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 Delaware for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to Delaware 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. Delaware (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.

Philip Schwartz (NPI 1144291212)

Field	Value
Entity Type	Individual
Organization	Philip Schwartz
Address	1902 N Scott St
City	Wilmington
State	DE
ZIP	19806
Taxonomy	Rheumatology Physician
NPI Enumerated	January 27, 2006

Payer Source	Total Paid
Medicare	$937.1K
Medicaid	$0

Key Findings

Revenue concentration is extreme: the precomputed top-3 Medicare codes account for 90.9% of this provider's total Medicare revenue, and a single code, J0717, represents 79.6% of Medicare revenue. With total Medicare revenue of $937.1K, this profile is heavily dependent on a narrow set of drug-administration services rather than diversified fee-for-service care.

Clinical/service-line signal aligns with rheumatology practice focused on on-site biologic administration: J0717 (certolizumab pegol) is the dominant revenue driver and appears to be administered under physician supervision rather than self-injection. The presence of procedure codes such as 20610 and 20600 and steroid injection J3301 supports a mix of joint procedures and biologic therapy management alongside routine office visits.

Payer mix is effectively single-payer Medicare: lifetime Medicare revenue is $937.1K and there is no Medicaid billing on file, so this provider has no recorded Medicaid exposure. This concentration means the practice's reimbursement and patient mix are tied to Medicare policy and formulary/reimbursement changes.

Competitive standing on drug-administration codes is strong nationally: J0717 ranks #34 of 848 providers nationally (96th percentile) and is described as notably above typical national volume, indicating the provider is a major national presence for that specific injectable biologic. Similarly, 96401 ranks #73 of 3868 providers (98th percentile) and is labeled an extreme outlier, reinforcing that administration services are unusually high relative to peers.

Office visit activity is steady but not the primary revenue source: 99214 accounts for 5.4% of Medicare revenue and ranks #39503 of 479517 providers nationally (92nd percentile) with a characterization of typical, unremarkable volume. In contrast, 99212 is an extreme outlier (rank #1286 of 99011; 99th percentile), suggesting a high volume of lower-complexity visits that may reflect frequent follow-ups or brief visits associated with ongoing therapy management.

Operational and financial risk arises from revenue concentration and outlier administration patterns: reliance on J0717 for 79.6% of Medicare revenue and the top-3 codes contributing 90.9% of revenue exposes the practice to changes in biologic pricing, reimbursement policy, or utilization management. The extreme outlier status of 96401 further amplifies this concentration risk, as shifts in coverage or coding guidance for administration services would have outsized impact.

Tenure and likely established referral base: the provider's NPI was enumerated 2006-01-27 (~20 years ago), indicating long-standing enrollment in Medicare which may support the sustained, high-volume administration patterns observed. This longevity is consistent with an established clinical operation focused on chronic biologic therapy delivery.

Secondary services and minor revenue streams exist but are small: several procedural and lab codes (for example, 20610, 20600, J3301, and lab codes 85810 and 89060) appear on the profile but contribute only modest amounts to revenue. These codes indicate the practice performs joint procedures and basic rheumatology-related labs, but they do not materially alter the overall picture of drug-administration–driven Medicare revenue.

Medicare: Complete Services Breakdown

The CPT/HCPCS codes generating the most Medicare revenue for this provider.

15 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J0717	Injection, certolizumab pegol, 1 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)	191,200	$1	$764.8K
96401	The provider administers nonhormonal, antineoplastic chemotherapy drugs subcutaneously or intramuscularly to the patient.	990	$60	$56.3K
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…	570	$90	$52.1K
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…	450	$60	$27.7K
99212	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,…	470	$50	$21K
99215	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the…	90	$130	$11.5K
99204	The provider sees a new 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 provider…	70	$120	$8.5K
20610	In this procedure, the provider inserts a needle through the skin of a patient and into a major joint or bursa and then uses the syringe attachment to the needle to remove fluid or he may inject a…	160	$50	$7.9K
99205	The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the provider…	30	$170	$4.3K
20600	In this procedure, the provider inserts a needle through the skin of a patient and into a small joint or bursa and then uses the syringe attachment to the needle to remove fluid or he may inject a…	40	$40	$1.5K

Showing 1–10 of 15

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 15 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Delaware Distribution

Philip Schwartz — 3 of 15 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Delaware

Full comparison — all codes billed, vs. state median

15 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0717	1	10	98,800	$1	$376.8K
99214	286	1,830	150	$80	$25.5K
96401	4	30	110	$60	$18.4K
99213	246	1,810	120	$60	$13.6K
20610	42	120	60	$50	$12.4K
99215	158	570	40	$120	$11K
99204	217	950	30	$110	$6.5K
99205	126	230	30	$150	$6.4K
99212	11	480	30	$40	$3.1K
20550	39	50	30	$40	$2.7K

Showing 1–10 of 15

Related Providers

Other providers that share a Tax Identification Number (TIN) with Philip Schwartz, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Rheumatology Consultants	DE	Rheumatology Physician	$0	$81.8K

Nearby Providers

Other providers in the same ZIP code as Philip Schwartz, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Nancy Pancko	DE	Orthodontics and Dentofacial Orthopedics Dentistry	$0	$10M
Ingleside Homes, Inc	DE	Assisted Living Facility	$0	$2.5M
Paula Ko	DE	Ophthalmology Physician	$1.7M	$0
Liberty Dialysis - Wilmington LLC	DE	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$1.6M
Eye Physicians & Surgeons, PA	DE	Ophthalmology Physician	$0	$1.6M
Brandywine Medical Associates, Inc.	DE	Family Medicine Physician	$0	$1.3M
Brian Toussaint	DE	Ophthalmology Physician	$1.2M	$0
Ingleside Homes, Inc	DE	Homemaker	$0	$1.2M
Rmb Group, LLC	DE	In Home Supportive Care Agency	$0	$1.1M
Anthony Vattilana	DE	General Practice Dentistry	$0	$668.6K

Philip Schwartz — Billing Profile & Reimbursement Data

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Philip Schwartz — Billing Profile & Reimbursement Data

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Key Findings

Medicare: Total Revenue Breakdown by CPT/HCPCS Code

Medicare: Complete Services Breakdown

Medicare: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References