NPI 1396754727 — Billing Profile & Reimbursement Data
NPI 1396754727 · XX · healthcare
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NPI 1396754727 is a healthcare provider located in Unspecified Location. This profile covers 88 Medicare and 0 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services. Note: "XX" is a placeholder CMS uses when a provider's practice-location state wasn't reported — not a traditional US state; claims coded under it are grouped and benchmarked here the same way a traditional state would be.
Provider details (source: NPPES NPI Registry)
| Field | Value |
|---|---|
| Entity Type | Individual |
| Organization | NPI 1396754727 |
| Address | |
| City | |
| State | XX (Unspecified Location) |
| ZIP | |
| Taxonomy | N/A |
| NPI Enumerated | |
| NPI Deactivated | October 16, 2024 |
(source: CMS Medicare & Medicaid claims data)
Key Findings
Revenue concentration is heavy: the provider reports $2.5M in total Medicare revenue and the precomputed top 3 Medicare codes (J9271, J9299, 78815) account for 64.3% of that Medicare revenue, indicating a business tightly focused on a small set of high-revenue services. Those three codes alone include J9271 ($645K, 26.5%) and J9299 ($604.8K, 24.8%), showing most income is driven by high-cost injectable oncology agents and associated imaging.
Service-line profile points to oncology/infusion and advanced imaging services: high revenue from J9271 (pembrolizumab) and J9299 (nivolumab) combined with substantial billing for 78815 (PET/CT, $316K, 13.0%) and radiopharmaceuticals and suggests the provider operates as an infusion/imaging practice supporting cancer care. Additional chemotherapy administration codes (, , ) and infusion-related supplies (, ) reinforce an infusion‑center or oncology outpatient service-line.
Medicare: Total Revenue Breakdown by CPT/HCPCS Code
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
Medicare: Complete Services Breakdown
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
88 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J9271 | Injection, pembrolizumab, 1 mg | 15,000 | $40 | $645K |
| J9299 | Injection, nivolumab, 1 mg | 25,200 | $20 | $604.8K |
| 78815 | PET and CT scans are both standard imaging tools that allow doctors to evaluate the location and metabolic actions of tumors or cancer inside the body before beginning an active treatment regimen.… | 250 | $1,270 | $316K |
| J1568 | Injection, immune globulin, (octagam), intravenous, non-lyophilized (e.g., liquid), 500 mg | 6,900 | $30 | $227.7K |
| J0897 | Injection, denosumab, 1 mg | 6,960 | $20 | $125.3K |
| J0881 | Injection, darbepoetin alfa, 1 microgram (non-esrd use) | 40,620 | $1 | $81.2K |
| A9552 | Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries | 260 | $280 | $74.7K |
| 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… | 990 | $60 | $59.5K |
| A9595 | Piflufolastat f-18, diagnostic, 1 millicurie | 120 | $490 | $57.2K |
| 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… | 420 | $100 | $43.4K |
Showing 1–10 of 88
Medicare: Competitive Analysis & Benchmarks
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 88 CPT/HCPCS codes. Note: this provider's state, "XX," is a placeholder CMS uses when a provider's practice-location state wasn't reported — not a traditional US state; the State panel below benchmarks against other providers coded under the same designation.
View: State1 / 2
Full comparison — all codes billed, vs. state median
88 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J9271 | 13 | 10 | 17,200 | $40 | $743.5K |
| 78815 | 4 | 10 | 200 | $1,090 | $220.7K |
| A9552 | 4 | 10 | 220 | $400 | $87.4K |
| 96413 | 9 | 10 | 350 | $100 | $34.2K |
| 78816 | 4 | 10 | 30 | $1,090 | $29.4K |
| J0897 | 14 | 10 | 1,440 | $20 | $26.6K |
| 74177 | 122 | 10 | 210 | $120 | $23.9K |
| 99213 | 61 | 10 | 140 | $60 | $18.8K |
| 99214 | 841 | 10 | 80 | $90 | $15.8K |
| 99215 | 373 | 10 | 60 | $110 | $13.3K |
Showing 1–10 of 88
Frequently Asked Questions
References
- 1.Medicare Physician & Other Practitioner by Provider and Service. CMS.gov.Provider-level Medicare Part B utilization and payment data.
- 2.NPPES NPI Registry. CMS.gov.National Provider Identifier registry used for provider enumeration and taxonomy metadata.
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