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.

Jose Avitia (NPI 1669511663)

Field	Value
Entity Type	Individual
Organization	Jose Avitia
Address	4901 Lang Ave Ne
City	Albuquerque
State	NM
ZIP	87109
Taxonomy	Hematology & Oncology Physician
NPI Enumerated	February 6, 2007

Payer Source	Total Paid
Medicare	$880.2K
Medicaid	$0

Key Findings

This provider’s Medicare billing profile is concentrated in outpatient oncology infusions and associated evaluation-and-management visits: the single largest Medicare revenue line is J9271 with $387K (45.1% of Medicare revenue), and other top drug lines include J0897 ($144.7K, 16.8%) and J9217 ($43.7K, 5.1%). The presence of multiple chemotherapy administration CPTs (96413, 96401, 96402, 96415) and infusion-related J-codes indicates the practice operates as an infusion-centered hematology/oncology service line rather than a predominantly office-visit practice.

Revenue is highly concentrated: the top 3 Medicare codes by revenue account for 72.0% of this provider’s total Medicare revenue, with J9271 ($387K, 45.1%), J0897 ($144.7K, 16.8%) and 99215 ($86.7K, 10.1%) driving the bulk of receipts out of $880.2K in lifetime Medicare revenue. That concentration implies the provider’s financial performance is materially tied to utilization and reimbursement for a small set of oncology drugs and high-level E/M visits.

Payer mix is effectively single-payer Medicare: lifetime Medicare revenue is $880.2K while there is no Medicaid billing on file (none). This makes the provider operationally and financially dependent on Medicare volume and reimbursement policies, with limited exposure to Medicaid-managed care or fee-for-service Medicaid.

Competitive standing is mixed by service line: for the top drug J9271 the provider ranks #1299 of 1841 (29th percentile) and is described as delivering typical, unremarkable volume nationally, while for J0897 the rank is #1572 of 10057 (84th percentile) and similarly labeled typical. In contrast, the provider is an extreme outlier on high-complexity office visits: 99215 ranks #922 of 145531 (99th percentile) and is labeled an "extreme outlier," indicating substantially higher-than-typical billing of high-level E/M visits compared with national peers.

Several specific codes are statistically notable beyond the headline drugs: 99215 is explicitly flagged as an extreme outlier (662 claims, $131 avg paid/claim, $86.7K revenue, 10.1%), while J9217 (344 claims, $127 avg paid/claim, $43.7K revenue, 5.1%) and 96402 (150 claims, $25 avg paid/claim, $3.8K revenue, 0.4%) are described as notably above typical national volume. These flagged positions suggest the provider bills more frequently for certain high-complexity visits and specific hormonal/chemotherapy administrations than most peers.

Operational throughput is evident from very large claim counts for low-dollar supportive/injectable drugs: J0881 shows 18.6K claims with $2 avg paid/claim for $37.1K revenue, and J1439 shows 20.3K claims with $1 avg paid/claim for $20.3K revenue. The combination of many low-unit-value supportive drug administrations alongside fewer high-dollar immunotherapy administrations (J9271) points to a mixed workflow in which routine supportive care is provided at scale while a smaller number of expensive immunotherapy administrations produce most revenue.

Tenure and continuity are long-standing: the provider’s NPI was enumerated on 2007-02-06 (~19 years ago), indicating an established presence in the market that may support stable referral patterns and an experienced infusion practice. This longevity, combined with the code mix, is consistent with a mature outpatient oncology operation.

The concentration in a few high-revenue codes creates sensitivity to utilization and reimbursement changes: with J9271 alone representing $387K (45.1%) and the top three codes totaling 72.0% of Medicare revenue, any changes to coverage, dosing patterns, or payment for these drugs or for high-level E/M visits could materially affect overall revenue. Analysts should monitor policy and utilization trends for pembrolizumab (J9271) and for high-complexity E/M billing (99215) when assessing future revenue risk.

Medicare: Complete Services Breakdown

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

51 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J9271	Injection, pembrolizumab, 1 mg	9,000	$40	$387K
J0897	Injection, denosumab, 1 mg	8,040	$20	$144.7K
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…	660	$130	$86.7K
J9217	Leuprolide acetate (for depot suspension), 7.5 mg	340	$130	$43.7K
J0881	Injection, darbepoetin alfa, 1 microgram (non-esrd use)	18,560	$1	$37.1K
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…	290	$90	$25.2K
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…	240	$100	$23.7K
J1439	Injection, ferric carboxymaltose, 1 mg	20,250	$1	$20.3K
G6015	Intensity modulated treatment delivery, single or multiple fields/arcs,via narrow spatially and temporally modulated beams, binary, dynamic mlc, per treatment session	60	$250	$16.3K
J9041	Injection, bortezomib, 0.1 mg	2,730	$10	$13.7K

Showing 1–10 of 51

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 51 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. New Mexico Distribution

Jose Avitia — 5 of 25 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

51 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J9271	7	10	9,400	$40	$469.6K
J0897	8	50	3,150	$20	$113.2K
G6015	5	10	70	$260	$49.4K
J0881	1	10	12,320	$1	$31.2K
J9217	1	20	180	$130	$23.4K
J1439	8	10	25,500	$1	$23.1K
96413	12	40	170	$90	$17.7K
J3490	18	20	40	$150	$16.7K
99214	448	2,700	90	$70	$12.9K
J9041	1	10	2,190	$1	$10.7K

Showing 1–10 of 51

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
New Mexico Oncology Hematology Consultants, Ltd.	NM	Hematology & Oncology Physician	$0	$4.2M
Gregg Franklin	NM	Radiation Oncology Physician	$2.5M	$0
Scott Stoerner	NM	Rheumatology Physician	$1.5M	$0
Shaya Ansari	NY	Diagnostic Radiology Physician	$1.5M	$1K
Pranshu Bansal	AZ	Hematology & Oncology Physician	$1.4M	$0
Ronald Kubica	NM	Medical Oncology Physician	$1M	$0
Annette Fontaine	NM	Medical Oncology Physician	$918.5K	$0
Mrunal Tailor	NM	Diagnostic Radiology Physician	$897.5K	$0
Amyn Alidina	NM	Medical Oncology Physician	$785K	$0
Masoud Shiehmorteza	NM	Diagnostic Radiology Physician	$773.7K	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Presbyterian Healthcare Services	NM	Internal Medicine Physician	$0	$240.8M
Heritage Home Healthcare Services, Inc.	NM	Home Health Agency	$0	$141.5M
Home Medical Equipment Specialists LLC	NM	Durable Medical Equipment & Medical Supplies	$0	$100M
The New Beginnings LLC	NM	Adult Day Care Clinic/Center	$0	$85.1M
We Care Agency, Inc.	NM	In Home Supportive Care Agency	$0	$60.1M
Lovelace Health System, LLC	NM	General Acute Care Hospital	$0	$57.7M
Adelante Development Center, Inc.	NM	Personal Care Attendant	$0	$57M
Eye Associates Of New Mexico Ltd	NM	Ophthalmology Physician	$0	$46.9M
Southwest Labs LLC	NM	Clinical Medical Laboratory	$1.1M	$41.5M
Southwest Medical Associates, LLC	NM	General Practice Physician	$0	$41.4M

Jose Avitia — 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