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

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

Peter Mathern (NPI 1316995699)

Field	Value
Entity Type	Individual
Organization	Peter Mathern
Address	77 W Forest Ave
City	Flagstaff
State	AZ
ZIP	86001
Taxonomy	Medical Oncology Physician
NPI Enumerated	May 5, 2006

Payer Source	Total Paid
Medicare	$3M
Medicaid	$0

Key Findings

PETER MATHERN is a Medical Oncology Physician based in FLAGSTAFF, AZ with an NPI enumerated on 2006-05-05 (~20 years ago), indicating long-standing enrollment and continuity in Medicare billing. The taxonomy and tenure are consistent with an established oncology practice providing infusion and outpatient oncology services.

This provider is effectively single-payer at the claims level: lifetime Medicare revenue is $3M and there is no Medicaid billing on file (none). That concentration means Medicare reimbursement dynamics will largely drive this provider's financial performance and payer negotiations.

Revenue is highly concentrated in a small set of drug administrations: the precomputed top 3 Medicare codes account for 78.1% of this provider's total Medicare revenue, led by J9271 ($1.5M; 50.9% of Medicare revenue), followed by J1930 ($458.6K; 15.5%) and J0897 ($346.7K; 11.7%). This concentration signals material dependence on a few high-revenue biologic and targeted agents for the majority of payments.

The CPT/HCPCS mix strongly reflects an oncology infusion practice focused on high-cost biologic and supportive therapies rather than office-based E/M encounters: J9271 (pembrolizumab), J1930 (lanreotide), and J0897 (denosumab) dominate revenue, supplemented by chemotherapy administration codes such as 96413 and 96401 and supportive agents like J2506 (pegfilgrastim) and J0185 (aprepitant). The presence of laboratory code 85025 and multiple add-on infusion codes (96417, 96415) further supports a high-throughput infusion/infusion-support service model.

National competitive standing on key codes is strong in several areas: J9271 ranks #62 of 1841 (97th percentile; notably above typical national volume) and J0897 ranks #314 of 10057 (97th percentile; notably above typical national volume), indicating this provider delivers considerably higher volume of these agents than most peers. M0010 (EOM monthly enhanced oncology services) is an extreme outlier at rank #3 of 544 (100th percentile; extreme outlier), and 99213 is also labeled an extreme outlier at 99th percentile, suggesting unusually high reported volumes for these specific service lines versus national peers.

Participation in value-based or enhanced payment programs is evident: M0010 appears with $43.6K revenue and a rank of #3 of 544 (100th percentile; extreme outlier), which indicates active receipt of the Enhanced Oncology Model monthly enhanced services payment and a level of engagement with EOM that is rare nationally. This could reflect strategic alignment with oncology quality/payment reforms and may influence referral or contracting opportunities.

Volume metrics emphasize drug-driven throughput: the provider reported 35.1K claims for J9271, 11.8K claims for J1930 and 19.3K claims for J0897, alongside procedural chemo volumes such as 734 claims for 96413. In contrast, typical E/M visits generate far smaller shares of revenue (for example 99213 accounts for $78.9K or 2.7% of Medicare revenue and 99214 $68.4K or 2.3%), reinforcing that drug administration rather than office visits is the primary revenue engine.

The payer and service-line profile presents both operational strengths and risks: strength comes from high national percentile positioning on key biologic agents and deep engagement in oncology-specific payment models, while risk stems from heavy reliance on a few high-revenue drugs (78.1% concentration among the top three codes) and the absence of Medicaid billing (none), which limits payer diversification and could amplify sensitivity to Medicare policy, drug pricing, or reimbursement changes.

Medicare: Complete Services Breakdown

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

46 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J9271	Injection, pembrolizumab, 1 mg	35,100	$40	$1.5M
J1930	Injection, lanreotide, 1 mg	11,760	$40	$458.6K
J0897	Injection, denosumab, 1 mg	19,260	$20	$346.7K
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…	1,290	$60	$78.9K
Q5119	Injection, rituximab-pvvr, biosimilar, (ruxience), 10 mg	3,490	$20	$76.8K
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…	730	$100	$70.5K
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…	740	$90	$68.4K
J2506	Injection, pegfilgrastim, excludes biosimilar, 0.5 mg	740	$80	$56.5K
J0885	Injection, epoetin alfa, (for non-esrd use), 1000 units	7,560	$10	$45.4K
Q5122	Injection, pegfilgrastim-apgf (nyvepria), biosimilar, 0.5 mg	540	$80	$44.3K

Showing 1–10 of 46

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 46 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Arizona Distribution

Peter Mathern — 8 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Arizona

Full comparison — all codes billed, vs. state median

46 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J9271	1	80	10,000	$40	$487.4K
J1930	1	10	11,760	$40	$454.5K
J0897	21	260	2,940	$20	$115.6K
Q5119	4	40	1,480	$20	$42.6K
Q5122	4	10	410	$90	$36.5K
J2506	2	20	220	$80	$29.3K
96413	12	230	190	$100	$24.8K
99214	739	10,410	120	$80	$20.6K
J9217	19	140	120	$130	$19.7K
J0185	3	30	8,450	$1	$12.8K

Showing 1–10 of 46

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Columbus Radiology Corp	OH	Diagnostic Radiology Physician	$0	$49.9M
Wilfredo Blasini	FL	Clinical Pathology Physician	$16.9M	$307.9K
Arizona Oncology Associates PC	AZ	Specialist	$0	$13.9M
Ryan Olson	FL	Anatomic Pathology & Clinical Pathology Physician	$12.8M	$80
American Oncology Partners PA	OH	Hematology & Oncology Physician	$0	$11.8M
Robert Mcdonald	AZ	Diagnostic Radiology Physician	$7.5M	$0
David Smith	MD	Hematology & Oncology Physician	$6.4M	$0
Stephen Divers	AR	Hematology & Oncology Physician	$3.9M	$1.5K
Iyad Hamarneh	AZ	Medical Oncology Physician	$3.5M	$0
Robert Muldoon	AR	Hematology & Oncology Physician	$3.2M	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Flagstaff Medical Center	AZ	General Acute Care Hospital	$0	$63.3M
Flagstaff Medical Center	AZ	Land Ambulance	$0	$46.2M
Flagstaff Medical Center	AZ	Air Ambulance	$0	$37.6M
New Life Wellness Flagstaff	AZ	Community/Behavioral Health Agency	$0	$14.6M
Northern Arizona Healthcare Corporation	AZ	Family Medicine Physician	$0	$11.4M
Flagstaff Emergency Physicians	AZ	Emergency Medicine Physician	$0	$10.4M
Flagstaff Dentistry 4 Kids, PLLC	AZ	General Practice Dentistry	$0	$10.4M
North Country Healthcare, Inc.	AZ	Pediatrics Physician	$0	$7.5M
Emeritol Lo Flagstaff LLC	AZ	Assisted Living Facility	$0	$6.5M
Alexander Hu	AZ	Internal Medicine Physician	$3.8M	$0

Peter Mathern — 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