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NPI 1972784452 · Johnston, RI · Orthopaedic Surgery of the Spine Physician
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John Czerwein is a orthopaedic surgery of the spine physician provider located in Johnston, Rhode Island. This profile covers 28 Medicare and 5 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.
Provider details (source: NPPES NPI Registry)
| Field | Value |
|---|---|
| Entity Type | Individual |
| Organization | John Czerwein |
| Address | 1524 Atwood Ave |
| City | Johnston |
| State | RI |
| ZIP | 02919 |
| Taxonomy | Orthopaedic Surgery of the Spine Physician |
| NPI Enumerated | November 26, 2007 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $250.3K |
| Medicaid | $65.2K |
This provider’s Medicare billing is concentrated in a mix of office visits, image‑guided spinal injections, and targeted epidural procedures: the top Medicare codes include 99213 ($39K, 15.6% of Medicare revenue), 64493 ($36.2K, 14.5%), and 62323 ($26.6K, 10.7%), and the top 3 Medicare codes together account for 40.8% of total Medicare revenue. That mix — dominant E/M plus lumbar facet and epidural injections — is consistent with an interventional spine practice that also bills for procedural spinal care rather than pure general orthopedics.
Medicaid billing is heavily weighted to office visits: 99213 represents $59.5K or 91.2% of this provider’s Medicaid revenue, and the precomputed top‑3 share for Medicaid is 98.2%. In practical terms this means Medicaid business is almost entirely routine follow‑up or established‑patient visits, with only minimal procedure or imaging revenue coming from Medicaid claims.
Scale and payer mix: lifetime Medicare revenue is $250.3K versus lifetime Medicaid revenue of $65.2K, so Medicare is the larger payer by reported dollars and appears to be the primary revenue source. While both payers are present, the provider is not a Medicaid‑centric practice — Medicaid volumes appear to support mostly office‑based follow up care rather than procedural volume.
Competitive standing on Medicare for conservative spine services is relatively strong: 99213 ranks #21086 of 457151 providers nationally (95th percentile; notably above typical national volume) and 64493 ranks #449 of 7519 providers nationally (94th percentile). At the same time, several fusion and instrumentation codes (for example 22633 at the 32th percentile and 22612 at the 64th percentile) place this provider in a more modest national position for complex surgical spine procedures, suggesting they generate proportionally more volume in outpatient visits and injections than in higher‑acuity surgical fusion work.
Statistical outliers and notable signals: the lumbar radiograph code 72110 is reported as an extreme outlier on Medicare (rank #183 of 13711, 99th percentile; extreme outlier, far above typical national volume), and J3301 ranks in the 96th percentile nationally (notably above typical national volume). These elevated percentiles for imaging and corticosteroid injection supply indicate above‑typical utilization of diagnostic radiographs and injectable steroids in the Medicare population compared with peers.
Medicaid competitive context is more muted: 99213 is the dominant Medicaid code and ranks #479 of 2046 providers in‑state (77th percentile; typical, unremarkable volume), while other Medicaid procedure codes (for example 64493 and J3301) show low absolute revenue and mixed in‑state ranks. This pattern reinforces that the provider’s Medicaid footprint is largely E/M driven and not a major source of interventional or procedural Medicaid market share in‑state.
Service‑line implication: the overall CPT mix — heavy counts of 99213, frequent facet and epidural injections (64493, 62323), and substantial use of spine radiographs and occasional surgical fusion codes — characterizes an orthopaedic spine practice oriented toward interventional outpatient management with supplemental operative capability. Analysts should view the practice as an established interventional spine provider that maintains some surgical activity rather than a high‑volume inpatient spine surgery center.
