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 District of Columbia for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to District of Columbia 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. District of Columbia (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.

David Borenstein (NPI 1366441727)

Field	Value
Entity Type	Individual
Organization	David Borenstein
Address	2021 K St Nw
City	Washington
State	DC
ZIP	20006
Taxonomy	Rheumatology Physician
NPI Enumerated	July 19, 2005

Payer Source	Total Paid
Medicare	$327.9K
Medicaid	$0

Key Findings

This provider’s billing picture is effectively single‑payer: total Medicare revenue is $327.9K and there is no Medicaid billing on file. The absence of Medicaid activity means payer-mix analysis should treat this profile as Medicare‑centric when assessing commercial or state-level risk exposure.

Revenue is highly concentrated in a small set of services: the top three Medicare codes (J0897, 99214, 99204) account for 78.4% of this provider's total Medicare revenue. In dollar terms those three codes are J0897 $141.5K (43.4%), 99214 $99.2K (30.4%), and 99204 $15K (4.6%), indicating the practice derives most of its income from one biologic injection and office E/M visits.

The mix of high-volume codes points to an office-based rheumatology practice that combines biologic injections with longitudinal evaluation and management. J0897 (denosumab injection) and E/M codes 99214/99204 dominate revenue, while ancillary services such as DXA (77080), vitamin D testing (82306), and autoimmune serologies (86235, 86200) support osteoporosis and autoimmune disease management workflows.

Competitively, the provider is a notable E/M volume outlier but not a dominant national supplier of the biologic: 99214 ranks #14473 of 479517 providers (97th percentile; notably above typical national volume), signaling unusually high established‑patient visit volume relative to peers. By contrast J0897 ranks #1616 of 10057 (84th percentile; typical, unremarkable volume) which is above median but described as typical, so the provider is high-volume on office visits while J0897 usage is less exceptional.

Infusion and in‑office administration appear as secondary revenue streams rather than primary drivers. Codes for drug administration and infusion—96401 $10.9K (3.3%), 96413 $7.7K (2.4%), and 96365 $2.5K (0.8%)—alongside the large J0897 component indicate routine in‑office injection/administration capability that complements the E/M service line.

Laboratory and imaging services are present but represent modest revenue percentages and function as monitoring/diagnostic support for rheumatology care. Examples include 86235 ENA testing $4.7K (1.4%), 80053 CMP $4.1K (1.2%), and 82306 vitamin D $4K (1.2%); these codes appear frequently by claim count but each contributes a small share of total Medicare revenue.

This provider has a long tenure on file—NPI enumerated 2005-07-19 (~21 years ago)—which, together with the billing mix dominated by E/M and biologic administration, suggests an established clinical practice focused on outpatient rheumatologic care to a Medicare population. The overall revenue scale ($327.9K) and concentration in a few services indicate a stable but relatively compact Medicare practice footprint rather than a large multispecialty or high-volume infusion center.

Medicare: Complete Services Breakdown

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

27 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J0897	Injection, denosumab, 1 mg	7,860	$20	$141.5K
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…	910	$110	$99.2K
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…	110	$130	$15K
96401	The provider administers nonhormonal, antineoplastic chemotherapy drugs subcutaneously or intramuscularly to the patient.	160	$70	$10.8K
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…	130	$80	$9.9K
77080	The provider performs an imaging procedure, called dual–energy X–ray absorptiometry (DXA), of one or more bony areas on the trunk to determine the bone mineral density (BMD) and whether the patient…	180	$50	$8.1K
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…	60	$130	$7.7K
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,…	260	$20	$4.7K
80053	The lab analyst performs a comprehensive metabolic panel, or CMP test in which he measures the blood level of 14 chemicals the code descriptor lists for the panel.	410	$10	$4K
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…	140	$30	$4K

Showing 1–10 of 27

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 27 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. District of Columbia Distribution

David Borenstein — 3 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — District of Columbia

Full comparison — all codes billed, vs. state median

27 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0897	3	20	4,680	$20	$91.2K
99214	19	1,400	90	$100	$15.3K
96401	5	10	160	$70	$14.3K
96413	10	20	60	$120	$11.4K
99213	317	1,200	50	$70	$8.5K
77080	22	40	230	$30	$7.9K
99204	58	670	30	$130	$6.4K
20610	34	60	60	$60	$6.2K
80053	6	20	320	$10	$3.6K
82306	5	10	100	$30	$2.9K

Showing 1–10 of 27

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Alan Matsumoto	MD	Rheumatology Physician	$2.2M	$0
Emma Diiorio	MD	Rheumatology Physician	$2.1M	$0
Grant Louie	MD	Rheumatology Physician	$2.1M	$0
David Wolfe	MD	Rheumatology Physician	$1.4M	$0
Nitasha Kumar	MD	Rheumatology Physician	$1.2M	$0
Jeffrey Potter	MD	Rheumatology Physician	$1.1M	$0
Rami Eltaraboulsi	MD	Rheumatology Physician	$1.1M	$0
Rachel Kaiser	MD	Rheumatology Physician	$1M	$0
Ashley Beall	MD	Rheumatology Physician	$1M	$0
Guada Respicio Duque	MD	Rheumatology Physician	$969.5K	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Capitol View Home Healthcare Agency	DC	Respite Care	$0	$26.2M
Amazing Grace Supports Inc	DC	In Home Supportive Care Agency	$0	$20.2M
Mba Non Profit Solutions, LLC	DC	Developmentally Disabled Services Day Training Agency	$0	$3.4M
Premier Support Services Inc	DC	Case Management Agency	$0	$2.9M
Hamid Saranjam	DC	Orthodontics and Dentofacial Orthopedics Dentistry	$0	$1.8M
District Endodontics PLLC	DC	Endodontics	$0	$1.8M
Kerman Dental LLC	DC	General Practice Dentistry	$0	$1.4M
Lifetree Health, Inc	DC	Primary Care Clinic/Center	$0	$1.2M
Kaveh Zand	DC	Endodontics	$0	$1M
Limitless Possibilities, LLC.	DC	Mental Health Counselor	$0	$741.8K

David Borenstein — 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