Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • NPI Medicare & Medicaid
    • Healthcare Providers
    • Health Insurance Payers
    • States
    • Service Lines
    • Taxonomy Codes
    Lookup tools
    • Billing Code Lookup
    • CPT Modifier Lookup
    • Provider Taxonomy Code Lookup
    • Healthcare Provider & Facility Lookup
    • Health Insurance Payer Lookup
    • Payer Contact Directory

    Policy & Benchmark Tools

    • Prior Authorization Lookup
    • Coverage Criteria Lookup
    • Timely Filing Lookup
    • Billing Code Reimbursement Rates
    • Payer Comparison Dashboard
    • Facility Comparison Dashboard
    • All tools

    Company

    • About OpenPayer
    • Data Sources
    • Trek Health
    OpenPayerby Trek Health
    LinkedInYouTube

    © 2026 Trek Health. All rights reserved.

    OpenPayer is built and maintained by Trek Health.

    v1.0.28
    OpenPayerNPI Medicare & MedicaidMary Lee Villanueva
    Ask Trek AI about this page

    Mary Lee Villanueva — Billing Profile & Reimbursement Data

    NPI 1699857821 · Yankton, SD · Hematology & Oncology Physician

    Customize your policy alerts

    Sign up for Mary Lee Villanueva — Billing Profile & Reimbursement Data policy alerts

    Get alerted when relevant policies change without checking for updates manually.

    Monitor payer policy activity

    Receive email alerts as soon as relevant payer policies are published or updated.

    Mary Lee Villanueva is a hematology & oncology physician provider located in Yankton, South Dakota. This profile covers 53 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.

    Table of contents

    Progress1 / 9

    Explore openpayer tools

    • Billing CodesCPT, HCPCS, DRG & more
    • Reimbursement RatesCommercial vs. Medicare rate reports
    • ProvidersHospitals & facilities
    • PayersPlans & market footprint
    • Taxonomy CodesNUCC specialty codes
    • ModifiersCPT modifiers & usage
    • Prior AuthorizationPA policies by payer & drug
    • Timely FilingFiling deadlines by payer
    • Coverage CriteriaMedical necessity by payer
    • Payer ContactsClaims, PA & appeals contacts
    View all tools

    Provider details (source: NPPES NPI Registry)

    FieldValue
    Entity TypeIndividual
    OrganizationMary Lee Villanueva
    Address1104 W 8th St
    CityYankton
    StateSD
    ZIP57078
    TaxonomyHematology & Oncology Physician
    NPI EnumeratedOctober 19, 2006

    Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)

    Payer SourceTotal Paid
    Medicare$788.7K
    Medicaid$0

    Key Findings

    Revenue concentration is very high: the provider's top three Medicare codes account for 75.7% of total Medicare revenue, with J9271 alone representing $453.6K (59.1% of Medicare revenue). This indicates the practice’s financial performance is heavily dependent on a single high-cost oncology drug line.

    Clinical/service-line profile aligns with outpatient medical oncology and supportive care: dominant use of J9271 (pembrolizumab, 10.8K claims) plus supplemental agents such as J0897 (denosumab, 4.5K claims) and Q5108 (pegfilgrastim biosimilar, 474 claims) suggests an infusion-centered oncology practice that administers checkpoint inhibitor therapy and provides bone-support and growth-factor support. Chemotherapy administration codes (96413, 294 claims) and infusion supply codes (96365, 116 claims) further corroborate an infusion/infusion-support operational model.

    Payer mix is effectively single-payer Medicare: total Medicare revenue is $788.7K and there is no Medicaid billing on file, so revenue and utilization analysis should treat this as a Medicare-focused practice with limited exposure to Medicaid reimbursement dynamics. This concentration can affect payer negotiation leverage and patient-mix assumptions.

    Competitive standing on drug administration is modest nationally: J9271 ranks #1079 of 1841 providers (41th percentile; typical, unremarkable volume) and J0897 ranks #3133 of 10057 providers (68th percentile; typical, unremarkable volume), indicating the provider is not a dominant national outlier for these high-revenue oncology drugs but operates at an expected volume level for its specialty. By contrast, supportive-agent Q5108 ranks #37 of 125 providers (71th percentile; typical, unremarkable volume), consistent with a focused cohort of biosimilar users.

    High-complexity evaluation-and-management activity is an outlier relative to national peers: 99215 accounts for $46.1K (6.0% of Medicare revenue) across 352 claims and ranks #4217 of 145531 providers (97th percentile; notably above typical national volume). Combined with 99205 activity (71 claims, $11.7K; 89th percentile), this pattern suggests substantial management of complex or time-intensive oncology patients in the outpatient setting rather than only brief visits.

