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

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

Richard Divalerio (NPI 1841298072)

Field	Value
Entity Type	Individual
Organization	Richard Divalerio
Address	3009 N Ballas Rd
City	Saint Louis
State	MO
ZIP	63131
Taxonomy	Rheumatology Physician
NPI Enumerated	July 12, 2005

Payer Source	Total Paid
Medicare	$1.4M
Medicaid	$0

Key Findings

RICHARD DIVALERIO is a Rheumatology Physician in SAINT LOUIS, MO with an NPI enumerated 2005-07-12 (~21 years ago). Lifetime Medicare revenue on file is $1.4M and there is no Medicaid billing on file, indicating the provider operates effectively as a Medicare-centric practice. This single-payer profile should shape network and reimbursement analyses.

Revenue is highly concentrated in a small set of biologic drug codes: the top 3 Medicare codes by revenue (J0129, J1602, J0717) account for 80.0% of this provider’s total Medicare revenue. The largest single code is J0129 at $674.9K (48.1% of Medicare revenue), followed by J1602 at $249.5K (17.8%) and J0717 at $198.4K (14.1%), showing heavy dependence on a few high-cost infused biologics.

The CPT/HCPCS mix points to an in-office infusion and biologic administration business model rather than a purely clinic-based, office-visit practice. High-revenue J-codes such as J0129, J1602, J0717 and the presence of infusion/administration codes 96365 and 96413 (among the top codes) indicate routine physician-supervised IV/subcutaneous biologic administration and an infusion suite workflow, supported by usage of J7050 (normal saline) and multiple infusion add-on codes.

Competitive standing varies by drug: J0129 ranks #128 of 1221 nationally (90th percentile) and is described as typical, unremarkable volume, which nevertheless places this provider above most peers on that specific drug. J1602 is stronger than average as well (rank #225 of 1041, 78th percentile), while J0717 falls near the median of peers (rank #410 of 848, 51th percentile), indicating the practice is a major participant for specific biologics but a more modest participant for others.

Evaluation-and-management activity is relatively elevated versus national peers: 99214 appears with 709 claims and $62.4K revenue (4.4% of Medicare revenue) and 99213 with 553 claims and $33.2K revenue (2.4% of Medicare revenue), and both codes are labeled notably above typical national volume at the 95th percentile. This suggests a busy established-patient clinic supporting the infusion workload, where E/M visits are an active service line even though they represent a minority of total Medicare dollars.

Infusion administration and supportive services show consistent, above-average utilization alongside the high-cost drug billing: 96365 has 456 claims and $21.4K revenue (1.5% of Medicare revenue) and ranks in the 95th percentile, while 96413 and other infusion-related codes also appear in the top codes. The pattern of repeated administration codes plus direct drug billing (including J1745 infliximab at $130.4K, 9.3%) reinforces an operational footprint centered on repeat IV biologic infusions.

From a commercial and payer-risk perspective, the provider’s reliance on a narrow set of biologic J-codes and the absence of Medicaid revenue creates concentration risk: changes in Medicare reimbursement, biosimilar uptake, or formulary placement for a small number of molecules could materially affect revenue. Given the $1.4M Medicare revenue baseline and the fact that a single code (J0129) delivers nearly half of that amount, contracting teams should treat this as a focused infusion practice with limited diversification across payers and drug types.

Medicare: Complete Services Breakdown

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

18 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)	20,450	$30	$674.9K
J1602	Injection, golimumab, 1 mg, for intravenous use	24,950	$10	$249.5K
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)	49,600	$1	$198.4K
J1745	Injection, infliximab, excludes biosimilar, 10 mg	5,670	$20	$130.4K
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…	710	$90	$62.4K
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…	550	$60	$33.2K
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.	460	$50	$21.4K
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…	180	$80	$14.6K
99204	The provider sees a new 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 provider…	50	$110	$5.8K
36415	In this procedure, the provider inserts a needle into a vein to collect a blood sample.	580	$10	$4.6K

Showing 1–10 of 18

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 18 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Missouri Distribution

Richard Divalerio — 4 of 17 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Missouri

Full comparison — all codes billed, vs. state median

18 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0129	6	20	10,880	$30	$443.6K
J1602	8	20	13,150	$10	$266.8K
J0717	8	10	61,500	$1	$259.7K
J1745	11	40	3,060	$30	$118.1K
96413	65	160	140	$100	$19.1K
99214	315	8,960	100	$80	$13.9K
99213	296	8,730	70	$50	$7K
99204	1,313	4,360	30	$100	$4.8K
20610	599	830	60	$40	$4.6K
96365	7	210	40	$50	$4.4K

Showing 1–10 of 18

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Ying Du	MO	Rheumatology Physician	$1.4M	$0
Hashim Raza	MO	Internal Medicine Physician	$339.1K	$470
Phillip Brick	MO	Internal Medicine Physician	$206K	$0
Steven Fern	MO	Gastroenterology Physician	$101.2K	$0
Meher Mallick	MO	Nephrology Physician	$88.9K	$0
Michael Cannon	MO	Family Medicine Physician	$61K	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Community Alternatives Missouri, Inc.	MO	Developmentally Disabled Services Day Training Agency	$0	$48.8M
Nextra Health, Inc.	MO	Durable Medical Equipment & Medical Supplies	$0	$25.4M
Support Innovations Inc.	MO	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$11.8M
Special School District Of St. Louis County	MO	Local Education Agency (LEA)	$0	$4.8M
Sona Kamat	MO	Rheumatology Physician	$4.1M	$0
Des Peres Eye Surgery Center, LLC	MO	Ambulatory Surgical Clinic/Center	$3.5M	$162.2K
Family Hire LLC	MO	In Home Supportive Care Agency	$0	$3.6M
Lizette Alvarez	MO	Physical Medicine & Rehabilitation Physician	$1.3M	$0
Manchester Ambulatory Surgery Center LP	MO	Ambulatory Surgical Clinic/Center	$848.9K	$0
Andrew Krainik	MO	Clinical Cardiac Electrophysiology Physician	$395.6K	$0

Richard Divalerio — 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