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

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

Metro Infectious Disease Consultants, LLC (NPI 1235125717)

Field	Value
Entity Type	Organization
Organization	Metro Infectious Disease Consultants, LLC
Address	901 Mcclintock Dr
City	Burr Ridge
State	IL
ZIP	60527
Taxonomy	Infectious Disease Physician
NPI Enumerated	September 21, 2005

Payer Source	Total Paid
Medicaid	$44.3M
Medicare	$0

Key Findings

This provider is effectively single‑payer in the available federal data: there is no Medicare billing on file while Medicaid billing totals $44.3M in lifetime revenue. The absence of Medicare claims suggests its public‑program footprint is concentrated exclusively in Medicaid rather than distributed across both Medicare and Medicaid payers.

Revenue is highly concentrated in a small set of high‑cost drugs and biologic infusions: the top three Medicaid codes (J3380, J2350, Q5103) account for 53.8% of this provider’s total Medicaid revenue. Those three codes alone generate $10.2M (J3380, 2.1K claims, 23.2%), $8.6M (J2350, 365 claims, 19.5%), and $4.9M (Q5103, 4.5K claims, 11.1%) respectively, indicating a business model materially dependent on a handful of product lines.

Clinical/service‑line mix is dominated by specialty infusion and biologic administration: the top revenue drivers are drug injection codes (J3380, J2350, Q5103) and high volumes of infusion/chemotherapy administration codes such as 96413 and 96365. The presence of many branded monoclonal antibody and biosimilar J‑codes (including J1745, J2323, J2357, J2182) together with high counts of infusion administration CPTs signals an operational focus on outpatient or hospital‑based infusion therapy rather than routine primary care.

Inpatient and consultative E/M activity is unusually large for the specialty: 99233 shows 90.9K claims and $4.5M revenue (10.3% of Medicaid revenue) and ranks #1 of 3828 providers in‑state (100th percentile; extreme outlier, far above typical state volume). Additional inpatient E/M codes (99232, 99223, 99255, 99254, 99222) also appear with very high claim volumes and are labeled as extreme outliers in state comparisons, which together suggest substantial hospital‑based consultative work or a facility partnership driving high case volumes.

State competitive standing is dominant for multiple high‑value codes: several drugs and E/M codes rank #1 in‑state (for example J3380 is #1 of 1 providers in‑state with no peer comparison available, J2350 is #1 of 2 providers in‑state (100th percentile; typical, unremarkable volume), and numerous inpatient codes are top‑ranked and described as extreme outliers). This pattern indicates the group is a leading Medicaid provider statewide for both specific biologic therapies and inpatient consult services rather than a marginal participant.

The payer/unit economics show reliance on high avg‑paid per claim for select items: J2350 has an average paid/claim of $23697 and J3380’s avg paid/claim is $4795, meaning a small number of claims can generate outsized revenue contributions. That dynamic amplifies the impact of utilization changes for those specific drugs on the practice’s overall Medicaid revenue profile.

Tenure and establishment: the NPI was enumerated on 2005-09-21 (~21 years ago), indicating this entity has long been active in the market. That longevity is consistent with the scale and statewide leadership observed across multiple complex drug and inpatient service codes, suggesting established referral relationships and institutional access.

From an operational and financial concentration perspective, reliance on the top three codes for 53.8% of Medicaid revenue represents a strategic vulnerability: formulary, coverage or administration policy changes affecting J3380, J2350, or Q5103 could materially alter revenue. Given the provider’s heavy inpatient E/M volumes and dominance in select high‑cost biologics, payers and network planners should treat this entity as a major Medicaid infusion and inpatient consult provider whose financial profile is closely tied to a few high‑value therapies.

Medicaid: Complete Services Breakdown

Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.

