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NPI 1063640225 · Johnston, RI · Internal Medicine Physician
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Kiley Toder is a internal medicine physician provider located in Johnston, Rhode Island. This profile covers 13 Medicare and 4 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.
Provider details (source: NPPES NPI Registry)
| Field | Value |
|---|---|
| Entity Type | Individual |
| Organization | Kiley Toder |
| Address | 1524 Atwood Ave |
| City | Johnston |
| State | RI |
| ZIP | 02919 |
| Taxonomy | Internal Medicine Physician |
| NPI Enumerated | June 26, 2009 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $1.1M |
| Medicaid | $43.4K |
This provider’s Medicare activity is heavily driven by infusion and biologic drug administration: J0129 (10.5K claims, $34 avg paid/claim, $355.3K revenue, 30.9% of Medicare revenue), J3262 (63.6K claims, $5 avg paid/claim, $317.9K revenue, 27.6% of Medicare revenue) and J1602 (15.4K claims, $11 avg paid/claim, $168.9K revenue, 14.7% of Medicare revenue) make up the top chemotherapy/biologic mix. The code descriptions show office-based intravenous and injectable biologic therapy activity, indicating the practice operates significant in-office infusion services alongside general internal medicine care.
Medicare revenue is concentrated: the precomputed top-three codes account for 73.1% of this provider’s total Medicare revenue, which signals reliance on a small set of high-revenue biologic/injectable therapies for the bulk of Medicare payments. That concentration suggests revenue sensitivity to utilization or reimbursement changes for those specific drugs and J-codes.
Medicaid billing is effectively single-service dominated: 99213 accounts for $39.8K and 91.6% of the provider’s total Medicaid revenue, and the precomputed top-three Medicaid codes account for 99.0% of Medicaid revenue. This indicates the provider’s Medicaid footprint is almost entirely office visit–based rather than infusion- or drug-driven.
Payer mix is heavily Medicare-weighted: total Medicare revenue is $1.1M versus total Medicaid revenue of $43.4K, so Medicare is the primary commercial scale for this provider while Medicaid represents a small share of overall revenue. For network and contracting analyses, prioritize Medicare-related infusion and drug reimbursement trends when assessing financial exposure and growth opportunities.
Competitive standing on Medicare infusion codes is moderate rather than dominant: J0129 ranks #452 of 1221 providers nationally (63th percentile) and is described as typical/unremarkable volume, J3262 ranks #159 of 618 (74th percentile) described as typical/unremarkable, and J1602 ranks #443 of 1041 (57th percentile) described as typical/unremarkable. These percentiles place the provider as a competent participant in biologic infusion services but not a top national outlier.
On Medicaid, the provider’s office-visit volume for established patients (99213) ranks #680 of 2046 providers in-state (67th percentile) and is characterized as typical/unremarkable; 99214 contributes only 6.5% of Medicaid revenue and ranks #1287 of 1731 in-state (25th percentile). This pattern reflects a modest in-state presence for higher-complexity outpatient visits and a middle-tier position for routine established-patient office visits.
Service-line detail beyond the top-three shows additional infusion and oncology-adjacent activity at smaller scale: codes such as 96413 (341 claims, $101 avg paid/claim, $34.4K revenue) and 96365 (146 claims, $50 avg paid/claim, $7.3K revenue) appear on the Medicare list, indicating some chemotherapy administration services in addition to biologic injections. These ancillary oncology/infusion codes are meaningful but represent a minority of total Medicare revenue compared with the top biologic J-codes.
Provider tenure is established: the NPI was enumerated 2009-06-26 (~17 years ago), indicating long-term operation in the market. That longevity, combined with a concentrated biologic/infusion revenue base on Medicare and a Medicaid practice that is largely office-visit driven, frames the provider as an experienced, infusion-capable internal medicine practice with Medicare-focused financial exposure.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
13 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J0129 | Injection, abatacept, 10 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered) | 10,450 | $30 | $355.3K |
| J3262 | Injection, tocilizumab, 1 mg | 63,580 | $10 | $317.9K |
| J1602 | Injection, golimumab, 1 mg, for intravenous use | 15,350 | $10 | $168.8K |
| Q5104 | Injection, infliximab-abda, biosimilar, (renflexis), 10 mg | 3,760 | $30 | $112.8K |
| J0897 | Injection, denosumab, 1 mg | 4,980 | $20 | $89.6K |
| 96413 | Chemotherapy is a therapeutic procedure used for the treatment of cancer via the use of chemical agents. These chemical agents (drugs) work on the cancerous cells of the body to destroy them. These… | 340 | $100 | $34.4K |
| 99213 | The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the… | 470 | $70 | $31.8K |
| 99214 | The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the… | 290 | $90 | $26.8K |
| 96365 | The provider administers the initial intravenous infusion of a medication or other substance for a period up to one hour to prevent, treat, or diagnose a condition or disease. | 150 | $50 | $7.3K |
| 96415 | In this add on procedure, the provider continues administration of a chemotherapy drug into a vein using an infusion technique. He uses this code to report each additional hour of infusion beyond the… | 120 | $20 | $2.5K |
Showing 1–10 of 13
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 13 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
13 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J0129 | 1 | 10 | 10,450 | $30 | $352.2K |
| J3262 | 1 | 10 | 63,580 | $1 | $298.2K |
| J1602 | 1 | 10 | 13,420 | $10 | $140.2K |
| Q5104 | 1 | 10 | 3,760 | $30 | $111.2K |
| J0897 | 3 | 10 | 3,000 | $20 | $67.3K |
| 99214 | 277 | 1,950 | 100 | $80 | $11.7K |
| 96413 | 1 | 10 | 50 | $110 | $8.6K |
| 99213 | 89 | 1,950 | 70 | $60 | $7.4K |
| 99204 | 525 | 740 | 30 | $110 | $4.6K |
| 96365 | 2 | 10 | 70 | $50 | $4.2K |
Showing 1–10 of 13
Medicaid revenue breakdown by year and by CPT/HCPCS procedure code, including monthly billing trends and the top codes driving revenue.
View: By Year1 / 3
Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.
4 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 99213 | The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the… | 690 | $60 | $39.8K |
| 99214 | The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the… | 50 | $50 | $2.8K |
| 85025 | A complete blood count (better known as a CBC) is a blood test request by a doctor that provides detailed information about various types of cells in a patient's blood. Usually a pathologist or a… | 30 | $20 | $440 |
| 82565 | The lab analyst measures the amount of creatinine in a patient specimen, typically of blood. Creatinine is the waste material generated by the muscle tissue produced from the breakdown of creatine… | 40 | $10 | $430 |
How this provider's Medicaid billing volume and revenue compare to other Rhode Island providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Rhode Island median
4 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 85025 | A complete blood count (better known as a CBC) is a blood test request by a doctor that provides detailed information about various types of cells in a patient's blood. Usually a pathologist or a… | 210 | 290 | 100 | $30 | $88K |
| 99214 | The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the… | 1,287 | 1,730 | 220 | $70 | $75.2K |
| 99213 | The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the… | 680 | 2,050 | 300 | $50 | $72.3K |
| 82565 | The lab analyst measures the amount of creatinine in a patient specimen, typically of blood. Creatinine is the waste material generated by the muscle tissue produced from the breakdown of creatine… | 29 | 40 | 260 | $20 | $45.7K |
Other providers in the same ZIP code as Kiley Toder, ranked by combined Medicare and Medicaid revenue.
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