NPI 1598738262 — Billing Profile & Reimbursement Data
NPI 1598738262 · XX · healthcare
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NPI 1598738262 is a healthcare provider located in Unspecified Location. This profile covers 22 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 1598738262 |
| 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
This provider’s Medicare revenue is $3.2M while there is no Medicaid billing on file, making their Medicaid footprint effectively nil and their contractual exposure heavily concentrated with Medicare payers. The absence of any Medicaid claims suggests this is a near–single-payer (Medicare) billing profile rather than a balanced dual‑payer practice, which has direct implications for network contracting and risk exposure to Medicare policy changes.
Revenue concentration is extreme: the precomputed top‑3 Medicare codes account for 78.4% of total Medicare revenue, driven primarily by J1602 ($1.6M, 47.3%), J0129 ($688.9K, 20.5%), and J0717 ($356.8K, 10.6%). Such concentration indicates the business is reliant on a very small set of high‑revenue drug administrations, making overall revenue sensitive to formulary, reimbursement, or utilization changes affecting these specific agents.
The code mix (J1602, J0129, , , ) plus infusion/administration codes (, , ) points to an infusion‑focused practice model that primarily administers biologic and parenteral specialty drugs, consistent with services for autoimmune or inflammatory conditions and some chemotherapy/infusion activity. Additional procedure codes for joint injections () and intra‑articular hyaluronan () suggest the site also performs office‑based musculoskeletal injections and procedural care alongside biologic infusions.
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.
22 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J1602 | Injection, golimumab, 1 mg, for intravenous use | 144,100 | $10 | $1.6M |
| 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) | 20,880 | $30 | $688.9K |
| 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) | 89,200 | $1 | $356.8K |
| J3262 | Injection, tocilizumab, 1 mg | 68,360 | $10 | $341.8K |
| J1745 | Injection, infliximab, excludes biosimilar, 10 mg | 4,810 | $30 | $125.1K |
| 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… | 1,260 | $80 | $104.8K |
| 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. | 940 | $50 | $42.3K |
| 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… | 330 | $90 | $29.8K |
| 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… | 300 | $80 | $24.7K |
| J7323 | Hyaluronan or derivative, euflexxa, for intra-articular injection, per dose | 170 | $100 | $17.3K |
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Medicare: Competitive Analysis & Benchmarks
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 22 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
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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