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

Why is the Medicaid comparison limited to New Mexico 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. New Mexico (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.

James Kerner (NPI 1962429563)

Field	Value
Entity Type	Individual
Organization	James Kerner
Address	141 N Roadrunner Pkwy Ste 228
City	Las Cruces
State	NM
ZIP	88011
Taxonomy	Dermatology Physician
NPI Enumerated	July 17, 2006

Payer Source	Total Paid
Medicare	$615.4K
Medicaid	$0

Key Findings

This provider’s billing is effectively single‑payer: total Medicare revenue is $615.4K and there is no Medicaid billing on file. The NPI was enumerated on 2006-07-17 (~20 years ago), indicating a long tenure in practice but no recorded Medicaid participation during the available reporting period, which will materially shape payer-mix and access analyses.

Revenue is highly concentrated in a small set of Medicare codes: the precomputed top‑3 Medicare codes account for 49.4% of total Medicare revenue. The leading contributors are 99213 ($148.2K, 24.7% of Medicare revenue), 11102 ($105K, 17.5%), and 17000 ($43.3K, 7.2%), together driving roughly half of the provider’s Medicare dollar volume.

The procedural and E/M code mix points to a procedure‑focused dermatology practice that couples high volumes of outpatient visits with frequent biopsies and lesion destruction. High counts for 99213 (2.6K claims), 11102 (1.7K claims) and add‑on lesion codes such as 17003 (4K claims) plus a substantial pathology footprint (88305: 952 claims, $26.7K) indicate regular in‑office sampling and specimen submission for pathology review.

Several of the provider’s top CPT codes are extreme national outliers in volume, signaling market dominance for those services: 99213 ranks #329 of 457151 providers nationally (100th percentile; extreme outlier) and 11102 ranks #35 of 18797 (100th percentile; extreme outlier). Other high‑volume codes such as 11103 and 17000 also carry labels of “extreme outlier” or “notably above typical,” underscoring that this clinician bills substantially more of these common dermatology procedures than peers.

While biopsies and basic lesion destruction dominate, the mix also includes intermediate repairs and excisions consistent with minor surgical capability. Codes such as 12032 ($19.5K, ranks #740 of 6420, 88th percentile; typical), 11602 ($5.5K, ranks #779 of 5197, 85th percentile; typical) and a range of malignant‑destruction codes (17281, 17262, 17261) show activity across both benign and malignant lesion management, with some malignant‑destruction codes at notably above typical percentiles.

High unit volumes of low‑paid add‑on lesion codes (for example 17003: 4K claims, $5 avg paid/claim, $20.1K revenue) suggest many encounters involve multiple lesion treatments in a single visit. That operational pattern — frequent, multiple small procedures per encounter — has implications for supply needs, clinic throughput, and pathology workflow reflected in the sizable 88305 volume.

From a competitive and contracting perspective, the provider’s national ranks for core dermatology services (many in the 97–100th percentiles and labeled “extreme outlier” or “notably above typical”) position them as a major national volumetric outlier for routine dermatology procedures on Medicare. However, the absence of Medicaid billing means their commercial and Medicaid network leverage will be driven almost entirely by Medicare‑era performance and local market dynamics rather than a dual‑payer footprint.

For payer analysis, key risks and opportunities are clear: the provider brings a concentrated, Medicare‑heavy revenue stream of $615.4K driven by a handful of high‑volume codes (top 3 = 49.4% of Medicare revenue), which supports predictable volume for biopsy and lesion‑destruction services but also signals limited Medicaid access for beneficiaries unless contracting or participation changes. Analysts should consider the operational footprint implied by thousands of in‑office procedures and specimens when evaluating network adequacy, reimbursement negotiations, or referral patterns in the LAS CRUCES, NM market.

