Physician

James R Cain, MD

According to 2025 Medicare claims, James Cain, MD (NPI: 1174615868) practices nephrology in the Sumter, SC market, with the plurality of this provider's patient population coming from Sumter, SC. This provider's primary affiliated billing organization is MUSC COMMUNITY PHYSICIANS (NPI: 1841878006; TIN: 853861695) and primary practice location at 29150-1900. Cain is affiliated with the MUSC Health Alliance, LLC (ACO ID: A5535), participating under the MSSP model.

Cain's data goes back to 2015 and runs through 2024. For example, in 2024, this provider had 253 traditional Medicare patients, billed 8,695 HCPCS/CPT codes, and received $258,924 in Medicare payments. The top billing code was 90960 (Dialysis services, 4 or more physician visits per month (20 years or older)). Part D data shows 2,739 prescription claims across 254 beneficiaries totaling $639,493 in drug costs, led by Farxiga (Dapagliflozin Propanediol). DME data shows 71 claims. Open Payments data shows 53 records totaling $1,114. You can download detailed data with all billing codes (2015-2024). For more recent data, please contact us.

Over the past 10 years, this provider's Medicare Part B carrier billing did not follow a clear longitudinal pattern. Concurrently, Part D prescription costs have declined steadily, from $1,287,968 to $639,493. In contrast, DME billing represents a smaller volume and started with an early spike, then settled into a lower baseline, moving from $28,259 to $3,824.

Part B Carrier Billing Trend

Medicare payment trend, with N of patients and claim lines in the table.

Year	Patients	Clm Lines	Payment
2015	477	6,593	$310,350
2016	481	7,527	$307,211
2017	557	8,554	$322,521
2018	433	8,203	$344,054
2019	389	8,304	$333,922
2020	455	32,667	$510,268
2021	402	43,469	$622,505
2022	338	12,576	$570,616
2023	266	6,864	$225,110
2024	253	8,695	$258,924

Part D Events Trend

Drug cost trend, with N of patients and prescription claims in the table.

Year	Patients	Claims	Drug Cost
2015	304	4,143	$1,287,968
2016	297	3,695	$1,105,799
2017	364	4,332	$1,226,924
2018	321	4,366	$853,265
2019	273	3,445	$807,403
2020	255	3,204	$800,995
2021	274	2,839	$686,387
2022	292	3,145	$881,581
2023	247	2,994	$918,216
2024	254	2,739	$639,493

DME Billing Trend

Medicare payment trend, with N of patients and DME claim records in the table.

Year	Patients	Claims	Payment
2015	65	305	$15,657
2016	62	249	$9,082
2017	22	220	$7,443
2018	20	169	$6,045
2019	13	153	$5,809
2020	N/R	197	$11,934
2021	N/R	97	$6,802
2022	N/R	85	$6,228
2023	N/R	73	$4,149
2024	N/R	71	$1,340

* / # = suppressed by CMS; 0 = reported zero; N/R = not reported or blank.

Top 5 Part B carrier billing codes in 2024

By total payments.

Code	Description	Patients	Clm Lines	Total Payment
90960	Dialysis services, 4 or more physician visits per month (20 years or older)	84	141	$262
99214	Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	89	218	$87
80053	Blood test, comprehensive group of blood chemicals	76	177	$10
36415	Insertion of needle into vein for collection of blood sample	92	279	$8
85025	Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count	81	206	$8

Top 5 Part D drugs in 2024

By total drug costs.

Drug	Generic	Claims	Total Day Supply	Total Drug Cost
Farxiga	Dapagliflozin Propanediol	169	7,698	$143,834
Ozempic	Semaglutide	83	3,356	$100,214
Jardiance	Empagliflozin	59	3,065	$59,366
Trulicity	Dulaglutide	37	1,120	$37,414
Velphoro	Sucroferric Oxyhydroxide	16	480	$36,254

Top 5 DME services in 2024

By Total Medicare Payment Amount.

HCPCS Code	HCPCS Description	Supplier Rental Indicator	Total Supplier Beneficiaries	Total Supplier Claims	Total Medicare Payment Amount
J7515	Cyclosporine, oral, 25 mg	N	N/R	12	$666
Q0512	Pharmacy supply fee for oral anti-cancer, oral anti-emetic or immunosuppressive drug(s); for a subsequent prescription in a 30-day period	N	N/R	24	$276
Q0511	Pharmacy supply fee for oral anti-cancer, oral anti-emetic or immunosuppressive drug(s); for the first prescription in a 30-day period	N	N/R	12	$207
J7517	Mycophenolate mofetil, oral, 250 mg	N	N/R	12	$187
J7512	Prednisone, immediate release or delayed release, oral, 1 mg	N	N/R	11	$4

Open Payments Summary in 2024

Category	Definition	Records	Total Reported Amount	Top Related Entity
General Payments	Reported payment or transfer-of-value amount.	53	$1,114	Amgen Inc.
Research Payments	Reported research-related payment or transfer-of-value amount.	0	$0	N/R
Ownership / Investment Interests	Reported value of ownership or investment interests.	0	$0	N/R

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FAQ

What Medicare data is available for James R. Cain, MD?

Tedicare shows public-source Medicare data for James R. Cain, MD (NPI 1174615868), including provider identity, specialty, market context, Medicare Part B activity, Part D prescribing, DME records, Open Payments where available, billing organization details, and ACO affiliation signals where available. Profile data covers 2015-2024, with current attribution based on 2025 claims where available.

Does James R. Cain, MD have ACO affiliation data?

James R. Cain, MD is shown with ACO affiliation data for MUSC Health Alliance, LLC (MSSP, ACO ID A5535).

What billing organization is linked to James R. Cain, MD?

James R. Cain, MD is linked to MUSC COMMUNITY PHYSICIANS (billing NPI 1841878006) in the available physician profile data.

Does James R. Cain, MD have Open Payments data?

James R. Cain, MD has 53 connected Open Payments records in the available 2024 summary data.

Can I download physician-level Medicare data from Tedicare?

Yes. Tedicare provides sample physician export data and paid custom physician data exports for research, planning, outreach, and market analysis. Exports can include physician profile fields, market and specialty context, billing organization details, ACO affiliation signals where available, and Medicare utilization data.