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NPI 1518073220 · Vineyard, UT · Rheumatology Physician
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Shruti Sanghvi is a rheumatology physician provider located in Vineyard, Utah. This profile covers 16 Medicare and 1 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.
Provider details (source: NPPES NPI Registry)
| Field | Value |
|---|---|
| Entity Type | Individual |
| Organization | Shruti Sanghvi |
| Address | 691 E 400 N, Ste. 110 |
| City | Vineyard |
| State | UT |
| ZIP | 84058 |
| Taxonomy | Rheumatology Physician |
| NPI Enumerated | August 23, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $642.5K |
| Medicaid | $6.5K |
This provider is a rheumatology physician with an NPI enumerated on 2006-08-23 (~20 years ago) and lifetime Medicare revenue of $642.5K and lifetime Medicaid revenue of $6.5K. The long-tenure enumeration suggests an established billing history and potential stable referral patterns into a specialty practice focused on chronic rheumatologic care.
Medicare revenue is heavily driven by biologic drug administration: J0129 ($267.8K, 41.2%), J0717 ($199.2K, 30.6%), and Q5104 ($88.7K, 13.7%) together account for 85.5% of Medicare revenue. These three codes are all injectable/infusion biologics, indicating the practice’s commercial model centers on in-office administration of disease-modifying biologic therapies rather than purely office-based cognitive care.
The provider’s Medicare revenue concentration in the top three codes (85.5%) exposes the practice to utilization and reimbursement changes for specific biologics; operationally this implies reliance on drug procurement, infusion workflows, and payer prior-authorization processes. On the Medicaid side, billing is also concentrated but in a different way: 99214 is reported as $6.6K and accounts for 100.0% of the provider’s Medicaid revenue, which suggests Medicaid encounters are limited to routine established outpatient visits rather than biologic administrations.
Competitive standing for the top Medicare drug codes is modest rather than dominant. J0129 ranks #638 of 1221 providers (48th percentile; typical, unremarkable volume), J0717 ranks #406 of 848 providers (52th percentile; typical, unremarkable volume), and Q5104 ranks #66 of 178 providers (63th percentile; typical, unremarkable volume), indicating typical commercial-scale participation in these therapies with Q5104 somewhat above median among peers but not an outlier.
Office evaluation-and-management activity is present but not the primary revenue source in Medicare: 99214 accounts for $36.9K (5.7% of Medicare revenue) across 424 claims and ranks #63543 of 479517 providers (87th percentile; typical, unremarkable volume). The same E/M code dominates Medicaid billing (99214, 126 claims, $6.6K reported), where it ranks #772 of 1340 in-state (42th percentile; typical, unremarkable volume), signaling the provider treats established outpatients for Medicaid but generates minimal Medicaid revenue overall.
Procedure and infusion coding beyond the top biologic drugs supports an on-site administration model: 96365 ($13.4K, 297 claims), 96401 ($13.2K, 244 claims), and 96366 ($2.7K, 182 claims) are present on the Medicare ledger. The presence of ultrasound-guided arthrocentesis codes (20611, 20604, 20606) and limited extremity ultrasound (76882) further indicates combined ambulatory infusion and point-of-care procedural services typical of a rheumatology clinic that performs joint injections and imaging-guided procedures.
From a payer-mix perspective the practice is effectively Medicare-dominated by scale: Medicare $642.5K versus Medicaid $6.5K. While Medicaid encounters exist (all reported Medicaid revenue tied to 99214), Medicaid represents an immaterial share of lifetime revenue, so strategic contracting or care-delivery discussions should focus primarily on Medicare-related drug administration and infusion reimbursement.
Overall the provider’s pattern is consistent with a community rheumatology practice that derives the majority of revenue from onsite biologic administration and related infusion services, shows typical national percentile positioning on key drug codes, and maintains a low-volume Medicaid footprint. The combination of long tenure (2006-08-23 enumeration) and concentrated drug-revenue exposure suggests attention to drug supply, payer authorizations, and shifts in biologic utilization will materially affect financial performance.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
16 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) | 7,880 | $30 | $267.8K |
| 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) | 49,800 | $1 | $199.2K |
| Q5104 | Injection, infliximab-abda, biosimilar, (renflexis), 10 mg | 3,060 | $30 | $88.7K |
| 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… | 420 | $90 | $36.9K |
| 96365 | The provider administers the initial intravenous infusion of a medication or other substance for a period up to one hour to prevent, treat, or diagnose a condition or disease. | 300 | $50 | $13.4K |
| 96401 | The provider administers nonhormonal, antineoplastic chemotherapy drugs subcutaneously or intramuscularly to the patient. | 240 | $50 | $13.2K |
| 99215 | The 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… | 70 | $130 | $9.6K |
| 99205 | The 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… | 40 | $150 | $5.7K |
| 20611 | In this procedure, the provider inserts a needle through the skin of a patient and into a major joint or bursa, typically the shoulder, hip, knee, or subacromial bursa, and then uses the syringe… | 60 | $70 | $4K |
| 20604 | In this procedure, the provider inserts a needle through the skin of a patient and into a small joint or bursa, typically the fingers or toes, and then uses the syringe attachment to the needle to… | 50 | $60 | $3K |
Showing 1–10 of 16
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 16 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
16 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J0717 | 7 | 10 | 57,900 | $1 | $388K |
| J0129 | 4 | 10 | 7,880 | $30 | $287.1K |
| Q5104 | 4 | 10 | 3,550 | $30 | $99.1K |
| 96401 | 4 | 20 | 140 | $50 | $13.7K |
| 99214 | 305 | 4,080 | 80 | $80 | $11.6K |
| 99215 | 333 | 1,190 | 40 | $110 | $7.5K |
| 20611 | 33 | 90 | 50 | $60 | $6K |
| 96365 | 7 | 80 | 90 | $40 | $5.2K |
| 99205 | 100 | 460 | 20 | $140 | $4K |
| 96366 | 7 | 20 | 100 | $10 | $2.2K |
Showing 1–10 of 16
Medicaid revenue breakdown by year and by CPT/HCPCS procedure code, including monthly billing trends and the top codes driving revenue.
View: By Year1 / 3
Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.
1 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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… | 130 | $50 | $6.6K |
How this provider's Medicaid billing volume and revenue compare to other Utah providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Utah median
1 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 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… | 772 | 1,340 | 200 | $80 | $144K |
Other providers in the same ZIP code as Shruti Sanghvi, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Mountain View Retirement, Inc. | UT | Assisted Living Facility | $0 | $3.9M |
| Discovery House Uc, Inc | UT | Methadone Clinic | $0 | $2.8M |
| Advance Medical Services, Inc | UT | Oxygen Equipment & Supplies (DME) | $0 | $1.7M |
| Wasatch Behavioral Health Special Service District | UT | Clinical Medical Laboratory | $0 | $1.2M |
| Wilson Senior Solutions, Inc. | UT | In Home Supportive Care Agency | $0 | $476.9K |
| Sandhill Operations LLC | UT | Substance Abuse Rehabilitation Facility | $0 | $369.1K |
| Kimball Taylor | UT | Physical Therapist | $127.1K | $0 |
| Eric Freeman | UT | Interventional Pain Medicine Physician | $108.8K | $9.1K |
| Bryan Hoelzer | UT | Interventional Pain Medicine Physician | $106.2K | $7.6K |
| Scott Peterson | UT | Family Medicine Physician | $66.2K | $6.5K |
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