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NPI 1871706218 · Hillsboro, OR · Rheumatology Physician
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Shawn Macalester is a rheumatology physician provider located in Hillsboro, Oregon. This profile covers 18 Medicare and 1 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 | Shawn Macalester |
| Address | 545 Se Oak St Ste F |
| City | Hillsboro |
| State | OR |
| ZIP | 97123 |
| Taxonomy | Rheumatology Physician |
| NPI Enumerated | May 8, 2007 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $887.2K |
| Medicaid | $6.2K |
Provider SHAWN MACALESTER is a rheumatology physician in HILLSBORO, OR with long tenure in Medicare billing; the NPI was enumerated 2007-05-08 (~19 years ago), indicating nearly two decades of billing history and likely established clinical relationships and referral streams. This tenure supports the observed volumes in specialty drug administration and infusion services.
Medicare dominates this provider's public-payer mix: total Medicare revenue is $887.2K versus total Medicaid revenue of $6.2K, so the practice is effectively Medicare-driven rather than Medicaid-facing. Medicaid revenue is de minimis relative to Medicare and concentrates entirely in office E/M visits (see below).
Revenue concentration on Medicare is high and concentrated in biologic/injectable therapy codes: the precomputed top 3 Medicare codes by revenue account for 80.0% of the provider's total Medicare revenue. Those top codes (J0129, J3262, J1602) are biologic infusion/administration drugs (abatacept, tocilizumab, golimumab), which indicates the practice’s primary service line is in-office administration of biologic therapies for rheumatologic conditions.
Specific Medicare drug codes show typical but meaningful participation in national markets. J0129 accounts for $314.4K (36.8% of Medicare revenue) and ranks #494 of 1221 (59th percentile), J3262 accounts for $197.6K (23.1%) and ranks #231 of 618 (62th percentile), and J1602 accounts for $171K (20.0%) and ranks #382 of 1041 (63th percentile). These percentiles indicate the provider is a modest-to-typical participant nationally for these infusion/injectable biologic codes rather than a dominant outlier.
Clinical mix and operational implications: high revenue share from injectable biologics plus notable counts for infusion-related E/M and chemotherapy administration codes (for example 96413, 96401, 96365) suggest the practice operates an infusion-capable clinic that administers intravenous/subcutaneous biologic agents and related infusions. The presence of 99214 and other E/M codes tied to outpatient visits indicates routine office management of chronic rheumatologic conditions around those infusions.
Medicaid activity is narrowly concentrated into office E/M: the provider’s total Medicaid revenue ($6.2K) is 100.0% represented by 99214 (95 claims), and the in-state rank for that code is #1153 of 1503 (23th percentile). This reflects limited Medicaid panel participation and modest Medicaid patient volume relative to other in-state providers billing the same E/M service.
Competitive positioning for infusion drugs is middle-of-market. National ranks in the 59th–63th percentiles for the three highest Medicare drug codes indicate stable, typical volumes for a specialty clinic; the provider is neither a high-volume center nor an outlier with unusually concentrated market share for these biologic injectables. Lower-percentile ranks on other drug or injection codes (for example J0897 at 23th percentile) further support a mixed but not dominant presence across ancillary injectable items.
Service-line risk and operational focus: because 80.0% of Medicare revenue is driven by three biologic drug codes, the practice’s revenue is concentrated on reimbursement and utilization of high-cost biologic therapies administered in-office. Any changes in utilization patterns, drug mix, or reimbursement for these specific J-codes could disproportionately affect overall Medicare revenue for this provider.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
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) | 9,830 | $30 | $314.4K |
| J3262 | Injection, tocilizumab, 1 mg | 49,400 | $1 | $197.6K |
| J1602 | Injection, golimumab, 1 mg, for intravenous use | 17,100 | $10 | $171K |
| J1745 | Injection, infliximab, excludes biosimilar, 10 mg | 1,640 | $30 | $42.6K |
| 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… | 410 | $90 | $35.7K |
| 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… | 360 | $100 | $34.8K |
| J0897 | Injection, denosumab, 1 mg | 1,440 | $20 | $25.9K |
| 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… | 160 | $60 | $9.9K |
| 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 | $120 | $6.8K |
| 96401 | The provider administers nonhormonal, antineoplastic chemotherapy drugs subcutaneously or intramuscularly to the patient. | 90 | $50 | $5K |
Showing 1–10 of 18
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
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 | 6,300 | $30 | $260.7K |
| J3262 | 4 | 10 | 31,180 | $1 | $176.4K |
| J1602 | 8 | 20 | 13,600 | $10 | $156.4K |
| J1745 | 16 | 20 | 3,750 | $30 | $115.2K |
| J0897 | 53 | 70 | 2,400 | $20 | $78.3K |
| 96413 | 8 | 90 | 150 | $100 | $18.2K |
| 99214 | 380 | 6,070 | 80 | $70 | $10.3K |
| 99215 | 766 | 2,170 | 40 | $100 | $6.7K |
| 96365 | 63 | 110 | 70 | $50 | $5.8K |
| 99213 | 1,007 | 5,480 | 60 | $50 | $5.7K |
Showing 1–10 of 18
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.
1 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… | 100 | $70 | $6.2K |
How this provider's Medicaid billing volume and revenue compare to other Oregon providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Oregon median
1 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… | 1,153 | 1,500 | 650 | $70 | $312.4K |
Other providers in the same ZIP code as Shawn Macalester, ranked by combined Medicare and Medicaid revenue.
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