routine office-based minor surgical procedures (lesion removals and nail debridements) coupled with frequent follow-up or chronic-care visits rather than a practice centered on high-acuity, facility-based interventions.

Competitive standing on key codes is above typical national volumes for multiple high-revenue services: 11056 ranks #421 of 8266 providers nationally (95th percentile; notably above typical national volume), 99213 ranks #13632 of 457151 providers nationally (97th percentile; notably above typical national volume), and 11721 ranks #874 of 12535 providers nationally (93th percentile; notably above typical national volume). These percentiles indicate this provider is a high-volume performer for these commonly billed podiatry procedures relative to national peers.

Not all codes show the same outlier signal: related procedure 11055 (single lesion removal) ranks #388 of 6800 providers nationally (94th percentile) but is labeled as typical, unremarkable volume, and several other procedures such as 97597 and 99203 show typical, unremarkable volume at mid-to-high percentile ranks. This suggests high concentration in a few specific services rather than uniformly elevated billing across the entire podiatry service set.

The practice shows a procedure-focused revenue mix with wound/nail procedures contributing materially: 11721 has 1.2K claims at $35 avg paid/claim for $43K revenue (21.5% of Medicare revenue) and 97597 contributes $11.3K (5.7%) for wound debridement care. These data points support an operational emphasis on nail surgery and smaller-area wound care in the outpatient setting.

Ancillary injectable supplies and low-revenue drug administration are present but minimal in impact: J1020 and J1100 appear with low dollar impact ($344 and $0 respectively) and modest claim counts, indicating injections are not a major revenue driver for this clinician. Overall, the profile reads as a stable, Medicare-centric podiatry practice that achieves above-typical volume on a narrow set of office-based procedural codes.

Medicare: Complete Services Breakdown

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

13 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
11056	The provider removes 2 to 4 benign hyperkeratotic lesions by using surgical instruments like a scalpel or curette.	740	$70	$49.4K
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…	720	$70	$48.6K
11721	The provider surgically debrides (debulks or removes) 6 or more abnormal, diseased, or infected nails.	1,230	$40	$43K
11055	The provider removes a single benign hyperkeratotic lesion by using surgical instruments like a scalpel or curette.	330	$60	$19.6K
97597	The provider excises devitalized (dead) tissue from an open wound, choosing from a variety of techniques; treatment may include topical application of medicine or materials, wound assessment,…	140	$80	$11.3K
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…	130	$80	$11K
11750	The provider removes part or all of a fingernail or toenail, including the nail plate and matrix and including the lunula if the excision is complete.	50	$130	$6.4K
11730	The provider removes part or all of a single nail plate using simple avulsion techniques.	40	$90	$3.1K
11057	The provider removes more than 4 benign hyperkeratotic lesions by using surgical instruments like a scalpel or curette.	40	$80	$3K
20605	In this procedure, the provider inserts a needle through the skin of a patient and into an intermediate joint or bursa and then uses the syringe attachment to the needle to remove fluid or he may…	60	$40	$2.5K

Showing 1–10 of 13

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 13 CPT/HCPCS codes. Note: this provider's state, "XX," is a placeholder CMS uses when a provider's practice-location state wasn't reported — not a traditional US state; the State panel below benchmarks against other providers coded under the same designation.

View: State1 / 2

Claims Volume vs. Unspecified Location Distribution

Sam Spencer — 1 of 12 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Unspecified Location

Full comparison — all codes billed, vs. state median

13 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
11056	1	10	740	$70	$49.3K
11721	1	10	1,230	$30	$42.9K
11055	1	10	330	$60	$19.5K
99213	2	10	140	$60	$18.8K
99203	2	10	140	$90	$12.2K
97597	1	10	80	$80	$6.8K
11750	1	10	50	$130	$6.4K
11730	1	10	40	$90	$3.1K
11057	1	10	40	$70	$3K
20605	1	10	60	$40	$2.5K

Showing 1–10 of 13

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Caleb Ng	CA	Retina Specialist (Ophthalmology) Physician	$2.2M	$21K
John Carlson	CA	Ophthalmology Physician	$1.4M	$0
Jens Thiele	CA	Dermatology Physician	$1.4M	$800
Jack Schim	CA	Neurology Physician	$1.2M	$101.4K
Fred Shahan	CA	Dermatology Physician	$1.3M	$0
Hanh Bui	CA	Cardiovascular Disease Physician	$795.6K	$5.4K
Pingfeng Du	CA	Cardiovascular Disease Physician	$769.2K	$0
Nathan Miller	CA	Pain Medicine Physician	$763.7K	$0
Irene Oh	CA	Neurology Physician	$703.1K	$0
Damian Rasch	CA	Cardiovascular Disease Physician	$680.1K	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Arash Mozayan Isfahani	CA	Ophthalmology Physician	$2.6M	$0
Alberto Bessudo	CA	Hematology & Oncology Physician	$2M	$0
Natalie Maclean	CA	Rheumatology Physician	$1.9M	$0
Ucsd Center For Surgery Of Encinitas, L.P.	CA	Ambulatory Surgical Clinic/Center	$1.3M	$0
Laurie Frakes	CA	Hematology & Oncology Physician	$1.3M	$0
Katherine Ludington	CA	Cardiovascular Disease Physician	$1.2M	$0
Keven Tagdiri	CA	Internal Medicine Physician	$1M	$51.3K
James Howard	CA	General Practice Physician	$606.7K	$0
Martin Charlat	CA	Cardiovascular Disease Physician	$573.4K	$0
Encinitas Endoscopy Center, LLC	CA	Ambulatory Surgical Clinic/Center	$569.5K	$0

Sam Spencer — Billing Profile & Reimbursement Data

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Sam Spencer — 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