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NPI 1174747323 · Reno, NV · Hematology & Oncology Physician
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Santhosh Ambika is a hematology & oncology physician provider located in Reno, Nevada. This profile covers 54 Medicare and 1 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 | Santhosh Ambika |
| Address | 5423 Reno Corporate Dr. |
| City | Reno |
| State | NV |
| ZIP | 89511 |
| Taxonomy | Hematology & Oncology Physician |
| NPI Enumerated | April 12, 2007 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $1.9M |
| Medicaid | $1.6K |
Medicare billing is dominated by high-cost oncology infusions: J9271 (pembrolizumab) accounts for $885.8K (46.1% of the provider's Medicare revenue) and J9144 (daratumumab) accounts for $519.8K (27.0%). The code mix — large shares from biologic/immunotherapy injections plus chemotherapy administration codes — indicates an ambulatory oncology infusion operation that delivers monoclonal antibodies and immune checkpoint inhibitor therapy as primary services.
The provider’s Medicare revenue is highly concentrated: the precomputed top 3 Medicare codes drive 78.1% of total Medicare revenue, which signals dependence on a small set of high-revenue oncology drugs and associated visit/administration codes for the bulk of billed income. For Medicaid the top codes are even more concentrated, with the precomputed top 3 Medicaid codes accounting for 100.0% of the provider’s Medicaid revenue.
This practice is effectively Medicare-centric in scale: lifetime Medicare revenue is $1.9M versus just $1.6K in Medicaid, making Medicare by far the dominant payer and indicating minimal Medicaid activity in this provider’s mix. The Medicaid activity that does exist is entirely from a single code (99214) per the Medicaid top-codes list.
On national competitive standing for the two highest-revenue drugs, the provider appears as an above-median but not dominant participant: J9271 ranks #365 of 1841 providers nationally (80th percentile) and is labeled “typical, unremarkable volume,” while J9144 ranks #112 of 615 providers nationally (81th percentile) and is also described as “typical, unremarkable volume.” These positions suggest robust use of these therapies relative to many peers but not a top-tier national dominance.
For evaluation-and-management services this provider is a notable outlier: 99214 on Medicare ranks #12246 of 479517 providers nationally (97th percentile; labeled “notably above typical national volume”) and 99215 ranks #951 of 145531 providers nationally (99th percentile; labeled “extreme outlier, far above typical national volume”). That pattern points to a high volume of complex office visits or extended time spent on established patients compared with most clinicians.
Medicaid competitiveness for the same E/M activity is weak in-state: Medicaid 99214 is $1.6K (100.0% of the provider’s Medicaid revenue) but ranks #2175 of 2254 providers in-state (2th percentile) and is labeled “typical, unremarkable volume.” This reinforces that the provider’s patient and payer mix is concentrated on Medicare rather than on the state Medicaid population.
There are a few narrow or unusual reporting signals in the code-level data: J9033 (bendamustine) appears with $71.2K revenue and is reported as #2 of 2 providers nationally, which — despite the dataset’s “typical, unremarkable volume” label — indicates the provider is part of a very small peer group billing that specific code. Other ancillary drug and administration codes (for example Q5111, J0897, and a range of chemotherapy administration CPTs) provide additional but much smaller revenue streams alongside the two dominant biologic agents.
The provider has long-established billing tenure: NPI enumerated (registered) 2007-04-12 (~19 years ago). Combined with $1.9M in lifetime Medicare revenue and the concentrated oncology drug mix, that tenure is consistent with an established oncology practice with infrastructure to deliver repeated infusion-based therapies and manage complex outpatient oncology care.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
54 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J9271 | Injection, pembrolizumab, 1 mg | 20,600 | $40 | $885.8K |
| J9144 | Injection, daratumumab, 10 mg and hyaluronidase‑fihj | 13,680 | $40 | $519.8K |
| 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… | 970 | $100 | $96.2K |
| 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… | 660 | $140 | $91K |
| J9033 | Injection, bendamustine hydrochloride, 1 mg | 6,480 | $10 | $71.2K |
| Q5111 | Injection, pegfilgrastim-cbqv (udenyca), biosimilar, 0.5 mg | 610 | $100 | $63.6K |
| J0897 | Injection, denosumab, 1 mg | 3,000 | $20 | $57K |
| 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… | 410 | $100 | $43K |
| 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… | 90 | $170 | $14.4K |
| 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… | 650 | $10 | $7.8K |
Showing 1–10 of 54
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 54 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
54 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J9271 | 7 | 40 | 13,000 | $40 | $625.8K |
| J9144 | 3 | 10 | 9,180 | $40 | $445.4K |
| J0897 | 37 | 70 | 3,630 | $20 | $94.6K |
| J9033 | 1 | 10 | 6,480 | $10 | $69.5K |
| Q5111 | 3 | 10 | 400 | $110 | $46.4K |
| 99233 | 956 | 1,150 | 150 | $90 | $26.8K |
| 96413 | 11 | 70 | 210 | $100 | $23.7K |
| 99232 | 1,082 | 1,340 | 140 | $60 | $23.7K |
| 84443 | 59 | 80 | 50 | $20 | $22.7K |
| 80053 | 47 | 100 | 160 | $10 | $22.2K |
Showing 1–10 of 54
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.
1 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… | 10 | $120 | $1.6K |
How this provider's Medicaid billing volume and revenue compare to other Nevada providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Nevada median
1 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… | 2,175 | 2,250 | 290 | $60 | $138K |
Other providers in the same ZIP code as Santhosh Ambika, ranked by combined Medicare and Medicaid revenue.
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