JAMES A JONES, LCSW
NPI 1104856715, individual, Jackson, TN, Social Worker, Clinical
- Hours beyond a day in 2 months, but with up to 388 patients a month, which points to a supervising clinician on the claims rather than one person's hours.
- Records needed.
Hours billed per day
Medicaid billing converted into hours of hands-on care per day. The lower bound counts one unit per claim line and needs no price; the other two divide dollars by a unit price, the conservative one at 1.5 times the price. The clinician on the claim may be a supervisor under state rules, so billing organizations are counted too.
| month | what was found | hours per day, lower bound | hours per day, at price | hours per day, conservative | per working day | patients | billing organizations | codes | paid |
|---|---|---|---|---|---|---|---|---|---|
| Sep 2022 | More hours than a day holds, even counting one unit per claim line | 25.1 | 23.2 | 15.5 | 21.1 | 327 | 1 | 90791 90832 90834 90837 | $62K |
| Nov 2022 | More hours than a day holds, even counting one unit per claim line | 26.1 | 23.4 | 15.6 | 21.3 | 357 | 1 | 90791 90832 90834 90837 | $62K |
National provider registry
From the CMS NPPES Registry, refreshed daily.
| Name | JAMES A JONES, LCSW |
| Type | Individual |
| Status | Active |
| NPI issued | July 3, 2006, last updated May 10, 2012 |
| Practice location | 238 SUMMAR DR, Jackson, TN 38301-3906, 731-935-8200 |
| Mailing address | 1804 HIGHWAY 45 BYP, STE. 604, Jackson, TN 38305-4436 |
| Specialties | Social Worker, Clinical (1041C0700X, primary, license 3280 TN) Counselor (101Y00000X, license 3280 TN) |
Procedures billed
The specific codes behind the dollars. Medicaid figures come from T-MSIS (2018 to 2024) and are compared with every other provider billing the same code; Medicare figures come from the 2024 physician and supplier file and compare this provider's submitted charge with what Medicare allowed, against the usual ratio for that code.
| code | what it is | paid | share | per patient-month | typical | rank among providers | |
|---|---|---|---|---|---|---|---|
| 90837 | Psychotherapy, 1 hourhistory of abuse | $1.1M | 47% | $138 | $191 (top 5% from $442) | 26th percentile | |
| 90834 | Psychotherapy, 45 minutes | $617K | 27% | $66 | $101 (top 5% from $318) | 27th percentile | |
| 90791 | Psychiatric diagnostic evaluation | $411K | 18% | $120 | $105 (top 5% from $228) | 66th percentile | |
| 90832 | Psychotherapy, 30 minutes | $160K | 7% | $50 | $59 (top 5% from $239) | 41st percentile | |
| 90847 | Family psychotherapy with patient, 50 minutes | $3K | 0% | $106 | $130 (top 5% from $458) | too few months to rank | |
| 90836 | Psychotherapy with evaluation and management visit, 45 minutes | $952 | 0% | $33 | $72 (top 5% from $190) | too few months to rank | |
| 90853 | Group psychotherapyhistory of abuse | $710 | 0% | $51 | $60 (top 5% from $332) | too few months to rank |
| code | what it is | services | beneficiaries | paid | submitted per service | allowed per service | charge to allowed | usual for this code |
|---|---|---|---|---|---|---|---|---|
| 90837 | Psychotherapy, 1 hour | 112 | 19 | $8K | $150 | $96 | 1.6x | 1.6x (90th percentile 2.9x) |
A submitted charge many times the allowed amount is common and lawful; it matters when it is far above what other providers submit for the same code.
In this area
5 providers in Madison County, TN carry an indicator in the public record, with $2.2M at stake between them. The most common is more hours than a day holds, on 3 of them, followed by paid after a public list action on 2. 2 are tier 1: documented action, then payment.
| tier | provider | at stake | why |
|---|---|---|---|
| 1 | ALEXANDER ALPEROVICH Jackson, TN, ranked 269 | $12K |
|
| 1 | ADVANCED CARDIOVASCULAR & VEIN CENTER Jackson, TN, ranked 387 | $1K |
|
| 4 | TWANA MILLER Jackson, TN, ranked 8173 | $1.2M |
|
| 4 | KIMBERLY BEARE Jackson, TN, ranked 9194 | $533K |
|
| 4 | STEPHEN COLLIER Jackson, TN, ranked 9234 | $461K |
|
Recent enforcement in TN
All releasesDepartment of Justice and HHS-OIG releases for this state, newest first. Each opens in a new tab.
Referral packet
The packet is a draft for a reviewer. It reads every public record behind this case, states what the records show with a citation for each finding, names the regulation each finding relates to, and lists the ordinary explanations to rule out first. It never asserts intent.