Why are Medicare and Medicaid shown separately instead of combined?

They come from two different CMS data sources with no shared claim identifier, so they can't be reconciled into one number without double-counting or guessing. Every table and chart on this page keeps them fully separate.

Why is there no private/commercial revenue figure?

Private and commercial payer data comes from Transparency in Coverage files, which only publish negotiated rates — not claims or utilization volume. Without a volume figure, no revenue number can be computed for any provider from that data.

What does "Rank" mean in the Competitive Analysis & Benchmarks tables?

For a given CPT/HCPCS code, it's this provider's position by claims volume among all providers billing that same code at that geography level (State, National, or Puerto Rico for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to Puerto Rico only?

Medicaid is administered per-state with no single national fee schedule, so a state or national comparison the way Medicare has one isn't available. Puerto Rico (this provider's own state) is the only grouping that's conceptually meaningful.

Why are the numbers rounded to the nearest 10?

To avoid implying more precision than the underlying data supports at a single-provider level. Ratios are kept precise since they're a relative comparison, not a volume or dollar figure.

How current is this data?

The Medicare and Medicaid tables are both single current snapshots, not refreshed on a recurring schedule yet.

Sps Specialty Pharmacy Services Inc (NPI 1013070572)

Field	Value
Entity Type	Organization
Organization	Sps Specialty Pharmacy Services Inc
Address	75 Ave Luis Munoz Marin
City	Caguas
State	PR
ZIP	00725
Taxonomy	Specialty Pharmacy
NPI Enumerated	December 18, 2006

Payer Source	Total Paid
Medicaid	$4.2M
Medicare	$0

Key Findings

This provider effectively operates as a single-payer Medicaid biller: there is no Medicare revenue on file while lifetime Medicaid revenue is $4.2M, so Medicaid entirely drives the available public-payor billing footprint for SPS SPECIALTY PHARMACY SERVICES INC. Analysts should treat Medicaid reimbursement dynamics as the primary commercial reality for this entity.

Revenue is highly concentrated in a very small set of biologic oncology drugs: the precomputed top three codes (J9035, J9271, J9355) account for 94.8% of the provider's Medicaid revenue. Specifically, J9035 accounts for $2.2M (52.2%), J9271 for $1.6M (37.8%), and J9355 for $199.3K (4.8%), indicating the business is financially dependent on a few high-value agents.

The code mix points to a specialty oncology infusion/distribution model: the top codes are J9035 (bevacizumab), J9271 (pembrolizumab), and J9355 (trastuzumab), all high-cost biologic or immuno-oncology agents, which suggests the provider focuses on dispensing and/or administering complex cancer therapies rather than primarily providing routine primary-care injections. Presence of Q0081 (infusion therapy, $66 avg paid/visit, 560 claims) and numerous supportive antiemetic and corticosteroid entries further supports an infusion-service workflow.

Although the provider bills high-cost agents, its competitive standing in-state is modest rather than dominant. For the largest revenue driver J9035 it ranks #11 of 23 providers (55th percentile), for J9271 it ranks #4 of 6 providers (40th percentile), and for J9355 it ranks #5 of 6 providers (20th percentile), which together characterize it as a meaningful but not leading participant in Puerto Rico’s specialty oncology supply market.

High average paid-per-claim values amplify revenue from moderate claim volumes: J9035 produced $2.2M on 366 claims at an average paid/claim of $5955, and J9271 produced $1.6M on 178 claims at an average paid/claim of $8875. These unit-dollar dynamics show revenue is driven more by high reimbursement rates for biologics than by large claim counts.

Operational throughput includes a steady volume of low-dollar supportive medications and infusion visits, consistent with an infusion clinic or specialty pharmacy supporting oncology regimens. Examples include J2405 (1.7K claims, $5 avg paid/claim), J1100 (1.3K claims, $6 avg), and J1200 (1.4K claims, $2 avg), indicating routine administration of supportive care alongside high-cost biologics.

The provider has long tenure in the NPI registry (enumerated 2006-12-18, ~20 years ago), which suggests an established presence in the local market; however, the modest aggregate Medicaid revenue ($4.2M) and concentrated code mix imply a relatively small, specialized operation rather than a large regional chain.

