Physician

John H Upshaw, MD

According to 2025 Medicare claims, John Upshaw, MD (NPI: 1598770869) practices urology in the Lake Charles, LA market, with the plurality of this provider's patient population coming from Calcasieu, LA. This provider's primary affiliated billing organization is LAKE CHARLES MEDICAL SERVICES UROLOGY LLC (NPI: 1558491803; TIN: 20-8134509) and primary practice location at 70601-8994.

Upshaw's data goes back to 2015 and runs through 2024. For example, in 2024, this provider had 952 traditional Medicare patients, billed 46,322 HCPCS/CPT codes, and received $238,030 in Medicare payments. The top billing code was 99214 (Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more). Part D data shows 4,102 prescription claims across 865 beneficiaries totaling $503,749 in drug costs, led by Xtandi (Enzalutamide). DME data shows 24 claims. Open Payments data shows 11 records totaling $265. 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 has changed little. Concurrently, Part D prescription costs have moved sharply higher in recent years, from $230,724 to $503,749. In contrast, DME billing represents a smaller volume and declined steadily, from $1,629 to $823.

Part B Carrier Billing Trend

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

Year	Patients	Clm Lines	Payment
2015	1,178	46,664	$357,843
2016	1,168	39,987	$329,180
2017	1,118	38,407	$282,698
2018	1,189	64,210	$338,064
2019	1,125	59,017	$323,938
2020	955	46,653	$270,175
2021	896	39,041	$253,115
2022	998	58,359	$290,937
2023	989	55,014	$259,467
2024	952	46,322	$238,030

Part D Events Trend

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

Year	Patients	Claims	Drug Cost
2015	566	3,148	$230,724
2016	549	3,158	$220,343
2017	559	3,092	$213,777
2018	599	3,031	$248,648
2019	582	2,836	$187,360
2020	559	2,433	$172,697
2021	575	2,386	$335,256
2022	734	3,027	$338,020
2023	817	3,626	$595,568
2024	865	4,102	$503,749

DME Billing Trend

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

Year	Patients	Claims	Payment
2015	12	152	$14,003
2016	N/R	146	$12,279
2017	N/R	76	$7,378
2018	N/R	58	$6,216
2019	N/R	51	$2,993
2020	N/R	62	$8,462
2021	N/R	90	$7,603
2022	N/R	86	$8,484
2023	N/R	39	$6,867
2024	N/R	24	$944

* / # = 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
99214	Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	625	892	$82
99213	Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more	387	511	$57
51798	Ultrasound measurement of bladder capacity after voiding	278	348	$7
81000	Manual urinalysis test with examination using microscope, non-automated	740	1,274	$4
81002	Urinalysis, manual test	211	243	$3

Top 5 Part D drugs in 2024

By total drug costs.

Drug	Generic	Claims	Total Day Supply	Total Drug Cost
Xtandi	Enzalutamide	17	510	$194,968
Myrbetriq	Mirabegron	124	7,494	$115,814
Gemtesa	Vibegron	124	6,360	$98,962
Tamsulosin Hcl	Tamsulosin Hcl	1,272	103,665	$19,789
Finasteride	Finasteride	858	71,966	$13,420

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
A4349	Male external catheter, with or without adhesive, disposable, each	N	N/R	12	$773
A4358	Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each	N	N/R	12	$170

Open Payments Summary in 2024

Category	Definition	Records	Total Reported Amount	Top Related Entity
General Payments	Reported payment or transfer-of-value amount.	11	$265	PROCEPT BioRobotics Corporation
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

Explore More Providers

FAQ

What Medicare data is available for John H. Upshaw, MD?

Tedicare shows public-source Medicare data for John H. Upshaw, MD (NPI 1598770869), 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 John H. Upshaw, MD have ACO affiliation data?

No ACO affiliation record is shown in the available Tedicare data for this profile.

What billing organization is linked to John H. Upshaw, MD?

John H. Upshaw, MD is linked to LAKE CHARLES MEDICAL SERVICES UROLOGY LLC (billing NPI 1558491803) in the available physician profile data.

Does John H. Upshaw, MD have Open Payments data?

John H. Upshaw, MD has 11 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.