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

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

Margaret Denham (NPI 1306125455)

Field	Value
Entity Type	Individual
Organization	Margaret Denham
Address	1402 E County Line Rd
City	Indianapolis
State	IN
ZIP	46227
Taxonomy	Nurse Practitioner
NPI Enumerated	August 8, 2011

Payer Source	Total Paid
Medicare	$1.7M
Medicaid	$0

Key Findings

This provider’s billing is effectively single-payer Medicare: lifetime Medicare revenue is $1.7M while Medicaid revenue is none (no Medicaid billing on file), indicating no recorded Medicaid activity and heavy dependence on Medicare reimbursement for scale. The absence of Medicaid billing suggests the provider’s patient mix, contracting focus, or site of service places them outside Medicaid-covered settings.

Revenue is extremely concentrated in a very small set of drugs: the precomputed top-3 Medicare codes account for 95.3% of this provider’s total Medicare revenue, with J3245 representing 48.0%, J3380 representing 42.4%, and J0897 representing 4.9% of Medicare revenue. This concentration means most of the $1.7M Medicare revenue is driven by a handful of high-cost biologic/injection codes rather than a broad mix of office or evaluation codes.

The code mix identifies the practice as a biologics/infusion-oriented operation: J3245 (tildrakizumab) and J3380 (vedolizumab) are high-revenue injectable biologics and J0897 (denosumab) is an injectable bone-modifying agent, consistent with a practice that administers specialty biologic therapies and outpatient infusions rather than primarily performing routine clinic E/M visits. Operationally, this suggests emphasis on drug procurement, infusion nursing, and billing for high-cost drug administration as the core service line.

Competitive standing is mixed across drugs: for J3380 the provider ranks #13 of 620 providers nationally (98th percentile; extreme outlier), indicating an unusually large national share of vedolizumab activity and positioning the provider as a major outlier by volume for that drug. By contrast, for J3245 the provider ranks #33 of 225 (86th percentile; typical, unremarkable volume) and for J0897 ranks #3225 of 10057 (68th percentile; typical, unremarkable volume), implying national prominence for vedolizumab but more modest or typical participation for the other top drugs.

Ancillary infusion and chemotherapy administration codes are present but represent a small portion of revenue: 96413 shows $14.1K (0.8% of total Medicare revenue) and 96401 shows $11.4K (0.7% of total Medicare revenue), while other administration codes such as 96365 and 96372 account for trivial dollar amounts. These administration/chemotherapy entries indicate infusion capability is used beyond the top biologics but that oncology-style chemotherapy is not a primary revenue driver for the practice.

High dependence on two biologic codes (J3245 and J3380 together account for 90.4% of Medicare revenue) creates revenue sensitivity to formulary changes, utilization management, or supplier pricing for those agents; any shifts in coverage or access for these specific drugs could materially affect the provider’s Medicare revenue base. Given the extreme outlier status on J3380, operational disruptions or reimbursement changes for vedolizumab would likely have outsized impact.

The provider has an established enrollment tenure: NPI enumerated on 2011-08-08 (~15 years ago), which indicates a sustained presence in Medicare billing and suggests clinical and operational processes have been in place long enough to develop concentrated specialty lines of business. This longevity combined with the concentrated code mix supports the interpretation of a focused infusion/biologics practice rather than a newly established general primary-care provider.

Medicare: Complete Services Breakdown

The CPT/HCPCS codes generating the most Medicare revenue for this provider.

8 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J3245	Injection, tildrakizumab, 1 mg	7,400	$110	$814K
J3380	Injection, vedolizumab, intravenous, 1 mg	42,300	$20	$719.1K
J0897	Injection, denosumab, 1 mg	4,380	$20	$83.2K
J3111	Injection, romosozumab-aqqg, 1 mg	6,510	$10	$52.1K
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…	180	$80	$14.1K
96401	The provider administers nonhormonal, antineoplastic chemotherapy drugs subcutaneously or intramuscularly to the patient.	280	$40	$11.4K
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.	60	$40	$2.4K
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…	30	$10	$230

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 8 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Indiana Distribution

Margaret Denham — 2 of 8 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Indiana

Full comparison — all codes billed, vs. state median

8 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J3245	1	10	3,900	$110	$447.6K
J3380	1	20	7,200	$20	$212.7K
J3111	19	20	16,730	$10	$187.6K
J0897	61	220	2,730	$20	$74.9K
96413	52	120	140	$90	$19.1K
96401	12	60	100	$50	$8K
96365	81	140	80	$40	$5.2K
96372	816	1,300	50	$10	$720

Related Providers

Other providers that share a Tax Identification Number (TIN) with Margaret Denham, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Metro Infectious Disease Consultants, LLC	IL	Infectious Disease Physician	$0	$44.3M
Putnam County Hospital	IN	Critical Access Hospital	$0	$5.7M
Natalia Surowaniec	IL	Family Nurse Practitioner	$2.1M	$0
Martha Pawlukowsky	IL	Family Nurse Practitioner	$2M	$1.3K
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

Nearby Providers

Other providers in the same ZIP code as Margaret Denham, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Adult And Child Center, Inc	IN	Community/Behavioral Health Agency	$0	$114.1M
Community Hospital South, Inc.	IN	General Acute Care Hospital	$0	$27.3M
Adult And Child Mental Health Center Inc	IN	Community/Behavioral Health Agency	$0	$23.5M
Adult And Child Mental Health Center Inc	IN	Federally Qualified Health Center (FQHC)	$0	$10.7M
Emergency Dentist,llc	IN	General Practice Dentistry	$0	$9.3M
Spero Health Of Indiana, LLC	IN	Addiction Medicine (Family Medicine) Physician	$0	$8.6M
East 53rd Street Dental-1, PC	IN	General Practice Dentistry	$0	$7.4M
Freedom Home Care, LLC.	IN	Home Health Agency	$0	$7.4M
City Optical Co., Inc.	IN	Optometrist	$0	$6.5M
Windrose Health Network, Inc.	IN	Federally Qualified Health Center (FQHC)	$0	$6M

Margaret Denham — Billing Profile & Reimbursement Data

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Key Findings

Medicare: Total Revenue Breakdown by CPT/HCPCS Code

Medicare: Complete Services Breakdown

Medicare: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References