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NPI 1275535536 · Venice, FL · Rheumatology Physician
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Vinay Reddy is a rheumatology physician provider located in Venice, Florida. This profile covers 22 Medicare and 7 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 | Vinay Reddy |
| Address | 411 Commercial Ct Ste C |
| City | Venice |
| State | FL |
| ZIP | 34292 |
| Taxonomy | Rheumatology Physician |
| NPI Enumerated | June 1, 2005 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $1.4M |
| Medicaid | $58.7K |
The provider is effectively Medicare-dominant: reported total Medicare revenue is $1.4M versus total Medicaid revenue of $58.7K, indicating Medicare is the primary payer by a large margin. This payer mix suggests that analyses and interventions targeted at Medicare flows will capture the vast majority of this provider’s revenue activity.
Medicare revenue is highly concentrated in office-administered biologic and injectable drug codes: the top three Medicare codes (J0129, J0717, J1602) account for 88.4% of the provider’s Medicare revenue, with J0129 alone representing $865.4K (61.3% of Medicare revenue). That concentration signals a service-line focused on biologic therapies (abatacept, certolizumab pegol, golimumab) typically given under physician supervision rather than self-administered drugs.
The code mix and procedure codes support an in-office infusion and follow-up E/M model: substantial Medicare revenue comes from J0129, J0717, and J1602 (biologics) alongside evaluation-and-management codes (99213, 99204) and infusion administration codes (96413, 96401). Presence of 96413 ($37K Medicare revenue) and 96401 ($19.9K Medicare revenue) indicates the practice administers IV/subcutaneous therapies in-office and bills for chemotherapy/infusion administration workflows in addition to routine rheumatology visits.
Competitive standing on key Medicare codes is uneven: for J0129 the provider ranks #68 of 1221 nationally (95th percentile) and is described as notably above typical national volume, indicating a relatively prominent position among peers for abatacept administration. By contrast, J1602 ranks #720 of 1041 (31st percentile) and J0717 ranks #243 of 848 (71st percentile), both described as typical or unremarkable volumes, so the provider’s leadership is focused specifically on J0129 rather than across all biologics.
Medicaid activity is small but also concentrated: the top three Medicaid codes (99213, J0129, 99204) account for 94.0% of Medicaid revenue, with 99213 at $30.1K (51.7%) and J0129 at $21.6K (37.2%). This shows that, within Medicaid, revenue is split between routine E/M visits and the same office-administered biologic (abatacept) seen in Medicare, but the absolute Medicaid scale ($58.7K) is limited relative to Medicare.
State-level competitiveness for the Medicaid biologic is ambiguous due to a tiny peer set: J0129 for Medicaid ranks #2 of 2 providers in-state (0th percentile) and is labeled typical/unremarkable, which reflects a very small in-state denominator rather than clear dominance. Medicaid 99213 ranks #1867 of 5934 in-state (69th percentile), a typical volume, reinforcing that Medicaid engagement is modest and concentrated in routine visits.
Service-line and utilization implications for payers: given that one Medicare drug code (J0129) accounts for $865.4K and 61.3% of Medicare revenue, payers may prioritize medical management, site-of-care assessment, and contract strategies specific to abatacept administration in this office. The provider’s high Medicare 99213 activity (1.1K claims, $62.2K revenue; rank described as an extreme outlier nationally) also suggests frequent follow-up visits that could be examined for care coordination or alternative patient monitoring models.
Provider tenure and operational inference: the NPI was enumerated 2005-06-01 (~21 years ago), indicating an established practice. Coupled with the concentrated biologic revenue and in-office infusion billing, the pattern is consistent with a long-standing rheumatology practice that has built a high-volume administration pathway for certain biologic therapies, particularly abatacept (J0129).