Tenure and market durability: NPI enumerated 2007-11-26 (~19 years ago) indicates a long‑standing presence in the market, which supports interpretation of these billing patterns as established practice behavior rather than a short‑term fluctuation. Given the sustained mix of office visits, injections, and imaging across payers, the provider appears to have a stable outpatient spine practice footprint over time.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
28 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… | 570 | $70 | $39K |
| 64493 | The provider injects a diagnostic or therapeutic substance into a single lumbar or sacral paravertebral facet (zygapophyseal) joint, or into the nerves that supply that joint, using imaging guidance… | 210 | $180 | $36.2K |
| 62323 | The provider injects a diagnostic or a therapeutic substance, such as pain medication or a steroid, into the space around the spinal nerves of the lumbar (lower back) or sacral (caudal, or tailbone)… | 150 | $180 | $26.6K |
| 22612 | The provider performs arthrodesis, also known as spinal fusion, in the lumbar spine (lower back), to permanently join two vertebrae, the interlocking bones of the spine. The provider applies bone… | 20 | $1,190 | $26.2K |
| 22633 | In this procedure the provider joins two adjoining lumbar vertebral bodies permanently, accessing the operative site with a combination of approaches for a better outcome. The provider performs this… | 20 | $1,460 | $21.9K |
| 22614 | The provider performs arthrodesis, also known as spinal fusion, to permanently join two vertebrae, the interlocking bones of the spine. The provider applies bone graft material to fuse the spine. The… | 50 | $300 | $15.9K |
| 22842 | The provider places spinal instrumentation at the back of the spine across three to six vertebral segments to correct a spinal deformity during the course of a spinal surgery, such as a spinal… | 30 | $590 | $15.2K |
| 72110 | In this diagnostic procedure, the provider performs at least four X–ray views of the lumbosacral spine to evaluate the patient's spine for the presence of abnormal curves, fractures, or cancer. | 280 | $40 | $10.5K |
| 63047 | The provider performs a laminectomy (excision of the thin bony plate at the back of a vertebra), facetectomy (excision of an area of a vertebra characterized by its smooth surface), and foraminotomy… | 20 | $470 | $9.4K |
| 64494 | In this add–on procedure, the provider injects a diagnostic or therapeutic substance into a single lumbar or sacral paravertebral facet (zygapophyseal) joint, or into the nerves that supply that… | 80 | $90 | $7K |
Showing 1–10 of 28
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 28 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
28 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| 22633 | 4 | 10 | 20 | $1,010 | $19.2K |
| 22614 | 6 | 10 | 50 | $220 | $15.8K |
| 22612 | 2 | 10 | 20 | $850 | $15.2K |
| 62323 | 5 | 20 | 50 | $140 | $13.2K |
| 64493 | 1 | 20 | 50 | $170 | $12.8K |
| 64483 | 20 | 20 | 50 | $190 | $12.2K |
| 99214 | 1,433 | 1,950 | 100 | $80 | $11.7K |
| 63047 | 4 | 10 | 20 | $510 | $8.7K |
| 22842 | 2 | 10 | 20 | $430 | $8.1K |
| 99213 | 51 | 1,950 | 70 | $60 | $7.4K |
Showing 1–10 of 28
Medicaid revenue breakdown by year and by CPT/HCPCS procedure code, including monthly billing trends and the top codes driving revenue.
View: By Year1 / 3
Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.
5 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… | 1,140 | $50 | $59.5K |
| 64493 | The provider injects a diagnostic or therapeutic substance into a single lumbar or sacral paravertebral facet (zygapophyseal) joint, or into the nerves that supply that joint, using imaging guidance… | 10 | $200 | $2.4K |
| 72110 | In this diagnostic procedure, the provider performs at least four X–ray views of the lumbosacral spine to evaluate the patient's spine for the presence of abnormal curves, fractures, or cancer. | 60 | $40 | $2.2K |
| J3301 | Injection, triamcinolone acetonide, not otherwise specified, 10 mg | 110 | $10 | $1.1K |
| J1100 | Injection, dexamethasone sodium phosphate, 1 mg | 30 | $1 | $60 |
How this provider's Medicaid billing volume and revenue compare to other Rhode Island providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Rhode Island median
5 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| J1100 | Injection, dexamethasone sodium phosphate, 1 mg | 20 | 20 | 120 | $220 | $244.1K |
| 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… | 479 | 2,050 | 300 | $50 | $72.3K |
| 64493 | The provider injects a diagnostic or therapeutic substance into a single lumbar or sacral paravertebral facet (zygapophyseal) joint, or into the nerves that supply that joint, using imaging guidance… | 4 | 10 | 20 | $640 | $21.9K |
| 72110 | In this diagnostic procedure, the provider performs at least four X–ray views of the lumbosacral spine to evaluate the patient's spine for the presence of abnormal curves, fractures, or cancer. | 8 | 10 | 130 | $60 | $10.4K |
| J3301 | Injection, triamcinolone acetonide, not otherwise specified, 10 mg | 18 | 30 | 110 | $10 | $2.9K |
Other providers in the same ZIP code as John Czerwein, ranked by combined Medicare and Medicaid revenue.
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