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.

Lourdes Aponte (NPI 1144299959)

Field	Value
Entity Type	Individual
Organization	Lourdes Aponte
Address	1302 Savannah Rd
City	Lewes
State	DE
ZIP	19958
Taxonomy	Rheumatology Physician
NPI Enumerated	March 15, 2006

Payer Source	Total Paid
Medicare	$3.6M
Medicaid	$0

Key Findings

This provider’s Medicare footprint is the sole payer source on file: Total Medicare revenue is $3.6M and there is no Medicaid billing on file. The precomputed top-3 concentration shows that the practice derives a majority of its Medicare revenue from a very small set of drugs and services (top 3 codes account for 57.6% of Medicare revenue), indicating a narrow revenue base concentrated in specialty drug administration.

Clinical and operational mix is dominated by in-office injectable biologics and supervised drug administration rather than broad outpatient primary care. The top revenue-driving codes are J0897, J0717, and J1306 and the claims mix also contains high volumes of administration/infusion codes (96401, 96413, 96372) and frequent E/M encounters (99214, 99213), which together point to a rheumatology-focused infusion/injection practice that provides on-site biologic therapy.

Revenue concentration is substantial: J0897 accounts for $1M (29.2% of Medicare revenue), J0717 accounts for $518.4K (14.7%), and J1306 accounts for $483.6K (13.7%); those three codes collectively represent the precomputed 57.6% share of Medicare revenue. This degree of concentration means most revenue is driven by a few specific injectable products, so changes in utilization, pricing, or coverage for those products would disproportionately affect the provider’s Medicare revenue.

The provider’s competitive standing versus national peers is mixed but notable for specific drugs. J0897 ranks #15 of 10057 (100th percentile; extreme outlier, far above typical national volume for this code) and J1306 ranks #13 of 462 (97th percentile; notably above typical national volume for this code), indicating nationally exceptional volume for these agents, while J0717 ranks #90 of 848 (89th percentile; typical, unremarkable volume for this code). These rankings suggest the provider is a national outlier for certain high-revenue injectable drugs but more typical for others.

High E/M and administration volumes reinforce a busy ambulatory specialty practice with substantial patient throughput and drug delivery activity. Codes like 99214 (1.3K claims, $118.3K revenue; 99th percentile; extreme outlier), 99213 (1.3K claims, $87.1K revenue; 99th percentile; extreme outlier), 96401 (1.3K claims, $70.6K revenue; 99th percentile; extreme outlier), and 96372 (836 claims, $9.2K revenue; 99th percentile; extreme outlier) indicate frequent visits and many procedures involving onsite injections or infusions.

The therapeutic profile aligns with rheumatology and bone-health services: dominant product-level revenues include J0897 (denosumab) and J3111 (romosozumab) alongside multiple rheumatology biologics such as J0717 (certolizumab), J1602 (golimumab), J0129 (abatacept), and J1745 (infliximab). This mix supports a specialist practice model that manages autoimmune and metabolic bone disease with a broad portfolio of in-office biologic therapies.

Tenure data indicate long-standing Medicare enrollment: NPI enumerated 2006-03-15 (~20 years ago), which suggests sustained presence in the market and an established patient panel. That longevity, combined with the high-volume biologic and administration activity, points to an embedded ambulatory specialty practice rather than a recent entrant.

From a payer oversight and contracting perspective, the combination of heavy concentration (top 3 = 57.6% of Medicare revenue) and extreme outlier status on specific drug codes (notably J0897 and J1306) warrants focused utilization review and negotiation attention. Because there is no Medicaid billing on file, payers can treat this entity as effectively single-payer (Medicare) for state-level network planning, simplifying Medicaid risk exposure but concentrating Medicare financial exposure in a few high-cost items.

Medicare: Complete Services Breakdown

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

39 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J0897	Injection, denosumab, 1 mg	57,240	$20	$1M
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)	129,600	$1	$518.4K
J1306	Injection, inclisiran, 1 mg	53,740	$10	$483.6K
J3111	Injection, romosozumab-aqqg, 1 mg	38,850	$10	$310.8K
J1602	Injection, golimumab, 1 mg, for intravenous use	23,300	$10	$233K
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)	6,630	$30	$218.6K
J1745	Injection, infliximab, excludes biosimilar, 10 mg	8,250	$30	$214.5K
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…	1,260	$90	$118.3K
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…	1,320	$70	$87.1K
96401	The provider administers nonhormonal, antineoplastic chemotherapy drugs subcutaneously or intramuscularly to the patient.	1,330	$50	$70.6K

Showing 1–10 of 39

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 39 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Delaware Distribution

Lourdes Aponte — 8 of 25 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

39 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0129	7	10	11,030	$30	$432.5K
J0717	4	10	98,800	$1	$376.8K
J3111	3	10	29,930	$10	$245K
J1602	3	10	21,050	$10	$238.8K
J1306	1	10	8,950	$10	$180K
J1745	3	10	3,610	$30	$134.3K
J0897	1	60	3,360	$20	$132.9K
J7327	7	20	30	$560	$38.9K
96413	5	30	280	$100	$36.6K
99214	72	1,830	150	$80	$25.5K

Showing 1–10 of 39

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Irene Viola	DE	Internal Medicine Physician	$753K	$0
Morgan Popovich	DE	Physician Assistant	$31.6K	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Beebe Medical Center, Inc.	DE	General Acute Care Hospital	$0	$29.2M
Beebe Physician Network Inc.	DE	Internal Medicine Physician	$0	$19.7M
Juliano Senior Care, Inc.	DE	In Home Supportive Care Agency	$0	$5.9M
Sussex Emergency Associates LLC	DE	Emergency Medicine Physician	$0	$4.3M
Jose Pando	DE	Rheumatology Physician	$3.2M	$0
Delaware Psychological Services LLC	DE	Mental Health Counselor	$0	$3M
The Pediatric & Adolescent Center	DE	Specialist	$0	$2.9M
Sea Haven Home Care, LLC	DE	In Home Supportive Care Agency	$0	$2.3M
Southern Delaware Imaging Assoc	DE	Diagnostic Radiology Physician	$0	$2.3M
Egnm LLC	DE	Ambulatory Surgical Clinic/Center	$2.2M	$13.6K

Lourdes Aponte — Billing Profile & Reimbursement Data

Sign up for Lourdes Aponte — Billing Profile & Reimbursement Data policy alerts

Lourdes Aponte — Billing Profile & Reimbursement Data

Sign up for Lourdes Aponte — Billing Profile & Reimbursement Data policy alerts

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