Concentration risk is material: relying on a few high-cost oncology agents makes the provider sensitive to formulary shifts, changes in access to pembrolizumab or bevacizumab, competitive entry by other specialty pharmacies, and therapeutic substitutions (noting J9355 is listed as 'excludes biosimilar'). Payers and network managers should monitor utilization of these top codes because small changes in prescribing or contracting could meaningfully affect the provider’s Medicaid revenue base.

Medicaid: Complete Services Breakdown

Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.

15 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J9035	Injection, bevacizumab, 10 mg	370	$5,960	$2.2M
J9271	Injection, pembrolizumab, 1 mg	180	$8,880	$1.6M
J9355	Injection, trastuzumab, excludes biosimilar, 10 mg	50	$4,240	$199.3K
J9306	Injection, pertuzumab, 1 mg	10	$4,680	$65.5K
J0640	Injection, leucovorin calcium, per 50 mg	300	$210	$62.2K
Q0081	Infusion therapy, using other than chemotherapeutic drugs, per visit	560	$70	$37K
J9190	Injection, fluorouracil, 500 mg	460	$40	$17.1K
J9263	Injection, oxaliplatin, 0.5 mg	60	$170	$10.9K
J2405	Injection, ondansetron hydrochloride, per 1 mg	1,670	$10	$8.3K
J1100	Injection, dexamethasone sodium phosphate, 1 mg	1,310	$10	$7.9K

Showing 1–10 of 15

Medicaid: Competitive Analysis & Benchmarks

How this provider's Medicaid billing volume and revenue compare to other Puerto Rico providers billing the same CPT/HCPCS codes.

Claims Volume vs. Puerto Rico Distribution

Sps Specialty Pharmacy Services Inc — 0 of 15 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Puerto Rico

Full comparison — all codes billed, vs. Puerto Rico median

15 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J9271	Injection, pembrolizumab, 1 mg	4	10	220	$9,780	$16.9M
J9306	Injection, pertuzumab, 1 mg	5	10	420	$5,490	$5M
J9355	Injection, trastuzumab, excludes biosimilar, 10 mg	5	10	490	$4,520	$4.4M
J9035	Injection, bevacizumab, 10 mg	11	20	370	$2,820	$2.3M
J9263	Injection, oxaliplatin, 0.5 mg	6	10	510	$360	$364.4K
Q0081	Infusion therapy, using other than chemotherapeutic drugs, per visit	6	10	560	$70	$106.3K
J0640	Injection, leucovorin calcium, per 50 mg	7	10	830	$70	$98.7K
J3489	Injection, zoledronic acid, 1 mg	10	10	120	$90	$48.3K
J9045	Injection, carboplatin, 50 mg	7	10	190	$30	$30.4K
J9190	Injection, fluorouracil, 500 mg	8	10	600	$30	$28.7K

Showing 1–10 of 15

Nearby Providers

Other providers in the same ZIP code as Sps Specialty Pharmacy Services Inc, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Laboratorio Clinico Borinquen, Inc	PR	Clinical Medical Laboratory	$1.4M	$37.1M
Msl Therapeutical Services, Psc	PR	Occupational Therapist	$0	$12.8M
Laboratorio Clinico Bairoa Inc	PR	Clinical Medical Laboratory	$271.3K	$11.3M
Centro Medico Del Turabo Inc	PR	Multi-Specialty Clinic/Center	$0	$10.8M
Mediko Imaging Inc.	PR	Radiology Clinic/Center	$0	$6.8M
Consolidated Radiology Complex Csp	PR	Radiology Clinic/Center	$0	$6.8M
Caribbean Heart Institute LLC	PR	Clinical Cardiac Electrophysiology Physician	$0	$5.7M
Nuscan Csp	PR	Nuclear Medicine Physician	$0	$5.5M
Conmed Laboratories Inc	PR	Clinical Medical Laboratory	$105.5K	$5.4M
Advanced Hematology And Oncology Of Puerto Rico	PR	Hematology & Oncology Physician	$0	$3.6M

Sps Specialty Pharmacy Services Inc — Billing Profile & Reimbursement Data

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Sps Specialty Pharmacy Services Inc — Billing Profile & Reimbursement Data

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Key Findings

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Nearby Providers

Frequently Asked Questions

References