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

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

Gnanesh Patel (NPI 1316238298)

Field	Value
Entity Type	Individual
Organization	Gnanesh Patel
Address	150 Mundy St
City	Wilkes Barre
State	PA
ZIP	18702
Taxonomy	Rheumatology Physician
NPI Enumerated	April 26, 2011

Payer Source	Total Paid
Medicare	$3.2M
Medicaid	$0

Key Findings

This provider is effectively a Medicare-focused rheumatology practice: lifetime Medicare revenue is $3.2M while there is no Medicaid billing on file, indicating a single-payer footprint in available data rather than a mixed Medicaid/Medicare panel. The absence of Medicaid claims suggests payer exposure and referral relationships are concentrated in the Medicare population rather than state Medicaid programs.

Revenue is highly concentrated in a small set of drug administration codes: the top 3 Medicare codes (J0129, J1602, J0897) account for 72.1% of the provider's total Medicare revenue, signaling that biologic and injectable specialty therapies are the primary revenue drivers rather than office E/M visits or other procedure lines. This concentration implies the practice is structured around infusion/clinic-administered specialty drugs.

Drug codes dominate the top revenue lines and reflect a biologics-heavy service mix consistent with rheumatology infusion services: J0129 (abatacept), J1602 (golimumab IV), J0897 (denosumab), J3262 (tocilizumab), J0717 (certolizumab pegol) and J1745 (infliximab) together make up the largest revenue contributors, indicating on-site administration of high-cost injectable and IV biologics as the central operating activity. The presence of chemotherapy/infusion administration codes (96413, 96401, 96365, 96415) further supports an infusion/infusion-support operational model.

Competitive standing on key drug codes is prominent nationally: J1602 ranks #11 of 1041 providers nationally (99th percentile) and is described as an "extreme outlier, far above typical national volume," while J0129 ranks in the 97th percentile nationally and J0897 in the 98th percentile. These rank/percentile placements indicate the provider is a major national-volume administrator for certain biologic infusions rather than a typical low-volume clinic, especially for golimumab IV and abatacept.

Some office visit and E/M activity is present but comparatively small: 99213 generated $78.5K (2.5% of Medicare revenue) and ranks in the 99th percentile nationally for volume, which is notable given its small share of total revenue. However, overall revenue mix is still dominated by drug and infusion codes, so E/M services appear complementary to an infusion-focused practice rather than the primary revenue engine.

Tenure and experience are long-standing: the provider's NPI was enumerated on 2011-04-26 (~15 years ago), indicating roughly a decade and a half of enrollment in Medicare which aligns with an established practice likely set up to support infusion services over time. This longevity supports the high-volume status on specific injectable drug codes.

Several codes are labeled as statistical outliers or notably above typical national volume, reinforcing a specialized service profile: in addition to J1602 and J0129 being extreme/high outliers, 96413 (chemotherapy infusion) and 99213 are also flagged as extreme outliers or notably above typical national volume. These signals together point to unusually high utilization of infusion/administration services relative to national peers.

Despite the high-volume biologics and infusion activity, many procedural codes show typical or unremarkable national volume (for example J3262, J0717, J1745, 96401 and several injection codes are in mid to lower percentiles). This mixed pattern indicates the provider is concentrated and dominant on a few specific products while maintaining more typical volumes on other commonly used rheumatology biologics and supportive infusion procedures.

Medicare: Complete Services Breakdown

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

18 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)	31,480	$30	$1.1M
J1602	Injection, golimumab, 1 mg, for intravenous use	77,400	$10	$774K
J0897	Injection, denosumab, 1 mg	25,200	$20	$453.6K
J3262	Injection, tocilizumab, 1 mg	66,120	$10	$330.6K
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)	59,200	$1	$236.8K
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…	1,010	$100	$97.8K
J1745	Injection, infliximab, excludes biosimilar, 10 mg	3,450	$30	$89.7K
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…	1,310	$60	$78.5K
96401	The provider administers nonhormonal, antineoplastic chemotherapy drugs subcutaneously or intramuscularly to the patient.	290	$50	$15.8K
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…	140	$110	$15.2K

Showing 1–10 of 18

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 18 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Pennsylvania Distribution

Gnanesh Patel — 7 of 18 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Pennsylvania

Full comparison — all codes billed, vs. state median

18 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0129	2	60	7,900	$30	$353.8K
J3262	11	30	45,000	$1	$268K
J0717	20	70	38,610	$1	$223.7K
J1602	1	60	11,780	$10	$181.6K
J1745	42	80	3,630	$30	$115.4K
J0897	7	530	2,460	$20	$89.6K
96413	4	300	140	$100	$19.8K
99214	7,932	23,230	100	$80	$14.5K
96401	42	190	140	$60	$12.8K
99213	78	22,370	70	$60	$7.7K

Showing 1–10 of 18

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Julio Ramos	PA	Rheumatology Physician	$1.4M	$550
Martin Blidner	PA	Rheumatology Physician	$1.1M	$0
Joseph Briskie	PA	Cardiovascular Disease Physician	$465.1K	$0
Javid Amini	PA	Cardiovascular Disease Physician	$338.5K	$160
William Hottenstein	PA	Internal Medicine Physician	$303.4K	$0
Michael Rupp	PA	Cardiovascular Disease Physician	$217.3K	$55.1K
Loren Mangino	PA	Family Medicine Physician	$236.9K	$0
James Galasso	PA	Family Medicine Physician	$223.7K	$0
Michael Rittenberg	PA	Specialist	$219.8K	$0
Barbara Plucknett	PA	Gynecology Physician	$185.4K	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Bayada Home Health Care, Inc.	PA	Home Health Agency	$0	$47.6M
Step By Step Inc.	PA	Voluntary or Charitable Agency	$0	$35.3M
Children's Service Center Of Wyoming Valley Inc	PA	Community/Behavioral Health Agency	$0	$26M
Children's Service Center Of Wyoming Valley Inc	PA	Adolescent and Children Mental Health Clinic/Center	$0	$18.7M
Cleanslate Medical Group Of Pennsylvania LLC	PA	Multi-Specialty Clinic/Center	$0	$18.6M
Children's Service Center Of Wyoming Valley, Inc	PA	Counselor	$0	$17.8M
Caring Community Health Center	PA	Federally Qualified Health Center (FQHC)	$0	$17.4M
Golden Care Of Northeast PA, Inc.	PA	Home Health Agency	$0	$7.7M
Wilkes Barre Hospital Company LLC	PA	General Acute Care Hospital	$0	$7.4M
Geisinger Wyoming Valley Medical Center	PA	General Acute Care Hospital	$0	$7M

Gnanesh Patel — 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