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 New Mexico for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to New Mexico 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. New Mexico (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.

Leroy Pacheco (NPI 1568438752)

Field	Value
Entity Type	Individual
Organization	Leroy Pacheco
Address	1617 University Blvd Ne
City	Albuquerque
State	NM
ZIP	87102
Taxonomy	Rheumatology Physician
NPI Enumerated	February 27, 2006

Payer Source	Total Paid
Medicare	$787.7K
Medicaid	$0

Key Findings

LEROY PACHECO is a Rheumatology Physician in ALBUQUERQUE with an NPI enumerated 2006-02-27 (~20 years ago). Lifetime Medicare revenue for this provider is $787.7K and there is no Medicaid billing on file (none (no Medicaid billing on file)), indicating a long-tenured clinician whose observed payer activity is effectively single-payer Medicare.

Revenue concentration is high: the precomputed top-3 Medicare codes account for 80.0% of this provider's total Medicare revenue. Those top three are J0129 with $246.5K (30.6%), J9312 with $211.2K (26.2%), and J0717 with $187.4K (23.2%), showing most revenue is driven by a small set of billed biologic/infusion drugs.

The code mix (J0129, J9312, J0717 plus J1602 at $86.4K and infusion administration codes such as 96413 at $15K and 96365 at $6.4K) is consistent with in‑office administration of physician‑administered biologics and IV infusions. This pattern suggests the practice operates an infusion/administration service line rather than being limited to only office evaluation and management visits.

Competitive standing on the drug codes is generally modest to typical rather than dominant: J0129 ranks #694 of 1221 providers nationally (43th percentile; typical, unremarkable volume for this code), J9312 ranks #147 of 317 providers nationally (53th percentile; typical, unremarkable volume for this code), and J0717 ranks #437 of 848 providers nationally (49th percentile; typical, unremarkable volume for this code). These ranks indicate the provider is an active but not top-tier national biller for these biologic injections.

Office visit/E&M billing is relatively prominent: 99213 shows 556 claims with $33.9K revenue (4.2%) and ranks #22399 of 457151 providers nationally (95th percentile; notably above typical national volume for this code). This suggests a significant ongoing established-patient panel and frequent follow-up visits supporting the infusion work.

The practice also reports routine infusion/administration activity beyond the top drugs: 96413 (170 claims, $15K, 1.9%) ranks #3407 of 7514 (54th percentile; typical), 96372 (299 claims, $3K, 0.4%) ranks #3828 of 58224 (93th percentile; typical), and 96415 (169 claims, $3.4K, 0.4%) ranks #858 of 4959 (82th percentile; typical). Together these codes reinforce that medication administration and infusion time are material operational activities rather than rare ancillary services.

The payer mix is effectively single-payer Medicare: $787.7K in Medicare revenue versus none (no Medicaid billing on file) for Medicaid. This limited payer diversity means the provider’s financial performance and contracting leverage are concentrated in the Medicare market and may not reflect managed‑care or Medicaid patient flows.

Because 80.0% of Medicare revenue is concentrated in three physician‑administered drug codes, the practice has concentrated exposure to reimbursement, formulary, and referral changes that affect those products. J0129 is the single largest contributor at $246.5K, so shifts in utilization or payment for that drug in particular would have outsized revenue impact for this provider.

Medicare: Complete Services Breakdown

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

18 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)	7,250	$30	$246.5K
J9312	Injection, rituximab, 10 mg	3,300	$60	$211.2K
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)	46,840	$1	$187.4K
J1602	Injection, golimumab, 1 mg, for intravenous use	7,850	$10	$86.3K
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…	560	$60	$33.9K
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…	170	$90	$15K
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.	150	$40	$6.4K
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…	60	$90	$5.2K
96415	In 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 each additional hour of infusion beyond the…	170	$20	$3.4K
96372	A therapeutic, prophylactic, or diagnostic substance (a fluid, a drug, etc.) is injected via intramuscular or subcutaneous route into the patient's body. The procedure is performed by the physician…	300	$10	$3K

Showing 1–10 of 18

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 18 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. New Mexico Distribution

Leroy Pacheco — 2 of 18 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — New Mexico

Full comparison — all codes billed, vs. state median

18 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0129	8	10	9,930	$30	$358.6K
J0717	3	10	56,620	$1	$255.7K
J9312	3	10	3,700	$60	$225.8K
J1602	4	10	8,900	$10	$132.4K
96413	21	40	170	$90	$17.7K
99214	1,746	2,700	90	$70	$12.9K
99213	98	2,440	60	$50	$7.3K
96365	13	40	80	$40	$6K
90694	197	200	40	$70	$5.5K
96367	23	20	140	$20	$4.9K

Showing 1–10 of 18

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Scott Stoerner	NM	Rheumatology Physician	$1.5M	$0
Jacqueline Dean	NM	Rheumatology Physician	$601.6K	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Tricore Reference Laboratories	NM	Clinical Medical Laboratory	$0	$64.8M
Bright Horizons, Inc.	NM	Intellectual and/or Developmental Disabilities Residential Treatment Facility	$0	$46.9M
Lovelace Health System LLC	NM	General Acute Care Hospital	$0	$45.2M
Tricore Inc.	NM	Clinical Medical Laboratory	$7M	$35.8M
App Of New Mexico Ed PLLC	NM	Emergency Medicine Physician	$0	$42M
Duke City Recovery Toolbox LLC	NM	Community/Behavioral Health Agency	$108.4K	$28M
Metro Treatment Of New Mexico LP	NM	Methadone Clinic	$220.4K	$27.9M
Enchanted Care Solutions, LLC	NM	Home Health Agency	$0	$25.8M
Open Skies Healthcare	NM	Community/Behavioral Health Agency	$0	$23.8M
Krossroads Integrative Health And Recovery Solutions Inc	NM	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$16.7M

Leroy Pacheco — 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