    Operational risk from single-code reliance: with J9271 producing $453.6K of the $788.7K Medicare total, changes in pembrolizumab utilization, acquisition cost, or payer coverage could materially affect the provider’s revenue. Analysts should flag this sensitivity when modeling revenue scenarios or network contracting.

    Tenure and practice stability: the NPI was enumerated on 2006-10-19 (~20 years ago), indicating long-standing presence in the market which may support durable referral relationships and established infusion infrastructure. This longevity helps explain the significant infusion-related code mix and the presence of both high-complexity E/M and procedural billing.

    Code-level statistical signals are mixed: most high-revenue chemotherapy and infusion codes are characterized as "typical, unremarkable volume" at the national level (e.g., 96413, 96365, J0897), while 99215 is explicitly labeled "notably above typical national volume." This combination points to an infusion-focused oncology practice that is especially active in complex patient management relative to general national peers.

    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.

    53 rows

    CPT/HCPCS CodeDescriptionClaimsAvg PaidRevenue
    J9271Injection, pembrolizumab, 1 mg10,800$40$453.6K
    J0897Injection, denosumab, 1 mg4,500$20$81K
    99215The 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…350$130$46.1K
    Q5108Injection, pegfilgrastim-jmdb (fulphila), biosimilar, 0.5 mg470$100$45.5K
    96413Chemotherapy 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…290$100$29.7K
    99214The 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…340$80$28K
    74177The provider performs computed tomography of the abdomen and pelvis with contrast material to diagnose the cause of abdominal or pelvic pain or other abnormalities of the internal organs.70$250$16.4K
    99205The provider sees a new 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 provider…70$170$11.7K
    71260In this diagnostic procedure, the provider performs a computed tomography, or CT, examination of the thorax using contrast material.90$90$7.4K
    96365The 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.120$50$5.8K

    Showing 1–10 of 53

    Medicare: Competitive Analysis & Benchmarks

    How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 53 CPT/HCPCS codes.

    View: State1 / 2

    Full comparison — all codes billed, vs. state median

    53 rows

    CPT/HCPCS CodeRankProvider CountMedian ClaimsAvg PaidAverage Revenue
    J92711109,800$40$406.7K
    J08979402,460$20$52.8K
    Q5108110470$100$45.4K
    96413210110$100$13.5K
    770678912070$50$13.1K
    992142291,66090$70$11.4K
    74177508090$70$10K
    70553384040$90$7.6K
    770638411070$30$7.5K
    99215945040$100$7.5K

    Showing 1–10 of 53

    Related Providers

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

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    Sanford Medical Center FargoNDFamily Medicine Physician$0$75.9M
    Sanford Medical CenterSDFamily Medicine Physician$0$68.8M
    Avera MckennanSDFamily Medicine Physician$0$10.6M
    Avera MckennanSDPsychiatry Physician$0$9.1M
    Avera MckennanSDHome Infusion Agency$0$6.7M
    Yankton Medical Clinic PCSDInternal Medicine Physician$0$6.3M
    Avera MckennanSDAir Ambulance$0$5.3M
    Avera St MarysSDMulti-Specialty Clinic/Center$0$4.6M
    Avera MckennanSDEmergency Medicine Physician$0$4.1M
    Avera MckennanSDGeneral Acute Care Hospital$0$3.7M

    Nearby Providers

    Other providers in the same ZIP code as Mary Lee Villanueva, ranked by combined Medicare and Medicaid revenue.

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    Ability Building Services, Inc.SDIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility$0$39.2M
    Lewis & Clark Behavioral Health Services, Inc.SDCommunity/Behavioral Health Agency$0$24M
    Yankton PhSDAssisted Living Facility (Mental Illness)$0$4.1M
    Cedar Vilage Assisted Living CenterSDAssisted Living Facility (Mental Illness)$0$2.4M
    Heartland Psychological ServicesSDPsychiatry Physician$0$1.3M
    Avera At HomeSDHome Health Agency$0$1M
    Sacred Heart Health ServicesSDRural Acute Care Hospital$0$942.8K
    Sacred Heart Health ServicesSDEmergency Care Clinic/Center$0$766.6K
    Kore Cares In Home Services, LLCSDIn Home Supportive Care Agency$0$700.6K
    Autumn Winds LLCSDAssisted Living Facility$0$628K

    Frequently Asked Questions

    References

    1. 1.Medicare Physician & Other Practitioner by Provider and Service. CMS.gov.Provider-level Medicare Part B utilization and payment data.
    2. 2.NPPES NPI Registry. CMS.gov.National Provider Identifier registry used for provider enumeration and taxonomy metadata.

    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

    Medicare Revenue by CPT/HCPCS Code
    Claims Volume vs. South Dakota Distribution
    Mary Lee Villanueva — 6 of 25 codes billed far more than typical (above p95)
    p5–p95 (all providers)p25–p75MedianThis providerOutlier
    Rank Distribution — South Dakota