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NPI 1558380295 · Kingston, PA · Hematology & Oncology Physician
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David Greenwald is a hematology & oncology physician provider located in Kingston, Pennsylvania. This profile covers 63 Medicare and 3 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 | David Greenwald |
| Address | 382 Pierce St |
| City | Kingston |
| State | PA |
| ZIP | 18704 |
| Taxonomy | Hematology & Oncology Physician |
| NPI Enumerated | July 19, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $2.7M |
| Medicaid | $590 |
Practice profile and service line: The provider is a Hematology & Oncology Physician whose Medicare billing mix is dominated by high-cost oncology biologics and infusion services, led by J9271 ($748.2K), J9299 ($589.9K) and J0897 ($437.4K). The presence of chemotherapy administration codes such as 96413 ($95.9K), add-on infusion codes (96417, 96415) and the large volume of infusion-related codes indicates an infusion-centric oncology practice model rather than a primarily procedural or surgical specialty.
Medicare revenue concentration: Medicare accounts for $2.7M in lifetime revenue and the precomputed top 3 Medicare codes drive 67.5% of that Medicare revenue, indicating revenue heavily concentrated in a few oncology drug codes (notably J9271, J9299, J0897). This concentration means changes in utilization or reimbursement for these agents could materially affect the provider’s Medicare revenue.
Medicaid scale and concentration: Medicaid revenue is de minimis at $590 in lifetime revenue and the precomputed top 3 Medicaid codes account for 100.0% of Medicaid revenue, showing Medicaid is effectively a negligible payer for this provider. Medicaid payments are concentrated in office E/M (99214: $294, 61.6%) and lab panels (80053: $183, 38.4%), reinforcing that Medicaid contribution is small and non-specialty in character.
Competitive standing on key oncology drugs: The provider’s J0897 activity ($437.4K) is reported as an extreme outlier nationally (98th percentile) and J1439 ($227.3K) is an extreme outlier (100th percentile), signaling unusually high national volumes for those specific injectable agents compared with peers. By contrast, pembrolizumab J9271 ($748.2K) and nivolumab J9299 ($589.9K) are in the typical range nationally (J9271 at the 71th percentile; J9299 at the 79th percentile), suggesting strong but not dominant participation in those immunotherapy agents.
High visit and infusion throughput: The provider reports substantial E/M and infusion throughput on Medicare — 99214 accounts for $169.4K and ranks as an extreme outlier nationally (100th percentile), and 96413 accounts for $95.9K and is an extreme outlier (99th percentile). Together these codes imply a high-volume clinic workflow handling complex office visits and regular chemotherapy/immunotherapy infusions.
Lab and ancillary services: The provider bills lab panels and CBCs to Medicare at notable volumes (80053 $25.4K, 85025 $29.8K) and also bills these same labs to Medicaid (80053 $183, 85025 $0), indicating routine onsite ordering of baseline and monitoring labs consistent with an oncology infusion practice. Lab billing contributes meaningfully to Medicare revenue but is a minor component of the already-trivial Medicaid revenue.
Operational risk/opportunity implications: Given that 67.5% of Medicare revenue is concentrated in three drugs, the practice is exposed to reimbursement or utilization shifts for those agents; conversely, this concentration could make the provider an attractive target for payers or vendors looking to manage biologic utilization for a small number of high-impact codes. The provider’s extreme outlier status on specific agents (J0897, J1439) and infusion administration (96413) suggests any contracting or utilization-management initiatives would likely focus on those line items.
Tenure and billing history: The provider’s NPI was enumerated on 2006-07-19 (~20 years ago), indicating long-standing participation in federal programs; over that tenure the lifetime Medicare revenue of $2.7M far exceeds lifetime Medicaid revenue of $590, confirming Medicare as the dominant payer relationship for the practice. This long enrollment and Medicare-centric revenue profile are consistent with an established oncology clinic serving primarily Medicare beneficiaries.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
63 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J9271 | Injection, pembrolizumab, 1 mg | 17,400 | $40 | $748.2K |
| J9299 | Injection, nivolumab, 1 mg | 24,580 | $20 | $589.9K |
| J0897 | Injection, denosumab, 1 mg | 24,300 | $20 | $437.4K |
| J1439 | Injection, ferric carboxymaltose, 1 mg | 227,250 | $1 | $227.3K |
| 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… | 1,840 | $90 | $169.4K |
| 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… | 1,000 | $100 | $95.9K |
| Q5107 | Injection, bevacizumab-awwb, biosimilar, (mvasi), 10 mg | 3,570 | $20 | $82.1K |
| 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… | 790 | $60 | $48.4K |
| J9217 | Leuprolide acetate (for depot suspension), 7.5 mg | 250 | $130 | $32.5K |
| 85025 | A complete blood count (better known as a CBC) is a blood test request by a doctor that provides detailed information about various types of cells in a patient's blood. Usually a pathologist or a… | 3,720 | $10 | $29.8K |
Showing 1–10 of 63
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 63 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
63 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J9271 | 10 | 40 | 13,000 | $40 | $604.4K |
| J9299 | 1 | 10 | 9,330 | $20 | $291K |
| J0897 | 10 | 530 | 2,460 | $20 | $89.6K |
| Q5107 | 1 | 10 | 3,570 | $20 | $81.7K |
| J0881 | 45 | 50 | 24,690 | $1 | $72.7K |
| J1439 | 2 | 60 | 27,000 | $1 | $36K |
| J3490 | 21 | 110 | 60 | $70 | $27.9K |
| 80053 | 13 | 220 | 110 | $10 | $21.6K |
| J9217 | 20 | 130 | 130 | $130 | $21.3K |
| 96413 | 5 | 300 | 140 | $100 | $19.8K |
Showing 1–10 of 63
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.
3 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… | 100 | $1 | $290 |
| 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. | 180 | $1 | $180 |
| 85025 | A complete blood count (better known as a CBC) is a blood test request by a doctor that provides detailed information about various types of cells in a patient's blood. Usually a pathologist or a… | 560 | $0 | $0 |
How this provider's Medicaid billing volume and revenue compare to other Pennsylvania providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Pennsylvania median
3 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 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. | 267 | 340 | 2,320 | $10 | $88.6K |
| 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… | 5,156 | 8,160 | 210 | $60 | $68.4K |
| 85025 | A complete blood count (better known as a CBC) is a blood test request by a doctor that provides detailed information about various types of cells in a patient's blood. Usually a pathologist or a… | 268 | 450 | 1,220 | $1 | $48K |
Other providers in the same ZIP code as David Greenwald, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Beyond Behavior Consulting | PA | Behavior Analyst | $0 | $10.3M |
| Keystone Behavior Services, LLC | PA | Community/Behavioral Health Agency | $0 | $6.1M |
| Luzerne Intermediate Unit #18 | PA | Community/Behavioral Health Agency | $0 | $5.7M |
| Erik Kruger | PA | Ophthalmology Physician | $2.4M | $11.8K |
| Surgical Specialty Center Of Northeastern Pennsylvania, LLC | PA | Ambulatory Surgical Clinic/Center | $1.5M | $124.1K |
| Anthony Andrews | PA | Ophthalmology Physician | $1.3M | $100 |
| Radu Pacurariu | PA | Ophthalmology Physician | $1M | $0 |
| Mark Grohol | PA | Optometrist | $221.5K | $697.4K |
| Gateway Surgery Center LLC | PA | Ambulatory Surgical Clinic/Center | $756.7K | $11.8K |
| Dhirendra Kumar | PA | Family Medicine Physician | $638.2K | $0 |
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