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NPI 1790057123 · Sierra Vista, AZ · Hematology & Oncology Physician
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Hemant Sindhu is a hematology & oncology physician provider located in Sierra Vista, Arizona. This profile covers 64 Medicare and 9 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 | Hemant Sindhu |
| Address | 198 S Coronado Dr |
| City | Sierra Vista |
| State | AZ |
| ZIP | 85635 |
| Taxonomy | Hematology & Oncology Physician |
| NPI Enumerated | February 1, 2012 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $5.4M |
| Medicaid | $67.3K |
Medicare is the overwhelmingly dominant payer for this provider: reported Medicare revenue is $5.4M versus Medicaid revenue of $67.3K, so the practice is effectively Medicare-centric rather than balanced across payers. The scale difference indicates operations and reimbursement exposure are driven almost entirely by Medicare patients.
The provider’s service mix is consistent with an oncology/hematology infusion practice: the top Medicare revenue drivers are J9299, J9271, and J9145 (nivolumab, pembrolizumab, daratumumab), all high-volume injectable biologics and immune therapies, and infusion/chemotherapy administration codes (96413, 96365, 96367, 96415) appear repeatedly in the top code list. This code mix suggests a clinic with an active infusion suite that delivers routine immunotherapies, monoclonal antibodies, and supportive biologics rather than being focused solely on office-based E/M visits.
Revenue concentration on Medicare is high: the precomputed top-3 Medicare codes account for 53.1% of this provider’s Medicare revenue, with J9299 ($1M), J9271 ($911.6K), and J9145 ($891.4K) as the primary drivers. That concentration means a majority of Medicare dollars are tied to a small set of high-cost injectable agents and their associated infusion services.
Medicaid revenue is small in absolute terms but highly concentrated: the precomputed top-3 Medicaid codes account for 83.3% of Medicaid revenue, led by 99214 ($30K), 96365 ($18.6K), and 96367 ($7.4K). This indicates that for the much smaller Medicaid book of business the practice’s activity centers on office E/M and infusion administration rather than on high-cost cancer biologics.
Competitive standing is mixed across codes: for Medicare J9299 the provider ranks #26 of 505 (95th percentile) and is described as notably above typical national volume, making them a relatively high-volume national reporter for nivolumab. By contrast several other high-dollar drug codes (e.g., J9271 and J9145) are characterized as typical or unremarkable in national volume, and multiple infusion/administration codes (96413, 96365, 96367, 96366, 96375, 96415, 96372) are labeled as extreme outlier, far above typical national volume — collectively indicating unusually heavy infusion throughput relative to peers.
Several specific codes are statistical outliers in national comparisons and signal operational intensity: J0897 (denosumab) ranks #60 of 10057 and is an extreme outlier (99th percentile), while a suite of administration codes such as 96413 (rank #27 of 7514) and 96365 (rank #67 of 8873) are also described as extreme outliers. These flagged outlier labels point to an above-average utilization of infusion and injectable therapies that materially shape the provider’s Medicare billing profile.
The provider has an established tenure in the Medicare/Medicaid system, with the NPI enumerated 2012-02-01 (~14 years ago), which supports interpretation that the observed high volumes and specialized service mix reflect sustained practice patterns rather than a short-term anomaly. Longevity combined with the code mix makes it plausible the practice has built a stable oncology infusion operation over time.
Payer and utilization implications: several high-volume drug lines show low average paid/claim (for example J9299 avg paid/claim $24 and J0897 avg paid/claim $19) while other items like selected biosimilars and E/M codes show higher per-claim payments (e.g., Q5111 avg $106, 99215 avg $135). Given the precomputed concentration metrics (53.1% Medicare from top-3 codes; 83.3% Medicaid from top-3 codes), this reliance on a few high-volume agents and infusion services creates sensitivity to changes in utilization patterns or reimbursement for those specific codes.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
64 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J9299 | Injection, nivolumab, 1 mg | 42,560 | $20 | $1M |
| J9271 | Injection, pembrolizumab, 1 mg | 21,200 | $40 | $911.6K |
| J9145 | Injection, daratumumab, 10 mg | 18,570 | $50 | $891.4K |
| J0897 | Injection, denosumab, 1 mg | 36,360 | $20 | $690.8K |
| J1569 | Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g., liquid), 500 mg | 10,120 | $40 | $364.5K |
| J2796 | Injection, romiplostim, 10 micrograms | 3,720 | $70 | $275.3K |
| J3111 | Injection, romosozumab-aqqg, 1 mg | 17,430 | $10 | $139.4K |
| Q5111 | Injection, pegfilgrastim-cbqv (udenyca), biosimilar, 0.5 mg | 1,220 | $110 | $129.7K |
| 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… | 1,260 | $100 | $128K |
| 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… | 820 | $140 | $111K |
Showing 1–10 of 64
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 64 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
64 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J9145 | 1 | 10 | 18,570 | $50 | $884.9K |
| J9271 | 7 | 80 | 10,000 | $40 | $487.4K |
| J9299 | 2 | 30 | 7,480 | $20 | $290K |
| J2796 | 1 | 10 | 3,720 | $70 | $275.2K |
| J3111 | 24 | 40 | 19,530 | $10 | $178.8K |
| J0897 | 5 | 260 | 2,940 | $20 | $115.6K |
| Q5111 | 1 | 10 | 920 | $110 | $100.8K |
| J1569 | 1 | 40 | 1,220 | $40 | $81.2K |
| J1449 | 1 | 10 | 2,110 | $20 | $51.9K |
| Q5119 | 2 | 40 | 1,480 | $20 | $42.6K |
Showing 1–10 of 64
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.
9 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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… | 790 | $40 | $30K |
| 96365 | The 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. | 380 | $50 | $18.6K |
| 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… | 300 | $30 | $7.4K |
| J3490 | Unclassified drugs | 360 | $10 | $4.3K |
| 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… | 80 | $50 | $3.6K |
| 96372 | A therapeutic, prophylactic, or diagnostic substance (a fluid, a drug, etc.) is injected via intramuscular or subcutaneous route into the patient's body. The procedure is performed by the physician… | 130 | $10 | $1.4K |
| J2916 | Injection, sodium ferric gluconate complex in sucrose injection, 12.5 mg | 90 | $20 | $1.4K |
| 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… | 20 | $20 | $320 |
| J1200 | Injection, diphenhydramine hcl, up to 50 mg | 250 | $1 | $250 |
How this provider's Medicaid billing volume and revenue compare to other Arizona providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Arizona median
9 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 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… | 1,498 | 3,040 | 750 | $50 | $343.9K |
| 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… | 2,607 | 2,780 | 600 | $50 | $267K |
| 96365 | The 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. | 90 | 130 | 1,680 | $20 | $116.7K |
| 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… | 631 | 930 | 200 | $70 | $97.7K |
| 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… | 39 | 60 | 720 | $10 | $16.1K |
| 96372 | A therapeutic, prophylactic, or diagnostic substance (a fluid, a drug, etc.) is injected via intramuscular or subcutaneous route into the patient's body. The procedure is performed by the physician… | 414 | 640 | 360 | $10 | $14.3K |
| J3490 | Unclassified drugs | 116 | 170 | 1,120 | $1 | $5.3K |
| J2916 | Injection, sodium ferric gluconate complex in sucrose injection, 12.5 mg | 5 | 10 | 110 | $10 | $2K |
| J1200 | Injection, diphenhydramine hcl, up to 50 mg | 74 | 110 | 1,040 | $1 | $190 |
Other providers in the same ZIP code as Hemant Sindhu, ranked by combined Medicare and Medicaid revenue.
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