Physician
Nelson, James
Nelson, James was paid $936K by Medicaid between Jan 2018 and Oct 2020, across 33 billing codes. Its largest line is 99214, doctor's office visit, returning patient (more involved) — 34% of everything it billed.
33Billing provider infoNELSON, JAMES
DAYTON, TN 37321
DAYTON, TN 37321
33aNPI1104985340assigned 12/06/2006
33bProvider typePediatrics Physician
28Total paid$936K
24GClaims35,034
24DCodes billed33
24AFirst – last monthJan 2018 – Oct 2020
Compared with peers
Next to other Pediatrics Physician providers in Tennessee
Rank by total paid#75 of 333
Median peer was paid$139K
This provider vs. median6.7×
Peers share this provider's primary NPPES type and state. Size alone says nothing about billing quality: a big agency or a hospital system is expected to sit far above the median.
Box 24A · Dates of service
Paid by month
Paid that monthNov–Dec 2024: claims still arriving when the file was cut, so these months run low for every provider
By year, as a table
| Year | Claims | Paid | |
|---|---|---|---|
| 2018 | 13,189 | $365K | |
| 2019 | 15,252 | $406K | |
| 2020 | 6,593 | $165K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| 99214 | Doctor's office visit, returning patient (more involved)Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity | 34% | 5,171 | 4,777 | $315K |
| 99213 | Doctor's office visit, returning patient (routine)Office or other outpatient visit for the evaluation and management of an established patient, low complexity | 16% | 3,678 | 3,285 | $145K |
| 96110 | Developmental screening, with scoring and documentation, per standardized instrument | 13% | 3,149 | 2,581 | $124K |
| 90460 | Immunization administration through 18 years of age via any route, first or only component | 6.8% | 4,082 | 1,883 | $64K |
| 92587 | 5.6% | 1,074 | 998 | $52K | |
| 99392 | Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) | 4.2% | 542 | 511 | $39K |
| 87880 | Infectious agent antigen detection by immunoassay; Streptococcus, group A | 4.0% | 2,624 | 2,450 | $38K |
| 99393 | Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) | 3.5% | 452 | 430 | $32K |
| 85025 | Blood count; complete (CBC), automated, and automated differential WBC count | 2.8% | 2,390 | 2,212 | $26K |
| 87804 | Infectious agent antigen detection by immunoassay; Influenza, each type | 2.6% | 1,684 | 775 | $24K |
| 99173 | 1.6% | 1,676 | 1,560 | $15K | |
| 99391 | Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) | 1.5% | 229 | 207 | $14K |
21 more codes
| 99212 | Office or other outpatient visit for the evaluation and management of an established patient, straightforward | 1.5% | 494 | $14K |
| 99394 | Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) | 1.3% | 150 | $12K |
| 36416 | <1% | 2,324 | $7K | |
| 81003 | <1% | 1,396 | $4K | |
| 80061 | Lipid panel | <1% | 217 | $3K |
| 92558 | <1% | 365 | $3K | |
| 81002 | <1% | 395 | $1K | |
| 90461 | <1% | 531 | $744.14 | |
| 83655 | <1% | 24 | $415.44 | |
| 96127 | <1% | 68 | $306.81 | |
| 87070 | <1% | 1,202 | $216.48 | |
| 90686 | <1% | 559 | $130.00 | |
| 94760 | <1% | 66 | $116.85 | |
| 90658 | <1% | 13 | $90.00 | |
| 99211 | Office or other outpatient visit for the evaluation and management of an established patient, minimal severity | <1% | 51 | $81.56 |
| 86756 | <1% | 85 | $25.49 | |
| 90688 | <1% | 49 | $20.00 | |
| 90633 | 0% | 24 | $0.00 | |
| 90670 | 0% | 95 | $0.00 | |
| 90651 | 0% | 76 | $0.00 | |
| 90698 | 0% | 99 | $0.00 |
Claims and beneficiary counts add up across code × month rows, so one patient seen every month counts many times. Rows with fewer than 12 claims are suppressed by HHS, so small lines can be missing.