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.

Jose Pando (NPI 1306839048)

Field	Value
Entity Type	Individual
Organization	Jose Pando
Address	20268 Plantations Rd
City	Lewes
State	DE
ZIP	19958
Taxonomy	Rheumatology Physician
NPI Enumerated	August 29, 2005

Payer Source	Total Paid
Medicare	$3.2M
Medicaid	$0

Key Findings

Practice model and primary services: Medicare billing is heavily weighted toward in-office biologic and injectable therapies rather than outpatient-only evaluation and management. The top codes are J0129 (abatacept), J0717 (certolizumab pegol) and J0897 (denosumab), and the broader code mix also includes J3111 (romosozumab), J9312 (rituximab) and J1745 (infliximab), indicating the provider operates with on-site drug administration and infusion capabilities consistent with a rheumatology practice that delivers injectable biologic therapies.

High revenue concentration in a few drug codes: the precomputed top-three codes account for 49.9% of this provider's Medicare revenue, driven by J0129 ($627.3K, 19.6%), J0717 ($536K, 16.8%) and J0897 ($433.1K, 13.5%). This concentration shows the practice’s Medicare performance is materially dependent on a small set of high-revenue injectable drugs.

Payer mix and single‑payer dependence: lifetime Medicare revenue is $3.2M while there is no Medicaid billing on file, so the provider is effectively Medicare-focused and lacks an observable Medicaid revenue stream. That single-payer concentration increases exposure to Medicare reimbursement policy and utilization patterns for infused/subcutaneous biologics.

Competitive standing by code: the provider is an outlier on several national benchmarks for specific drug and infusion codes — J0897 (denosumab) ranks #175 of 10057 providers (98th percentile; extreme outlier, far above typical national volume) and J3489 (zoledronic acid) ranks #26 of 3032 providers (99th percentile; extreme outlier, far above typical national volume). At the same time, other high-revenue drugs show more typical volumes nationally (J0129 ranks #160 of 1221, 87th percentile; J0717 ranks #82 of 848, 90th percentile), so competitive strength is concentrated in a few specific biologics.

Infusion and chemotherapy administration footprint: the provider bills multiple chemotherapy/infusion administration codes at elevated percentiles — 96413 ($76.1K, 2.4%) ranks in the 97th percentile, 96401 ($38.5K, 1.2%) ranks in the 96th percentile, and 96415 ($9K, 0.3%) ranks in the 98th percentile — signaling routine delivery of IV/subcutaneous therapies and extended infusions in-office. Together with frequent billing for drug J1745 (infliximab, $277.7K, 8.7%), these entries indicate a clinically active infusion service line.

High-volume, low‑per‑claim drug administration pattern: several drug codes show very large claim counts with low average paid-per-claim, for example J0717 has 134K claims at $4 avg paid/claim ($536K revenue), J3111 has 55.2K claims at $7 avg paid/claim ($386.6K revenue), and J3262 has 54.1K claims at $4 avg paid/claim ($216.3K revenue). This pattern suggests many small-dose or unit-based billing events are driving substantial aggregate revenue rather than a small number of high-dollar per-claim administrations.

Clinical visit volume versus drug revenue: evaluation and management codes produce modest but notable Medicare revenue (99214 $92.1K, 2.9%; 99213 $55.4K, 1.7%), and both E/M codes rank in the high national percentiles for volume (99214 ranks in the 98th percentile; 99213 ranks in the 98th percentile and is labeled an extreme outlier, far above typical national volume). Despite these elevated E/M ranks, total Medicare dollars are dominated by biologic and infusion drug codes, indicating office visits support but do not primarily drive revenue.

Tenure and operational stability: the provider’s NPI was enumerated on 2005-08-29 (~21 years ago), indicating a long-tenured presence in the market which may support established referral patterns and sustained infusion operations. Combined with the concentrated biologic billing footprint, the tenure suggests an established practice model focused on in-office therapy delivery rather than recent entrants or transient providers.

Medicare: Complete Services Breakdown

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

29 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)	18,450	$30	$627.3K
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)	134,000	$1	$536K
J0897	Injection, denosumab, 1 mg	24,060	$20	$433.1K
J3111	Injection, romosozumab-aqqg, 1 mg	55,230	$10	$386.6K
J9312	Injection, rituximab, 10 mg	5,250	$60	$309.8K
J1745	Injection, infliximab, excludes biosimilar, 10 mg	10,680	$30	$277.7K
J3262	Injection, tocilizumab, 1 mg	54,080	$1	$216.3K
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…	1,000	$90	$92.1K
J1306	Injection, inclisiran, 1 mg	10,220	$10	$92K
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…	730	$100	$76.1K

Showing 1–10 of 29

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 29 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Delaware Distribution

Jose Pando — 5 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. state median

29 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0129	3	10	11,030	$30	$432.5K
J0717	3	10	98,800	$1	$376.8K
J9312	2	10	5,250	$60	$314K
J3111	2	10	29,930	$10	$245K
J3262	1	10	52,080	$1	$226.2K
J1306	2	10	8,950	$10	$180K
J1745	1	10	3,610	$30	$134.3K
J0897	5	60	3,360	$20	$132.9K
96413	3	30	280	$100	$36.6K
99214	113	1,830	150	$80	$25.5K

Showing 1–10 of 29

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Rheumatology Consultants Of De PA	DE	Rheumatology Physician	$0	$225.4K
Anusha Vuppala	CA	Rheumatology Physician	$170.7K	$0
Jennifer Rahn	DE	Physician Assistant	$122.7K	$0
Gregory Sender	DE	Physician Assistant	$81.6K	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Beebe Medical Center, Inc.	DE	General Acute Care Hospital	$0	$29.2M
Beebe Physician Network Inc.	DE	Internal Medicine Physician	$0	$19.7M
Juliano Senior Care, Inc.	DE	In Home Supportive Care Agency	$0	$5.9M
Sussex Emergency Associates LLC	DE	Emergency Medicine Physician	$0	$4.3M
Lourdes Aponte	DE	Rheumatology Physician	$3.6M	$0
Delaware Psychological Services LLC	DE	Mental Health Counselor	$0	$3M
The Pediatric & Adolescent Center	DE	Specialist	$0	$2.9M
Sea Haven Home Care, LLC	DE	In Home Supportive Care Agency	$0	$2.3M
Southern Delaware Imaging Assoc	DE	Diagnostic Radiology Physician	$0	$2.3M
Egnm LLC	DE	Ambulatory Surgical Clinic/Center	$2.2M	$13.6K

Jose Pando — 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