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NPI 1174512263 · Peoria, AZ · Rheumatology Physician
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Ravi Bhalla is a rheumatology physician provider located in Peoria, Arizona. This profile covers 27 Medicare and 18 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 | Ravi Bhalla |
| Address | 13943 N. 91st Ave |
| City | Peoria |
| State | AZ |
| ZIP | 85381 |
| Taxonomy | Rheumatology Physician |
| NPI Enumerated | October 20, 2005 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $2.8M |
| Medicaid | $435.8K |
RAVI BHALLA is a Rheumatology Physician with an NPI enumerated on 2005-10-20 (~21 years ago), indicating an established practice tenure in PEORIA, AZ. The provider reports $2.8M in total Medicare revenue and $435.8K in total Medicaid revenue, so Medicare is the much larger revenue source by scale.
Medicare revenue is highly concentrated in biologic and specialty drug codes: J0129 ($797.8K, 27.7%), J3262 ($588K, 20.4%), and J0897 ($463.3K, 16.1%) together account for 64.1% of this provider's total Medicare revenue. Those three codes point to a practice model that generates the majority of Medicare dollars from high-cost injectable biologic agents rather than routine office-only care.
The code mix and administration activity support an infusion/biologic administration service line: besides the high drug revenues, the provider reports notable Medicare utilization for infusion/administration codes such as 96365 (810 claims, $39.7K) and high-volume push/sequence codes 96375 and 96372, which are described as notably above typical or extreme outlier in national percentile listings. This combination of biologic drug billing and high infusion-administration claims is consistent with an office-based infusion capability tied to rheumatology biologic therapies.
On national competitive standing for Medicare drug codes, the provider ranks well above peers: J3262 ranks #32 of 618 providers (95th percentile; notably above typical national volume), J0129 ranks #86 of 1221 (93rd percentile; notably above typical national volume), and J0897 ranks #143 of 10057 (99th percentile; extreme outlier, far above typical national volume). These rank signals indicate the provider is a high-volume national outlier for several specific injectable agents, particularly denosumab (J0897).
Medicaid billing is concentrated in office evaluation-and-management codes rather than the high-cost biologics seen in Medicare: 99214 (3.8K claims, $191.6K, 44.0%) and 99213 (3.5K claims, $135.6K, 31.2%) are the top two Medicaid revenue drivers, and with 96413 ($22.6K, 5.2%) the top three codes account for 80.5% of total Medicaid revenue. This pattern shows Medicaid revenue is dominated by routine and moderate-complexity outpatient visits, contrasting with the Medicare drug-heavy mix.
Competitive standing within the state for Medicaid is modest: 99214 ranks #740 of 3041 in-state (76th percentile) and 99213 ranks #602 of 2775 (78th percentile), both described as typical, unremarkable volume for in-state peers. Even though office visits dominate Medicaid revenue, the provider does not appear to be a dominant statewide player on those E/M codes.
Several individual codes appear as statistical outliers nationally and should be noted for utilization monitoring: Medicare 99214 is flagged as an extreme outlier (rank #1926 of 479517, 100th percentile), J0897 is an extreme outlier nationally (99th percentile), and codes such as J3262 and J0129 are notably above typical national volume. These outlier designations reflect unusually high relative activity for specific services compared with peers and correspond with the provider's heavy biologic/infusion footprint on Medicare.
