Physician

James Douglas Birmingham, MD

According to 2025 Medicare claims, James Birmingham, MD (NPI: 1891811543) practices rheumatology in the Grand Rapids-Wyoming-Kentwood, MI market, with the plurality of this provider's patient population coming from Kent, MI. This provider's primary affiliated billing organization is AMERICAN ARTHRITIS & RHEUMATOLOGY ASSOCIATES -MI PLLC (NPI: 1538655469; TIN: 823851171) and primary practice location at 49301-9502. Birmingham is affiliated with the POM ACO (ACO ID: A1297) and Aledade 201 National MSSP (ACO ID: A5522), participating under the MSSP model.

Birmingham's data goes back to 2015 and runs through 2024. For example, in 2024, this provider had 140 traditional Medicare patients, billed 47,899 HCPCS/CPT codes, and received $377,254 in Medicare payments. The top billing code was 99205 (New patient office or other outpatient visit with a high level of medical decision making, if using time, 60 minutes or more). Part D data shows 2,022 prescription claims across 263 beneficiaries totaling $3,910,785 in drug costs, led by Humira(Cf) Pen (Adalimumab). Open Payments data shows 174 records totaling $45,808. 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 moved sharply higher in recent years, from $61,217 to $377,254. Similarly, Part D prescription costs have moved sharply higher in recent years, from $803,001 to $3,910,785. For DME billing, this provider has fewer than 5 years of reported data, so a reliable trend cannot be assigned.

Part B Carrier Billing Trend

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

Year	Patients	Clm Lines	Payment
2015	44	2,547	$61,217
2016	52	2,639	$96,064
2017	55	5,637	$174,842
2018	58	5,202	$154,091
2019	58	101	$7,233
2020	37	52	$3,447
2021	61	115	$8,978
2022	61	984	$14,730
2023	102	27,959	$255,215
2024	140	47,899	$377,254

Part D Events Trend

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

Year	Patients	Claims	Drug Cost
2015	77	950	$803,001
2016	80	915	$1,184,237
2017	85	961	$1,219,966
2018	102	989	$1,506,327
2019	125	1,291	$1,590,658
2020	118	972	$1,152,791
2021	141	1,020	$1,280,576
2022	157	1,181	$2,016,018
2023	205	1,710	$3,422,009
2024	263	2,022	$3,910,785

DME Billing Trend

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

No connected DME records

* / # = 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
99205	New patient office or other outpatient visit with a high level of medical decision making, if using time, 60 minutes or more	23	23	$132
99215	Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more	84	150	$116
99214	Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	80	112	$85
96413	Administration of chemotherapy into vein, 1 hour or less	18	123	$82
G2211	Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient's	47	58	$12

Top 5 Part D drugs in 2024

By total drug costs.

Drug	Generic	Claims	Total Day Supply	Total Drug Cost
Humira(Cf) Pen	Adalimumab	184	5,292	$1,396,779
Enbrel Sureclick	Etanercept	95	2,772	$931,233
Rinvoq	Upadacitinib	48	1,545	$321,471
Humira(Cf)	Adalimumab	23	644	$234,181
Enbrel	Etanercept	33	1,008	$184,990

Top 5 DME services in 2024

No connected or detailed DME service-level records for 2024.

Open Payments Summary in 2024

Category	Definition	Records	Total Reported Amount	Top Related Entity
General Payments	Reported payment or transfer-of-value amount.	172	$7,505	ABBVIE INC.
Research Payments	Reported research-related payment or transfer-of-value amount.	2	$38,302	Novartis Pharmaceuticals Corporation
Ownership / Investment Interests	Reported value of ownership or investment interests.	0	$0	N/R

Explore More Providers

FAQ

What Medicare data is available for James Douglas Birmingham, MD?

Tedicare shows public-source Medicare data for James Douglas Birmingham, MD (NPI 1891811543), 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 Douglas Birmingham, MD have ACO affiliation data?

James Douglas Birmingham, MD is shown with ACO affiliation data for POM ACO (MSSP, ACO ID A1297) and Aledade 201 National MSSP (MSSP, ACO ID A5522).

What billing organization is linked to James Douglas Birmingham, MD?

James Douglas Birmingham, MD is linked to AMERICAN ARTHRITIS & RHEUMATOLOGY ASSOCIATES -MI PLLC (billing NPI 1538655469) in the available physician profile data.

Does James Douglas Birmingham, MD have Open Payments data?

James Douglas Birmingham, MD has 174 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.