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
22 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) | 26,230 | $30 | $865.4K |
| 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) | 72,400 | $1 | $289.6K |
| J1602 | Injection, golimumab, 1 mg, for intravenous use | 9,250 | $10 | $92.5K |
| 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… | 1,110 | $60 | $62.2K |
| 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… | 430 | $90 | $37K |
| 96401 | The provider administers nonhormonal, antineoplastic chemotherapy drugs subcutaneously or intramuscularly to the patient. | 400 | $50 | $19.9K |
| 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… | 90 | $110 | $10.5K |
| 86235 | The lab analyst performs an assay to evaluate the patient’s serum for each antibody to an extractable nuclear antigen, also called ENA. Types of ENA antibodies include anti ribonuclear protein,… | 430 | $20 | $7.4K |
| 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… | 60 | $90 | $5.8K |
| 86480 | The lab analyst performs a test to evaluate a cell mediated immunity gamma interferon antigen response to certain tuberculosis, or TB, antibodies. | 80 | $60 | $4.9K |
Showing 1–10 of 22
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 22 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
22 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J0129 | 2 | 130 | 9,350 | $30 | $386.8K |
| J0717 | 3 | 120 | 52,000 | $1 | $302.7K |
| J1602 | 10 | 90 | 13,930 | $10 | $184.6K |
| 86480 | 4 | 20 | 90 | $60 | $87.3K |
| 86235 | 2 | 40 | 220 | $20 | $57.9K |
| 96413 | 14 | 730 | 200 | $100 | $26.1K |
| 99214 | 6,906 | 32,760 | 140 | $90 | $25K |
| 82306 | 28 | 920 | 70 | $30 | $21.5K |
| 96401 | 4 | 590 | 110 | $60 | $12.7K |
| 99213 | 67 | 30,010 | 80 | $60 | $12K |
Showing 1–10 of 22
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.
7 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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… | 1,500 | $20 | $30.1K |
| 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) | 30 | $700 | $21.6K |
| 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… | 50 | $60 | $3K |
| 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… | 50 | $60 | $2.9K |
| 82306 | The lab analyst measures the vitamin D level, typically on a serum specimen. This analyte, commonly known as vitamin D, is not really a vitamin, but is an important steroid hormone that is produced… | 10 | $30 | $460 |
| 80305 | The lab analyst performs presumptive drug test(s) by any method that the analyst can read by direct optical observation only, without instrument assistance, to screen for any number of drug classes… | 30 | $10 | $180 |
| 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. | 40 | $0 | $0 |
How this provider's Medicaid billing volume and revenue compare to other Florida providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Florida median
7 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 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… | 80 | 100 | 650 | $80 | $238.6K |
| 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… | 1,867 | 5,930 | 460 | $40 | $169.3K |
| 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. | 216 | 230 | 1,060 | $60 | $150.1K |
| 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… | 1,156 | 1,850 | 90 | $110 | $71.5K |
| 82306 | The lab analyst measures the vitamin D level, typically on a serum specimen. This analyte, commonly known as vitamin D, is not really a vitamin, but is an important steroid hormone that is produced… | 333 | 340 | 220 | $10 | $67.4K |
| 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) | 2 | 10 | 100 | $630 | $61.6K |
| 80305 | The lab analyst performs presumptive drug test(s) by any method that the analyst can read by direct optical observation only, without instrument assistance, to screen for any number of drug classes… | 159 | 200 | 180 | $10 | $6.2K |
Other providers in the same ZIP code as Vinay Reddy, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Sean Mazloom | FL | MOHS-Micrographic Surgery Physician | $1M | $0 |
| Jeffrey Hunek | FL | Dermatology Physician | $973K | $0 |
| Ki Hassler | FL | Cardiovascular Disease Physician | $858.6K | $0 |
| Derek Cuff | FL | Orthopaedic Surgery Physician | $648.1K | $0 |
| David Chan | FL | Orthopaedic Hand Surgery Physician | $536.7K | $0 |
| Michael Mercandetti | FL | Ophthalmic Plastic and Reconstructive Surgery Physician | $527.4K | $0 |
| Lindsey Watford | FL | Family Nurse Practitioner | $459.6K | $0 |
| Edmund Witkowski | FL | Sports Medicine (Orthopaedic Surgery) Physician | $435.5K | $0 |
| Elena Kesterson | FL | Physician Assistant | $434.2K | $0 |
| Anne Mcbride | FL | Dermatology Physician | $412.1K | $0 |
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