From a business-risk and opportunity perspective, the practice shows concentrated exposure to a small set of high-revenue codes (64.1% of Medicare revenue from the top three Medicare codes and 80.5% of Medicaid revenue from the top three Medicaid codes). That concentration suggests sensitivity to changes in reimbursement or utilization for those specific drugs and services, while the differing payer mixes (Medicare drug-heavy vs Medicaid visit-heavy) imply the provider operates distinct payer-specific service models that payers and network managers should consider when evaluating contract strategies.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
27 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) | 24,180 | $30 | $797.8K |
| J3262 | Injection, tocilizumab, 1 mg | 117,600 | $10 | $588K |
| J0897 | Injection, denosumab, 1 mg | 25,740 | $20 | $463.3K |
| J9312 | Injection, rituximab, 10 mg | 4,400 | $60 | $268.4K |
| J1602 | Injection, golimumab, 1 mg, for intravenous use | 22,400 | $10 | $246.4K |
| 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… | 1,810 | $90 | $157.7K |
| J1745 | Injection, infliximab, excludes biosimilar, 10 mg | 5,460 | $30 | $136.5K |
| J3111 | Injection, romosozumab-aqqg, 1 mg | 9,870 | $10 | $79K |
| 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. | 810 | $50 | $39.7K |
| 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… | 420 | $60 | $23.8K |
Showing 1–10 of 27
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 27 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
27 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J0129 | 4 | 30 | 14,700 | $30 | $494.5K |
| J3262 | 4 | 20 | 74,500 | $1 | $367.2K |
| J1602 | 16 | 30 | 24,040 | $10 | $316.2K |
| J9312 | 4 | 20 | 3,250 | $60 | $212.6K |
| J3111 | 30 | 40 | 19,530 | $10 | $178.8K |
| J0897 | 11 | 260 | 2,940 | $20 | $115.6K |
| J1745 | 9 | 40 | 2,980 | $30 | $103.9K |
| 96413 | 112 | 230 | 190 | $100 | $24.8K |
| 99214 | 95 | 10,410 | 120 | $80 | $20.6K |
| 99213 | 925 | 9,600 | 80 | $60 | $9.6K |
Showing 1–10 of 27
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.
18 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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… | 3,830 | $50 | $191.6K |
| 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… | 3,480 | $40 | $135.6K |
| 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… | 320 | $70 | $22.6K |
| 96372 | A therapeutic, prophylactic, or diagnostic substance (a fluid, a drug, etc.) is injected via intramuscular or subcutaneous route into the patient's body. The procedure is performed by the physician… | 2,440 | $10 | $22K |
| 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. | 410 | $40 | $18.1K |
| 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… | 150 | $90 | $13.6K |
| 96375 | Following the administration of a drug or other substance via intravenous, or IV, push, the provider sequentially infuses a different medication or medications, also via IV push. He administers the… | 970 | $10 | $8.8K |
| 20553 | Trigger point injection, or TPI, is a medical procedure in which the provider injects an anesthetic or corticosteroid substance into three or more muscles to relieve painful areas or knots in muscles… | 220 | $40 | $8.1K |
| 99442 | N/A | 140 | $40 | $5.2K |
| J0897 | Injection, denosumab, 1 mg | 10 | $410 | $4.9K |
Showing 1–10 of 18
How this provider's Medicaid billing volume and revenue compare to other Arizona providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Arizona median
18 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 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… | 740 | 3,040 | 750 | $50 | $343.9K |
| 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… | 602 | 2,780 | 600 | $50 | $267K |
| 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… | 26 | 40 | 1,120 | $60 | $259.6K |
| J0897 | Injection, denosumab, 1 mg | 14 | 20 | 180 | $650 | $258K |
| 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. | 88 | 130 | 1,680 | $20 | $116.7K |
| 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… | 580 | 1,160 | 150 | $90 | $96.5K |
| 20553 | Trigger point injection, or TPI, is a medical procedure in which the provider injects an anesthetic or corticosteroid substance into three or more muscles to relieve painful areas or knots in muscles… | 22 | 50 | 180 | $40 | $38.8K |
| 77080 | The provider performs an imaging procedure, called dual–energy X–ray absorptiometry (DXA), of one or more bony areas on the trunk to determine the bone mineral density (BMD) and whether the patient… | 71 | 90 | 150 | $30 | $33.3K |
| 96375 | Following the administration of a drug or other substance via intravenous, or IV, push, the provider sequentially infuses a different medication or medications, also via IV push. He administers the… | 99 | 130 | 3,450 | $1 | $29.1K |
| 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… | 21 | 20 | 910 | $10 | $24.4K |
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Other providers in the same ZIP code as Ravi Bhalla, ranked by combined Medicare and Medicaid revenue.
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