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.

Medical Oncology Hematology Consultants PA (NPI 1235199316)

Field	Value
Entity Type	Organization
Organization	Medical Oncology Hematology Consultants PA
Address	4701 Ogletown Stanton Rd
City	Newark
State	DE
ZIP	19713
Taxonomy	Hematology & Oncology Physician
NPI Enumerated	March 24, 2006

Payer Source	Total Paid
Medicaid	$7.7M
Medicare	$0

Key Findings

MEDICAL ONCOLOGY HEMATOLOGY CONSULTANTS PA reports no Medicare billing on file and $7.7M in lifetime Medicaid revenue, making its active payer footprint effectively single‑payer (Medicaid) in the available claims data. This concentration means Medicaid reimbursement dynamics and policy changes are likely to have outsized impact on the practice's revenue trajectory.

Revenue concentration is extreme at the code level: the precomputed top 3 Medicaid codes account for 84.3% of this provider's total Medicaid revenue. In particular, a single drug code, J9271, drives the majority of revenue with $5.5M (72.2% of Medicaid revenue) and an average paid/claim of $8003, indicating heavy dependence on a high-cost oncology agent.

The provider’s code mix and volumes are consistent with a medical oncology infusion practice: large volumes of chemotherapy administration (96413, 8K claims) and E/M visits (99214, 7.5K claims) are paired with high-dollar immunotherapy billing (J9271, 692 claims). This mix points to an outpatient infusion suite model focused on systemic cancer therapy and associated office visits rather than inpatient or surgical services.

Competitive standing for the top revenue drivers is mixed across codes. For 96413 the practice ranks #1 of 12 providers in-state and is described as "notably above typical state volume for this code", signaling a dominant position statewide for chemotherapy administration; by contrast, J9271 also ranks #1 of 1 providers in-state but the record notes "no state peer volume comparison available," meaning it is the sole in-state reporter but lacks a broader peer percentile for comparison.

Visit-level E/M coding shows substantial volume but not an extreme outlier pattern: 99214 represents $385K (5.0% of Medicaid revenue) with 7.5K claims and ranks #80 of 504 providers in-state (84th percentile), characterized as "typical, unremarkable volume for this code." This suggests a steady outpatient follow-up and management workload consistent with active oncology patient panels rather than anomalous E/M billing behavior.

The practice bills for a range of supportive and ancillary oncology medications and services (examples include J1454 fosnetupitant $248.1K, J2469 palonosetron $23.7K, J0897 denosumab $112.9K, and J1437 ferric derisomaltose $96.9K), which reinforces the clinical profile of comprehensive outpatient oncology care including antiemetic prophylaxis, bone-modifying therapy, and intravenous iron. Several of these codes (J1454, J1437) are noted as "no state peer volume comparison available," indicating the practice may be the only in-state reporter for certain newer or less-common drug codes.

Operational risk and contracting implications flow from the payer and product concentration: with no Medicare revenue on file and $7.7M of Medicaid revenue dominated by a single high-cost drug (J9271 at $5.5M), the practice faces revenue vulnerability to changes in Medicaid coverage, reimbursement, or utilization patterns for that therapy. For payers and network managers, this profile flags a small number of contract levers (drug pricing, infusion reimbursement, prior authorization terms) that could materially affect the provider's finances.

The provider has an established tenure in the dataset, with NPI enumerated on 2006-03-24 (~20 years ago). That longevity, combined with high volumes on core infusion and visit codes (e.g., 8K claims for 96413 and 7.5K claims for 99214), indicates an experienced outpatient oncology practice with sustained Medicaid-facing activity rather than a newly opened or transient operation.

Medicaid: Complete Services Breakdown

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

33 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J9271	Injection, pembrolizumab, 1 mg	690	$8,000	$5.5M
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…	8,040	$70	$538.6K
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…	7,550	$50	$385K
J1454	Injection, fosnetupitant 235 mg and palonosetron 0.25 mg	890	$280	$248.1K
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…	6,480	$40	$233.1K
J0897	Injection, denosumab, 1 mg	100	$1,180	$112.9K
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…	1,700	$70	$112.1K
J1437	Injection, ferric derisomaltose, 10 mg	110	$920	$96.9K
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…	5,890	$20	$88.4K
96417	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 administration of a different chemotherapy…	2,020	$40	$76.8K

Showing 1–10 of 33

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Delaware Distribution

Medical Oncology Hematology Consultants PA — 3 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. Delaware median

33 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J9271	Injection, pembrolizumab, 1 mg	1	10	690	$8,000	$5.5M
96361	The provider administers intravenous, or IV, fluids with electrolytes through an already established intravenous route for each additional hour to treat more severe dehydration.	7	10	8,920	$60	$420.9K
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…	7	10	9,490	$40	$345.2K
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.	8	10	3,740	$80	$308K
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…	37	50	1,030	$60	$292.3K
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…	56	80	940	$30	$277.8K
J1454	Injection, fosnetupitant 235 mg and palonosetron 0.25 mg	1	10	890	$280	$247.9K
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…	80	500	1,130	$50	$235.1K
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…	1	10	2,240	$70	$186.3K
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…	93	540	1,100	$40	$185.3K

Showing 1–10 of 33

Related Providers

Other providers that share a Tax Identification Number (TIN) with Medical Oncology Hematology Consultants PA, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Jamal Misleh	DE	Hematology & Oncology Physician	$6.8M	$0
Dhaval Shah	DE	Hematology & Oncology Physician	$2.5M	$0
Gregory Masters	DE	Medical Oncology Physician	$2.3M	$0
Evan Lapinsky	DE	Hematology & Oncology Physician	$1.7M	$0
Lydia Clements	DE	Medical Oncology Physician	$1.3M	$0
Sujung Park	DE	Hematology & Oncology Physician	$1.2M	$0
Amy Mcghee Jez	DE	Hematology & Oncology Physician	$1.1M	$0
Andrew Himelstein	DE	Hematology & Oncology Physician	$1.1M	$0
Roberto Ferro Valdes	SD	Hematology & Oncology Physician	$1.1M	$0
Martha Hosford Skapof	DE	Hematology & Oncology Physician	$748.2K	$0

Nearby Providers

Other providers in the same ZIP code as Medical Oncology Hematology Consultants PA, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Associated Retinal Consultants LLC	DE	Ophthalmology Physician	$0	$25.2M
Columbus Medical Services, LLC	DE	Case Management Agency	$0	$18.7M
Christiana Care Health Services Inc	DE	Hospitalist Physician	$0	$13.6M
Caritas Home Health Services, Inc	DE	Home Health Agency	$0	$11.2M
Delaware Center For Maternal Fetal Medicine Of Christiana Care	DE	Maternal & Fetal Medicine Physician	$0	$9.8M
Christiana Care Health Services Inc	DE	Neonatal-Perinatal Medicine Physician	$0	$8.9M
Christiana Care Quality Partners	DE	Urgent Care Clinic/Center	$0	$7M
Mid-atlantic Behavioral Health, LLC	DE	Intellectual & Developmental Disabilities Psychologist	$0	$6.5M
First State Orthopaedics, PA	DE	Orthopaedic Surgery Physician	$0	$6M
Autism Delaware	DE	Intellectual & Developmental Disabilities Psychologist	$0	$5.8M

Medical Oncology Hematology Consultants PA — Billing Profile & Reimbursement Data

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Medical Oncology Hematology Consultants PA — 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