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

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

Raphael Kieval (NPI 1730155029)

Field	Value
Entity Type	Individual
Organization	Raphael Kieval
Address	1351 Main St
City	Brockton
State	MA
ZIP	02301
Taxonomy	Rheumatology Physician
NPI Enumerated	February 27, 2006

Payer Source	Total Paid
Medicare	$1.6M
Medicaid	$0

Key Findings

This provider has $1.6M in total Medicare revenue and no Medicaid billing on file, making the practice effectively Medicare-focused. The absence of any Medicaid activity on file indicates limited or no participation in state Medicaid billing and a payer mix concentrated on Medicare reimbursement streams.

Revenue is highly concentrated in a small set of injectable drug codes: the top three Medicare codes (J0129, J0897, J3262) account for 48.2% of this provider's total Medicare revenue, with J0129 $317.1K (19.5%), J0897 $249.5K (15.3%), and J3262 $218.4K (13.4%). This level of concentration signals that a few high-cost biologic administrations drive nearly half of the practice's Medicare dollars.

The code mix shows a rheumatology/infusion-focused operation: J0129, J0897, and J3262 correspond to abatacept, denosumab, and tocilizumab injections, respectively, which are high-cost biologics typically administered under physician supervision. That pattern implies in-office drug administration infrastructure—staffing, infusion space, and drug procurement—are material components of the business model.

Beyond biologics, the practice bills chemotherapy/infusion administration codes (for example, 96413 and 96401) and a meaningful volume of evaluation-and-management visits (99214 and 99213), indicating a combined service line of infusion treatment plus ongoing clinic follow-up. Notably, 99213 is labeled 'notably above typical national volume for this code' and sits at the 96th percentile, which suggests sustained office visit throughput that supports ongoing infusion care.

Competitive standing is mixed across top codes: J0897 ranks #622 of 10057 providers nationally (94th percentile) but is described as 'typical, unremarkable volume for this code', while J0129 and J3262 rank in the mid-percentiles (57th and 56th) and are also labeled 'typical, unremarkable volume for this code'. Taken together, these ranks indicate the provider is a modest national participant for most biologic administrations with a relative rank strength on denosumab, but the data labels characterize volumes as broadly typical rather than dominant.

The provider's NPI was enumerated 2006-02-27 (~20 years ago), reflecting long tenure in Medicare billing. This longevity supports the likelihood of an established referral base and operational experience in delivering in-office biologic and infusion services.

Single-payer concentration creates both operational clarity and risk: having all reported revenue in Medicare simplifies contracting focus but increases exposure to Medicare coverage and payment changes for infused biologics and administration codes. For payer strategy, this profile suggests prioritizing Medicare contract terms and prior authorization workflows for high-cost J-codes.

Smaller procedure codes (for example, 20610 and 20600 joint injections and steroid injection codes such as J1040 and J0702) appear in the top 25 but contribute minimal revenue share relative to biologics, indicating the practice supplements its infusion-centric revenue with hands-on musculoskeletal procedures rather than relying on office-procedure volume as a primary revenue driver.

Medicare: Complete Services Breakdown

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

26 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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)	9,330	$30	$317.1K
J0897	Injection, denosumab, 1 mg	13,860	$20	$249.5K
J3262	Injection, tocilizumab, 1 mg	43,680	$10	$218.4K
J1602	Injection, golimumab, 1 mg, for intravenous use	21,100	$10	$211K
J9312	Injection, rituximab, 10 mg	2,800	$60	$176.4K
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)	33,200	$1	$132.8K
J3111	Injection, romosozumab-aqqg, 1 mg	15,540	$10	$124.3K
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…	640	$90	$59.1K
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…	440	$110	$47.7K
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…	620	$60	$39K

Showing 1–10 of 26

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 26 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Massachusetts Distribution

Raphael Kieval — 4 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Massachusetts

Full comparison — all codes billed, vs. state median

26 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0129	5	20	6,600	$30	$256.2K
J9312	4	10	3,300	$60	$243.4K
J3262	3	10	43,680	$1	$239.4K
J0717	3	10	40,600	$1	$169.2K
J1602	3	10	11,100	$10	$160K
J3111	2	10	14,910	$10	$104.1K
J0897	5	110	2,880	$20	$81.9K
96413	2	60	120	$110	$17.6K
99214	688	15,410	110	$80	$15.6K
96401	3	20	140	$60	$15.2K

Showing 1–10 of 26

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Columbus Radiology Corp	OH	Diagnostic Radiology Physician	$0	$49.9M
Evans Medical Foundation, Inc.	MA	Internal Medicine Physician	$0	$37.8M
Ari Schwartz	MA	Rheumatology Physician	$1.7M	$0
Andris Zauls	MA	Radiation Oncology Physician	$1.5M	$0
Syed Mahmood	MD	Medical Oncology Physician	$1M	$0
Frantz Gibbs	RI	Emergency Medicine Physician	$31.4K	$849.2K
Kyu Kim	MA	Rheumatology Physician	$628.4K	$0
Gregory Johnson	MA	Internal Medicine Physician	$54.6K	$550.9K
Albert Daly	MA	Primary Podiatric Medicine Podiatrist	$462.1K	$0
Hong Jun Yun	IL	Interventional Cardiology Physician	$432.4K	$15.9K

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Commonwealth Of Massachusetts	MA	Case Management Agency	$0	$309.8M
Old Colony Elderly Services, Inc.	MA	Case Management Agency	$0	$137.5M
South Bay Mental Health Center, Inc.	MA	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$112M
Massachusetts Mentor LLC	MA	Foster Care Agency	$0	$95.6M
Brockton Neighborhood Health Center	MA	Federally Qualified Health Center (FQHC)	$0	$91.2M
Sb Transitional Sub, LLC	MA	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$84.8M
Steward Good Samaritan Medical Center, Inc.	MA	General Acute Care Hospital	$0	$64.2M
Pediatric Services Of America, LLC	MA	Nursing Care Agency	$0	$47.8M
South Bay Mental Health Center, Inc.	MA	Adolescent and Children Mental Health Clinic/Center	$0	$43.2M
Sb Transitional Sub, LLC	MA	Early Intervention Provider Agency	$0	$35.9M

Raphael Kieval — 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