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

Why is the Medicaid comparison limited to Colorado 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. Colorado (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.

Paul Decarolis (NPI 1699759241)

Field	Value
Entity Type	Individual
Organization	Paul Decarolis
Address	2312 N Nevada Ave Ste 400
City	Colorado Springs
State	CO
ZIP	80907
Taxonomy	Hematology & Oncology Physician
NPI Enumerated	December 6, 2005

Payer Source	Total Paid
Medicare	$1.6M
Medicaid	$0

Key Findings

This provider is effectively single-payer: lifetime Medicare revenue is $1.6M while there is no Medicaid billing on file, indicating all reimbursed activity in the claims set is Medicare-based and the practice’s financial exposure is concentrated on Medicare policy and reimbursement dynamics. Analysts should treat Medicaid access or contracting as absent for this NPI.

Revenue is highly concentrated in a few oncology products: the precomputed top 3 Medicare codes account for 74.2% of this provider’s total Medicare revenue, led by J9271 with $743.9K (47.7% of Medicare revenue), followed by J9144 with $273.6K (17.6%) and A9595 with $138.6K (8.9%). This concentration means a small number of drug and diagnostic codes drive most of reported Medicare income.

The code mix is consistent with an infusion-centered hematology/oncology practice that also performs advanced diagnostic imaging: high-revenue drug codes J9271 (pembrolizumab) and J9144 (daratumumab) dominate, and imaging/diagnostic codes such as A9595 (piflufolastat f-18) and 78815 (PET/CT) contribute material revenue. Additional chemotherapy administration and infusion codes (96413, G0498, 96367) and routine oncology labs (85025, 82784, 83521) further support a model that combines in-office infusions, lab monitoring, and PET-based imaging.

Competitive standing on top drugs is active but not market-dominant: J9271 ranks #538 of 1841 providers nationally (71th percentile; typical, unremarkable volume), J9144 ranks #352 of 615 (41th percentile; typical, unremarkable volume), and A9595 ranks #187 of 528 (64th percentile; typical, unremarkable volume). These percentiles show the provider has meaningful utilization of flagship oncology agents and diagnostic radiotracers but generally sits in the middle of the national distribution rather than at the top.

Operational throughput appears substantive for office-based oncology services: the provider reported 17.3K claims for J9271 and 7.2K claims for J9144, alongside 412 claims for 99214 and 1.2K claims for 85025; routine venipuncture 36415 shows 1.1K claims and ranks high (97th percentile). Those volumes and high relative ranks for basic lab and visit codes indicate frequent in-office patient encounters and on-site specimen collection supporting infusion care.

The practice shows direct participation in oncology care model enhancements: M0010 (EOM monthly enhanced oncology services) has 123 claims and $8.6K revenue (0.6% of Medicare revenue) and ranks #186 of 544 providers nationally (66th percentile; typical, unremarkable volume), suggesting the provider bills for enhanced oncology care management in addition to drug and imaging revenue streams. This may reflect organizational processes for care coordination or billing under the oncology model.

Concentration in a few high-cost biologics creates revenue sensitivity to utilization or coverage changes: with J9271 alone representing $743.9K (47.7%) of Medicare revenue and the top three codes totaling 74.2%, payer policy changes, step edits, or shifts to site-of-care reimbursement for these agents could materially affect the provider’s Medicare revenue. Risk assessments and contract negotiations should prioritize these codes.

The provider has long tenure in the Medicare program, with an NPI enumerated on 2005-12-06 (~21 years ago), indicating an established billing history; combined with the drug-heavy code mix this suggests an experienced oncology practice that has operated through multiple reimbursement cycles and likely has existing clinical and billing workflows for high-cost infusions.

Medicare: Complete Services Breakdown

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

73 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J9271	Injection, pembrolizumab, 1 mg	17,300	$40	$743.9K
J9144	Injection, daratumumab, 10 mg and hyaluronidase‑fihj	7,200	$40	$273.6K
A9595	Piflufolastat f-18, diagnostic, 1 millicurie	300	$460	$138.6K
78815	PET and CT scans are both standard imaging tools that allow doctors to evaluate the location and metabolic actions of tumors or cancer inside the body before beginning an active treatment regimen.…	100	$1,220	$124.6K
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…	410	$100	$39.1K
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…	350	$100	$35.9K
J0897	Injection, denosumab, 1 mg	1,680	$20	$30.2K
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…	330	$70	$21.8K
78816	The patient is injected with a radiopharmaceutical tracer called FDG (fluoro–deoxyglucose, a radioactive substance containing glucose) about one hour before the imaging is scheduled to begin. The…	20	$1,220	$18.3K
J0881	Injection, darbepoetin alfa, 1 microgram (non-esrd use)	8,400	$1	$16.8K

Showing 1–10 of 73

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 73 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Colorado Distribution

Paul Decarolis — 1 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Colorado

Full comparison — all codes billed, vs. state median

73 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J9271	6	40	10,700	$40	$520.5K
J9144	14	20	7,560	$40	$354.8K
A9595	5	20	220	$540	$141.1K
J0897	98	140	2,580	$20	$68.8K
78815	32	120	60	$540	$58.9K
J0881	6	10	7,670	$1	$23.4K
J3490	22	60	50	$290	$23.1K
96413	24	140	130	$100	$19.7K
78816	30	40	20	$480	$18.4K
J9217	16	60	100	$130	$15.6K

Showing 1–10 of 73

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Nauman Moazzam	CO	Hematology & Oncology Physician	$3.6M	$0
Robert Rifkin	CO	Hematology & Oncology Physician	$3.3M	$0
Ioana Hinshaw	CO	Hematology & Oncology Physician	$2.7M	$0
John Burke	CO	Hematology & Oncology Physician	$2.6M	$0
Patrick Eulitt	CO	Medical Oncology Physician	$2.4M	$0
Patrick Richard	CO	Radiation Oncology Physician	$1.9M	$0
Christopher Benton	CO	Hematology & Oncology Physician	$1.8M	$0
Maurice Markus	CO	Hematology & Oncology Physician	$1.6M	$0
Sujatha Nallapareddy	CO	Hematology & Oncology Physician	$1.4M	$0
Manojkumar Bupathi	CO	Hematology & Oncology Physician	$1.4M	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
A Physicians Home Care	CO	In Home Supportive Care Agency	$0	$247.9M
A Circle Of Care Colorado, LLC.	CO	In Home Supportive Care Agency	$0	$101.8M
Goodwill Of Colorado	CO	Home Health Agency	$0	$33.3M
Stellar Care And Services, LLC	CO	Child Intellectual and/or Developmental Disabilities Respite Care	$0	$31M
Catholic Health Initiatives Colorado	CO	General Acute Care Hospital	$0	$25.2M
American Medical Response Of Colorado Inc	CO	Ambulance	$3.4M	$21.6M
Special Kids Special Families	CO	Developmentally Disabled Services Day Training Agency	$0	$24.8M
Lucas Inc	CO	Respite Care	$0	$23.6M
Achieve Whole Recovery, PC	CO	Specialist	$0	$22.7M
Loving Care Agency, Inc.	CO	In Home Supportive Care Agency	$0	$18.2M

Paul Decarolis — 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