Clinic
James E Fox MD PLLC
James E Fox MD PLLC was paid $380K by Medicaid between Jan 2018 and Dec 2024, across 22 billing codes. Its largest line is 99213, doctor's office visit, returning patient (routine) — 56% of everything it billed.
33Billing provider infoJAMES E FOX MD PLLC
KNOXVILLE, TN 37923
KNOXVILLE, TN 37923
33aNPI1508107533assigned 03/15/2013
33bProvider typePain Clinic/Center
28Total paid$380K
24GClaims57,845
24DCodes billed22
24AFirst – last monthJan 2018 – Dec 2024
Compared with peers
Next to other Pain Clinic/Center providers in Tennessee
Rank by total paid#2 of 10
Median peer was paid$55K
This provider vs. median6.9×
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 | 11,337 | $90K | |
| 2019 | 9,481 | $65K | |
| 2020 | 8,114 | $59K | |
| 2021 | 7,969 | $56K | |
| 2022 | 6,935 | $37K | |
| 2023 | 6,407 | $38K | |
| 2024incomplete | 7,602 | $35K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| 99213 | Doctor's office visit, returning patient (routine)Office or other outpatient visit for the evaluation and management of an established patient, low complexity | 56% | 19,502 | 16,495 | $214K |
| 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 | 23% | 5,929 | 5,112 | $89K |
| 80307 | Drug test(s), presumptive, any number of drug classes; immunoassay | 9.0% | 19,142 | 15,825 | $34K |
| 80306 | 4.5% | 2,792 | 2,509 | $17K | |
| G0480 | Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 1-7 drug class(es), including metabolite(s) if performed | 3.8% | 5,059 | 4,379 | $14K |
| 96132 | <1% | 486 | 270 | $3K | |
| 96130 | <1% | 486 | 270 | $2K | |
| G0481 | Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 8-14 drug class(es), including metabolite(s) if performed | <1% | 593 | 542 | $2K |
| 81025 | <1% | 571 | 497 | $1K | |
| 96127 | <1% | 1,243 | 1,114 | $1K | |
| 99211 | Office or other outpatient visit for the evaluation and management of an established patient, minimal severity | <1% | 319 | 309 | $1K |
| 96138 | <1% | 487 | 270 | $431.70 |
10 more codes
| 99406 | <1% | 298 | $395.68 | |
| 0012A | <1% | 15 | $339.14 | |
| 99439 | <1% | 14 | $232.93 | |
| 99490 | Ccm add 20min | <1% | 16 | $151.42 |
| 99423 | <1% | 19 | $99.80 | |
| G0396 | Alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes | <1% | 419 | $63.88 |
| G0008 | Administration of influenza virus vaccine | <1% | 17 | $46.26 |
| 99442 | <1% | 20 | $36.01 | |
| G0444 | Annual depression screening, 5 to 15 minutes | <1% | 398 | $33.12 |
| 96146 | <1% | 20 | $8.00 |
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.
From NPPES
Who's on the registration
Authorized officialFOX, JAMES (PHYSICIAN)
| Provider | Location | Paid |
|---|---|---|
| Fox Skin & Allergy Associates | Branchburg, NJ | $265K |
| Chiropractic Oasis of Gardendale, LLC | Gardendale, AL | $15K |
Matched on the authorized-official name exactly as entered in NPPES. A common name can match unrelated people.