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    OpenPayerNPI Medicare & MedicaidJames Heun
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    James Heun — Billing Profile & Reimbursement Data

    NPI 1497713697 · Platteville, WI · Hematology & Oncology Physician

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    James Heun is a hematology & oncology physician provider located in Platteville, Wisconsin. This profile covers 29 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.

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    Provider details (source: NPPES NPI Registry)

    FieldValue
    Entity TypeIndividual
    OrganizationJames Heun
    Address1400 Eastside Rd
    CityPlatteville
    StateWI
    ZIP53818
    TaxonomyHematology & Oncology Physician
    NPI EnumeratedMay 4, 2006

    Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)

    Payer SourceTotal Paid
    Medicare$756.4K
    Medicaid$0

    Key Findings

    This provider is a hematology & oncology physician with a long tenure in Medicare billing—NPI enumerated ~20 years ago (2006-05-04)—indicating established practice experience and continuity of care in PLATTEVILLE, WI. The longevity supports interpretation of the billing mix as representative of an ongoing specialty practice rather than a short-term or recently opened clinician.

    Medicare dominates this provider's public payer footprint: lifetime Medicare revenue is $756.4K and there is no Medicaid billing on file, so operational and revenue analyses should treat the provider as effectively single-payer (Medicare) in the claims that are visible. This lack of Medicaid activity suggests either limited participation in that program or a patient panel skewed toward Medicare beneficiaries.

    Revenue is highly concentrated in a small set of drugs/procedures: the top three Medicare codes by revenue account for 88.8% of the provider's total Medicare revenue. In particular, J9271 (pembrolizumab) alone contributes $597.7K (79.6% of Medicare revenue), signaling that high-cost oncology drug administration is the central revenue driver for this practice rather than routine office visits or ancillary testing.

    The code mix and descriptions point to a chemo‑focused ambulatory oncology operation: high volumes of J9271 (pembrolizumab), supportive administration codes like 96413 (chemotherapy administration), and add-on infusion codes such as 96417 and 96415 indicate predominantly in-clinic intravenous immunotherapy/chemotherapy sessions, supported by E/M visits (99215, 99214) and routine labs (85025, 80053). This pattern is consistent with a practice that primarily delivers infusion-based cancer therapies rather than general primary care.

    Competitive standing on key codes is mixed: for J9271 the provider ranks #766 of 1841 nationally (58th percentile), which is described as typical and indicates modest, unremarkable national volume for pembrolizumab relative to peers. By contrast, the provider's 99215 office visit volume ranks in the 96th percentile nationally (notably above typical), suggesting that while infusion revenue is typical among oncology peers, the practice bills a relatively high number of complex office E/M visits compared with the broader physician population.

    Other chemotherapy-related codes show generally typical volumes for an oncology practice: 96413 ranks in the 70th percentile and 96417 in the 49th percentile, both labeled typical, which reinforces the interpretation of a standard outpatient infusion workflow rather than an extreme outlier in chemotherapy administration. These patterns imply steady treatment throughput but not dominant national scale.

    The payer-code profile shows few low-revenue ancillary services: lab draws (36415), CBC (85025), and CMP (80053) appear among top codes but represent small shares of revenue, which is consistent with infusion-centered care where drug reimbursement (J-codes) drives dollars and labs/support services are secondary revenue contributors. This distribution highlights operational focus on drug procurement and infusion capacity rather than lab- or procedure-driven revenue.

    Given the high concentration of revenue in a single high-cost drug code (J9271 at $597.7K) prudently monitoring supply, reimbursement contracts, and utilization patterns for that therapy will be material to any commercial or network strategy. Small changes in pembrolizumab utilization or pricing would have outsized effects on this provider's Medicare revenue, because the top three codes already account for 88.8% of Medicare revenues.

    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.

    29 rows

    CPT/HCPCS CodeDescriptionClaimsAvg PaidRevenue
    J9271Injection, pembrolizumab, 1 mg13,900$40$597.7K
    99215The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the…310$130$39.9K
    J9217Leuprolide acetate (for depot suspension), 7.5 mg220$140$29.2K
    99214The 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…300$90$25.2K
    96413Chemotherapy 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…260$100$24.7K
    96417In this add–on procedure, the provider continues administration of a chemotherapy drug into a vein using an infusion technique. He uses this code to report administration of a different chemotherapy…80$50$3.9K
    99232The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…60$60$3.8K
    99205The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the provider…20$160$3.3K
    96375Following the administration of a drug or other substance via intravenous, or IV, push, the provider sequentially infuses a different medication or medications, also via IV push. He administers the…240$10$2.9K
    99223The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…20$130$2.3K

    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

    Full comparison — all codes billed, vs. state median

    29 rows

    CPT/HCPCS CodeRankProvider CountMedian ClaimsAvg PaidAverage Revenue
    J92711108,000$40$382.7K
    J9217630130$130$20.9K
    96413780110$90$12.7K
    992149079,80080$70$9.2K
    992321,6973,49060$60$7.2K
    99215623,32030$110$6.3K
    800537645040$10$6.3K
    992231,5372,08030$130$6.1K
    96365509050$50$5.8K
    992136,0139,38060$50$4.7K

    Showing 1–10 of 29

    Related Providers

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

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    Southwest Health Center, IncWICritical Access Hospital$225.5K$8.3M
    Southwest Health Center, Inc.WIRural Health Clinic/Center$0$2.3M
    Allison DunneWIPhysician Assistant$1.4M$0
    Emily GuerardNVHematology & Oncology Physician$1.3M$0
    Ruqin ChenFLHematology & Oncology Physician$1M$0
    Robert HegemanWIMedical Oncology Physician$393.7K$0
    Samuel GibsonWIDiagnostic Radiology Physician$241.9K$0
    Benjamin KleiberWICardiovascular Disease Physician$224K$100
    Eric EngelmanIAHematology & Oncology Physician$216.5K$0
    Cenon BuencaminoWIDiagnostic Radiology Physician$216.5K$0

    Nearby Providers

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

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    Wal-mart Stores East LPWICommunity/Retail Pharmacy$159.6K$2.3K
    Joshua LindseyWIOrthopaedic Surgery Physician$154.3K$0
    Walgreen CoWIPharmacy$139.9K$7.6K
    Jeffrey WhiteWIFamily Medicine Physician$72.6K$0
    Terrence NortonWIPsychiatry Physician$55.8K$0
    Scott KjarWIFoot & Ankle Surgery Podiatrist$28K$0
    Jacob HiattWIFamily Medicine Physician$21.1K$0

    Frequently Asked Questions

    References

    1. 1.Medicare Physician & Other Practitioner by Provider and Service. CMS.gov.Provider-level Medicare Part B utilization and payment data.
    2. 2.NPPES NPI Registry. CMS.gov.National Provider Identifier registry used for provider enumeration and taxonomy metadata.

    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

    Medicare Revenue by CPT/HCPCS Code
    Claims Volume vs. Wisconsin Distribution
    James Heun — 3 of 25 codes billed far more than typical (above p95)
    p5–p95 (all providers)p25–p75MedianThis providerOutlier
    Rank Distribution — Wisconsin