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

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

Andrew Himelstein (NPI 1841269966)

Field	Value
Entity Type	Individual
Organization	Andrew Himelstein
Address	4701 Ogletown Stanton Rd
City	Newark
State	DE
ZIP	19713
Taxonomy	Hematology & Oncology Physician
NPI Enumerated	March 14, 2006

Payer Source	Total Paid
Medicare	$1.1M
Medicaid	$0

Key Findings

This provider's payer mix is effectively single-payer: Total Medicare revenue is $1.1M and there is no Medicaid billing on file. Because Medicaid activity is absent, the provider's financial footprint and competitive comparisons are driven entirely by Medicare volumes and should be interpreted without a state Medicaid component.

Revenue is highly concentrated in three Medicare drug codes: the precomputed top-3 codes account for 86.2% of the provider's total Medicare revenue. Specifically, J9271 accounts for $516K (47.0%), J9144 accounts for $355.7K (32.4%), and J0897 accounts for $75.6K (6.9%) — together driving the vast majority of Medicare dollars reported for this NPI.

The code mix and top revenue drivers indicate an infusion-centered hematology/oncology practice focused on high-cost biologic agents rather than predominantly procedural chemotherapy. J9271 (12K claims, $43 avg paid/claim) and J9144 (9.4K claims, $38 avg paid/claim) dominate revenue, while traditional chemotherapy administration codes such as 96413 (138 claims, $104 avg paid/claim, $14.4K, 1.3%) contribute only a small share of Medicare revenue, suggesting treatment patterns oriented around monoclonal antibody and immunotherapy infusions.

Competitive standing for the top biologic agents is modest rather than dominant nationally: J9271 ranks #952 of 1841 providers (48th percentile; typical, unremarkable volume for this code), J9144 ranks #241 of 615 (59th percentile; typical, unremarkable volume for this code), and J0897 ranks #3359 of 10057 (66th percentile; typical, unremarkable volume for this code). These rankings indicate the provider is a routine, not outlier, participant in administering these agents at the national level.

Outpatient office evaluation-and-management activity is relatively prominent compared with peers: 99214 appears 780 claims, $94 avg paid/claim, $73.3K revenue (6.7% of Medicare revenue) and ranks #20731 of 479517 providers (96th percentile; notably above typical national volume for this code). High volume of 99214 encounters suggests substantial office-based patient management and follow-up accompanying infusion services.

Operational and billing pattern detail supports an in-office buy-and-bill model for weight- or milligram-priced biologics: the top drug lines show very large claim counts (J9271 12K claims, J9144 9.4K claims) paired with relatively low avg paid/claim amounts ($43 and $38 respectively), consistent with many unit-based drug entries rather than a small number of high-dollar per-claim procedures.

The remainder of the Medicare CPT/HCPCS mix is largely low-revenue, routine supportive and infusion codes (examples: 96365, 96401, 96417) with mostly typical, unremarkable percentiles; there are no other high-percentile drug-specific outliers above the top three that would suggest an atypical service line beyond the infusion/immunotherapy focus already noted.

The provider is an established clinician based on NPI tenure: NPI enumerated 2006-03-14 (~20 years ago). This long enumeration period, combined with the concentrated Medicare drug revenue and above-typical 99214 visit volume, is consistent with a steady outpatient oncology practice centered on in-office biologic administration rather than broad inpatient or Medicaid-facing services.

Medicare: Complete Services Breakdown

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

23 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J9271	Injection, pembrolizumab, 1 mg	12,000	$40	$516K
J9144	Injection, daratumumab, 10 mg and hyaluronidase‑fihj	9,360	$40	$355.7K
J0897	Injection, denosumab, 1 mg	4,200	$20	$75.6K
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…	780	$90	$73.3K
J9217	Leuprolide acetate (for depot suspension), 7.5 mg	160	$130	$20.7K
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…	140	$100	$14.4K
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…	60	$140	$8.7K
J1454	Injection, fosnetupitant 235 mg and palonosetron 0.25 mg	30	$320	$8.7K
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…	120	$60	$7.1K
96401	The provider administers nonhormonal, antineoplastic chemotherapy drugs subcutaneously or intramuscularly to the patient.	60	$60	$3.7K

Showing 1–10 of 23

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 23 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Delaware Distribution

Andrew Himelstein — 0 of 22 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Delaware

Full comparison — all codes billed, vs. state median

23 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J9271	8	10	17,600	$40	$992.4K
J9144	3	10	9,360	$40	$420.8K
J0897	22	60	3,360	$20	$132.9K
J1454	8	10	90	$340	$38.1K
96413	17	30	280	$100	$36.6K
J9217	13	30	160	$130	$31.1K
99214	181	1,830	150	$80	$25.5K
96401	17	30	110	$60	$18.4K
99213	902	1,810	120	$60	$13.6K
99215	211	570	40	$120	$11K

Showing 1–10 of 23

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Medical Oncology Hematology Consultants PA	DE	Hematology & Oncology Physician	$0	$7.7M
Jamal Misleh	DE	Hematology & Oncology Physician	$6.8M	$0
Dhaval Shah	DE	Hematology & Oncology Physician	$2.5M	$0
Gregory Masters	DE	Medical Oncology Physician	$2.3M	$0
Evan Lapinsky	DE	Hematology & Oncology Physician	$1.7M	$0
Lydia Clements	DE	Medical Oncology Physician	$1.3M	$0
Sujung Park	DE	Hematology & Oncology Physician	$1.2M	$0
Amy Mcghee Jez	DE	Hematology & Oncology Physician	$1.1M	$0
Roberto Ferro Valdes	SD	Hematology & Oncology Physician	$1.1M	$0
Martha Hosford Skapof	DE	Hematology & Oncology Physician	$748.2K	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Associated Retinal Consultants LLC	DE	Ophthalmology Physician	$0	$25.2M
Columbus Medical Services, LLC	DE	Case Management Agency	$0	$18.7M
Christiana Care Health Services Inc	DE	Hospitalist Physician	$0	$13.6M
Caritas Home Health Services, Inc	DE	Home Health Agency	$0	$11.2M
Delaware Center For Maternal Fetal Medicine Of Christiana Care	DE	Maternal & Fetal Medicine Physician	$0	$9.8M
Christiana Care Health Services Inc	DE	Neonatal-Perinatal Medicine Physician	$0	$8.9M
Christiana Care Quality Partners	DE	Urgent Care Clinic/Center	$0	$7M
Mid-atlantic Behavioral Health, LLC	DE	Intellectual & Developmental Disabilities Psychologist	$0	$6.5M
First State Orthopaedics, PA	DE	Orthopaedic Surgery Physician	$0	$6M
Autism Delaware	DE	Intellectual & Developmental Disabilities Psychologist	$0	$5.8M

Andrew Himelstein — 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