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NPI 1639332968 · Saint Louis, MO · Medical Oncology Physician
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Peter Oppelt is a medical oncology physician provider located in Saint Louis, Missouri. This profile covers 71 Medicare and 6 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 | Peter Oppelt |
| Address | 4921 Parkview Pl |
| City | Saint Louis |
| State | MO |
| ZIP | 63110 |
| Taxonomy | Medical Oncology Physician |
| NPI Enumerated | July 7, 2008 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $2.5M |
| Medicaid | $15.8K |
This provider is effectively Medicare‑centric: lifetime Medicare revenue is $2.5M compared with $15.8K in Medicaid, so Medicare accounts for the overwhelming share of billed revenue while Medicaid activity is minimal in scale. The disparity indicates that payer strategies or utilization reviews should be weighted toward Medicare line items for any financial or clinical oversight.
Medicare revenue is highly concentrated in a small set of biologic/oncology drugs: the precomputed top 3 Medicare codes account for 65.0% of total Medicare revenue, driven primarily by J9271 (48.9%, $1.2M), with J9299 ($208.6K, 8.4%) and J9144 ($191.5K, 7.7%) also in the top three. This concentration shows the provider’s Medicare book is dominated by a few high‑cost agents rather than a broad mix of small services.
The CPT/HCPCS mix and descriptions point to an infusion‑centric medical oncology practice: high revenue and claim counts for J9271 (pembrolizumab), J9299 (nivolumab), J9144 (daratumumab), plus chemotherapy administration codes such as 96413 and add‑on/infusion codes (96411, 96367, 96375) indicate routine in‑office systemic therapy and supportive oncology care. Supportive agents including J2506 (pegfilgrastim) and J0897 (denosumab) further reinforce a practice that provides both anticancer biologics and associated supportive medications.
The provider shows above‑typical national activity on several specific Medicare services: J9271 ranks #149 of 1841 providers nationally (92th percentile) indicating relatively strong national standing for pembrolizumab administration, while J9355 ranks #1 of 8 providers nationally (100th percentile, notably above typical national volume) and 96413 ranks #220 of 7514 providers nationally (97th percentile, notably above typical national volume). These rank/percentile signals identify discrete areas where the provider is a major participant nationally — particularly for trastuzumab (J9355) and certain chemotherapy administration workflows.
Medicaid billing is extremely concentrated but low in absolute dollars: the precomputed top 3 Medicaid codes account for 94.3% of Medicaid revenue, with 96413 alone representing 60.4% ($9.5K) of Medicaid revenue and 99214 contributing $4.6K (29.2%). Despite this concentration, the provider’s in‑state competitive standing on those Medicaid codes is modest (96413 ranks #29 of 42 in‑state, 32th percentile; 99214 ranks #1754 of 3166 in‑state, 45th percentile), indicating limited Medicaid market share.
Operationally, the high national percentile on infusion and continuation codes suggests frequent use of extended or community infusion pathways: G0498 ranks #23 of 896 providers nationally (98th percentile, notably above typical national volume), supporting the observation that the practice provides initiation in clinic with continuation in community/home settings. That usage pattern may affect how payers design coverage or site‑of‑care policies for ongoing infusions.
The provider’s tenure is long-standing: NPI enumerated 2008-07-07 (~18 years ago), which suggests an established clinical practice and potential continuity of local referral relationships that align with the observed sustained volumes in certain high‑cost biologics. Longevity combined with concentrated drug billing patterns amplifies the operational impact of any reimbursement or utilization changes for a small set of agents.
From a payer risk and opportunity perspective, the portfolio is exposed to utilization or price shifts in a few high‑impact agents: with 65.0% of Medicare revenue coming from the top three Medicare codes and 94.3% of Medicaid revenue from the top three Medicaid codes, changes in coverage, biosimilar uptake, or prior‑authorization policies for key codes such as J9271 and J9355 would disproportionately affect total payments. Payers should therefore prioritize monitoring these specific codes and consider targeted interventions (for example, biosimilar adoption where clinically appropriate) if the objective is to manage spend or utilization in this provider relationship.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
71 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J9271 | Injection, pembrolizumab, 1 mg | 28,200 | $40 | $1.2M |
| J9299 | Injection, nivolumab, 1 mg | 9,480 | $20 | $208.6K |
| J9144 | Injection, daratumumab, 10 mg and hyaluronidase‑fihj | 5,040 | $40 | $191.5K |
| J9355 | Injection, trastuzumab, excludes biosimilar, 10 mg | 2,060 | $60 | $131.5K |
| J0897 | Injection, denosumab, 1 mg | 6,900 | $20 | $124.2K |
| J9264 | Injection, paclitaxel protein-bound particles, 1 mg | 9,300 | $10 | $93K |
| J1561 | Injection, immune globulin, (gamunex-c/gammaked), non-lyophilized (e.g., liquid), 500 mg | 2,160 | $40 | $82.1K |
| 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… | 740 | $100 | $72.7K |
| Q5107 | Injection, bevacizumab-awwb, biosimilar, (mvasi), 10 mg | 2,810 | $20 | $61.8K |
| 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… | 620 | $100 | $61.2K |
Showing 1–10 of 71
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 71 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
71 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J9271 | 3 | 40 | 9,100 | $40 | $502K |
| J9299 | 18 | 20 | 14,170 | $20 | $360.3K |
| J9144 | 17 | 20 | 7,200 | $40 | $308.4K |
| J9355 | 1 | 10 | 2,060 | $60 | $131.1K |
| J1561 | 11 | 30 | 1,650 | $40 | $87.1K |
| J0897 | 34 | 210 | 2,400 | $20 | $82.4K |
| J9264 | 2 | 10 | 6,500 | $10 | $69.9K |
| J0881 | 10 | 10 | 15,500 | $1 | $63.1K |
| Q5119 | 3 | 10 | 1,570 | $20 | $43.6K |
| Q5107 | 1 | 10 | 1,520 | $20 | $41K |
Showing 1–10 of 71
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.
6 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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… | 180 | $50 | $9.5K |
| 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… | 170 | $30 | $4.6K |
| 96367 | The provider administers an additional intravenous infusion or infusions, after an initial infusion, of a different medication or substance for a period up to one hour to prevent, treat, or diagnose… | 40 | $20 | $750 |
| J2469 | Injection, palonosetron hcl, 25 mcg | 50 | $10 | $460 |
| 96375 | Following 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… | 20 | $20 | $400 |
| J1100 | Injection, dexamethasone sodium phosphate, 1 mg | 50 | $1 | $50 |
How this provider's Medicaid billing volume and revenue compare to other Missouri providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Missouri median
6 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 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… | 29 | 40 | 530 | $130 | $144.7K |
| 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… | 1,754 | 3,170 | 230 | $70 | $128.1K |
| 96375 | Following 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… | 84 | 90 | 490 | $40 | $52.5K |
| 96367 | The provider administers an additional intravenous infusion or infusions, after an initial infusion, of a different medication or substance for a period up to one hour to prevent, treat, or diagnose… | 8 | 10 | 100 | $40 | $17.4K |
| J2469 | Injection, palonosetron hcl, 25 mcg | 2 | 10 | 70 | $70 | $5K |
| J1100 | Injection, dexamethasone sodium phosphate, 1 mg | 27 | 40 | 70 | $1 | $1.4K |
Other providers in the same ZIP code as Peter Oppelt, ranked by combined Medicare and Medicaid revenue.
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