35 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J3380	Injection, vedolizumab, intravenous, 1 mg	2,140	$4,800	$10.2M
J2350	Injection, ocrelizumab, 1 mg	370	$23,700	$8.6M
Q5103	Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg	4,480	$1,100	$4.9M
99233	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	90,870	$50	$4.5M
J1745	Injection, infliximab, excludes biosimilar, 10 mg	3,170	$1,240	$3.9M
J2323	Injection, natalizumab, 1 mg	560	$4,860	$2.7M
J2357	Injection, omalizumab, 5 mg	1,530	$1,530	$2.3M
J2182	Injection, mepolizumab, 1 mg	640	$2,190	$1.4M
99232	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	33,420	$40	$1.2M
99223	The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	8,930	$100	$848.3K

Showing 1–10 of 35

Medicaid: Competitive Analysis & Benchmarks

How this provider's Medicaid billing volume and revenue compare to other Illinois providers billing the same CPT/HCPCS codes.

Claims Volume vs. Illinois Distribution

Metro Infectious Disease Consultants, LLC — 16 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Illinois

Full comparison — all codes billed, vs. Illinois median

35 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J3380	Injection, vedolizumab, intravenous, 1 mg	1	10	2,140	$4,790	$10.2M
J2350	Injection, ocrelizumab, 1 mg	1	10	190	$24,010	$4.6M
J2357	Injection, omalizumab, 5 mg	2	10	1,530	$2,120	$3.1M
Q5103	Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg	1	10	2,450	$1,070	$2.6M
J2323	Injection, natalizumab, 1 mg	1	10	530	$4,690	$2.5M
J1745	Injection, infliximab, excludes biosimilar, 10 mg	1	10	200	$1,230	$1.4M
J2182	Injection, mepolizumab, 1 mg	1	10	540	$2,470	$1.3M
Q5104	Injection, infliximab-abda, biosimilar, (renflexis), 10 mg	1	10	730	$1,000	$727.7K
J1569	Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g., liquid), 500 mg	1	10	140	$3,150	$425.1K
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…	1,424	14,680	300	$50	$48.7K

Showing 1–10 of 35

Related Providers

Other providers that share a Tax Identification Number (TIN) with Metro Infectious Disease Consultants, LLC, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Natalia Surowaniec	IL	Family Nurse Practitioner	$2.1M	$0
Martha Pawlukowsky	IL	Family Nurse Practitioner	$2M	$1.3K
Margaret Denham	IN	Nurse Practitioner	$1.7M	$0
Marie Rodriguez	IL	Gerontology Nurse Practitioner	$1.7M	$0
Walter Marbach	IL	Rheumatology Physician	$1.6M	$53.2K
Brooke Raney	IA	Family Nurse Practitioner	$1.6M	$0
Kristin Elatkin	IL	Family Nurse Practitioner	$1.6M	$5K
Robert Scribner	MI	Gerontology Nurse Practitioner	$1.5M	$0
Vishnu Chundi	IL	Infectious Disease Physician	$978.9K	$354.9K
Kimberly Balshi	FL	Nurse Practitioner	$1.3M	$0

Nearby Providers

Other providers in the same ZIP code as Metro Infectious Disease Consultants, LLC, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Clinical Hearing Services	IL	Audiologist-Hearing Aid Fitter	$0	$7.2M
Syed Khadri	IL	Psychiatry Physician	$0	$5.4M
Lincare Inc.	IL	Durable Medical Equipment & Medical Supplies	$0	$5.3M
Linda Palumbo	IL	Internal Medicine Physician	$8.6K	$4.3M
Clinicare Lab Ltd	IL	Clinical Medical Laboratory	$381.5K	$1.2M
Ram Ramani	IL	Infectious Disease Physician	$561.1K	$332.4K
R Ward	IL	Cardiovascular Disease Physician	$389.6K	$279.4K
William Mieler	IL	Ophthalmology Physician	$69.2K	$532.5K
Angela Crowley	IL	Rheumatology Physician	$543.2K	$0
Brian Harting	IL	Infectious Disease Physician	$266.4K	$249.5K

Metro Infectious Disease Consultants, LLC — Billing Profile & Reimbursement Data

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Metro Infectious Disease Consultants, LLC — Billing Profile & Reimbursement Data

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Key Findings

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References