Medicare: Complete Services Breakdown

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

40 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	2,650	$60	$148.2K
11102	The provider biopsies a single skin lesion using a tangential (side–ways) approach; he shaves off the lesion or scoops it out with a knife or curette.	1,670	$60	$105K
17000	The provider destroys a premalignant lesion using techniques such as chemosurgery, cryosurgery, electrosurgery, or others. This code reports the destruction of the first or only lesion.	1,400	$30	$43.3K
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…	390	$90	$32.9K
11103	The provider biopsies an additional skin lesion using a tangential (side–ways) approach; he shaves off the lesion or scoops it out with a knife or curette. Report +11103 for each separate lesion…	820	$40	$30.3K
17110	The provider destroys benign lesions using techniques such as chemosurgery, cryosurgery, electrosurgery, or others. This code reports the destruction of one to 14 lesions other than skin tags or…	390	$70	$28.2K
88305	The physician, typically a pathologist, performs a level IV examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally…	950	$30	$26.7K
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…	320	$70	$21.9K
17003	In this add–on procedure, the provider destroys a premalignant lesion using techniques such as chemosurgery, cryosurgery, electrosurgery, or others. This code is appropriate for the second through…	4,010	$10	$20.1K
17281	The provider destroys a malignant lesion on the face, ears, eyelids, nose, lips, or mucous membrane using techniques such as chemosurgery, cryosurgery, electrosurgery, or others. The malignant lesion…	160	$130	$19.6K

Showing 1–10 of 40

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 40 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. New Mexico Distribution

James Kerner — 13 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — New Mexico

Full comparison — all codes billed, vs. state median

40 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
88305	18	70	530	$30	$28.5K
13132	10	10	60	$210	$13.6K
99214	297	2,700	90	$70	$12.9K
11102	1	70	140	$60	$11.6K
17110	8	100	80	$70	$10.5K
17000	3	110	220	$30	$10.4K
17004	31	60	50	$100	$9.3K
12052	6	10	50	$120	$7.7K
99213	1	2,440	60	$50	$7.3K
12032	3	30	30	$170	$6.8K

Showing 1–10 of 40

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Epiphany Dermatology Of New Mexico, LLC	NM	Dermatology Physician	$0	$6.3M
John Pitcher	NM	Ophthalmology Physician	$5.1M	$0
Richard Kinsey	TN	Anatomic Pathology & Clinical Pathology Physician	$3.3M	$147.3K
Mark Carmichael	CA	Hematology & Oncology Physician	$3.1M	$0
Howard Martin	TX	Dermatopathology (Pathology) Physician	$3M	$0
Daniel Kasuga	TX	Retina Specialist (Ophthalmology) Physician	$2.9M	$0
Richard Hwang	TX	Retina Specialist (Ophthalmology) Physician	$2.6M	$0
Cary Chisholm	TX	Anatomic Pathology & Clinical Pathology Physician	$2.5M	$24.7K
Joseph Furlong	TX	Diagnostic Radiology Physician	$2.4M	$39.7K
Ryan Robetorye	AZ	Clinical Pathology/Laboratory Medicine Physician	$2.3M	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Mountain Shadows Home Care Services, Inc	NM	Home Health Agency	$0	$92.9M
Las Cruces Medical Center LLC	NM	General Acute Care Hospital	$0	$86.8M
Addus Healthcare, Inc.	NM	In Home Supportive Care Agency	$0	$81.1M
Phc-las Cruces Inc	NM	General Acute Care Hospital	$0	$64.8M
Las Cruces Physician Services LLC	NM	Orthopaedic Surgery Physician	$0	$62.9M
Multicultural Evaluation & Consultation Associates LLC	NM	Early Intervention Provider Agency	$0	$59.3M
Quality Life Services, LLC	NM	Specialist	$0	$44.9M
Las Cruces Physician Practices, LLC	NM	Family Medicine Physician	$0	$22.8M
Southwest Emergency Medical Associates Of Nm PC	NM	Emergency Medicine Physician	$0	$20.3M
Milagro De Vida Community Services LLC	NM	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$20.2M

James Kerner — 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