Andrew Mener — Billing Profile & Reimbursement Data

This provider is effectively a single-payer Medicare practice: lifetime Medicare revenue is $3.5M and there is no Medicaid billing on file, indicating all recorded public-payer activity comes from Medicare and the practice likely focuses on fee-for-service senior patients rather than Medicaid populations. The lack of Medicaid claims limits any in-state Medicaid competitive analysis and suggests payer mix is heavily Medicare-concentrated.

Revenue concentration is high: the precomputed top 3 Medicare codes account for 64.6% of total Medicare revenue, signaling that a few high-cost injectable oncology agents drive the majority of the provider’s Medicare receipts rather than office visits or routine labs. This concentration implies financial exposure to utilization or price changes for those specific medications.

The top revenue codes are oncology infusions and biologics — J9271 (pembrolizumab), J9144 (daratumumab), and J9299 (nivolumab) — which together dominate billing. Combined with substantial volumes of chemotherapy administration codes (96413, 96365, 96367) and supportive meds (J1568 immune globulin, J0897 denosumab), the code mix is consistent with a hematology-oncology infusion practice that bills primarily for high-cost cancer therapeutics and associated infusion services.

Competitive standing on principal drug codes is mixed. For J9271 the provider ranks #439 of 1841 (76th percentile), which indicates typical national volume; for J9144 the provider ranks #54 of 615 (91st percentile), identifying this provider as a relatively high-volume national participant on daratumumab; and for J9299 the provider ranks #97 of 505 (81st percentile), again a strong but not dominant national presence. These ranks show the provider is a notable user of certain monoclonal antibody therapies but not a national leader across all top drugs.

Several non-drug service codes are statistical outliers relative to national peers and reflect operational intensity: evaluation & management codes 99214 and 99213 rank in the 96th and 99th percentiles respectively (99213 labeled an "extreme outlier, far above typical national volume") and chemotherapy administration add-on codes such as 96417 and 96375 also rank in the mid-90s percentiles. These elevated percentiles suggest a higher-than-typical throughput of office visits and infusion encounters compared with peer providers.

The provider shows notable high-volume use of certain supportive and infusion-related injectable products: J1568 (immune globulin) ranks #32 of 381 (92nd percentile) and J1437 (ferric derisomaltose) ranks #38 of 581 (93rd percentile), indicating unusually strong utilization of these supportive therapies relative to national peers and reinforcing the characterization of an infusion-centered specialty practice.

Operational scale is further evidenced by large claim counts on some drug codes (e.g., J9271 ~19.2K claims, J9144 ~19.1K claims, J9299 ~26.1K claims) paired with relatively modest average paid-per-claim amounts reported; this pattern is consistent with frequent administrations of high-cost agents where revenue accrues from volume of dosing events and unit pricing. Use of both high-volume systemic oncology drugs and numerous infusion administration codes implies an integrated infusion service line managing ongoing treatment regimens.

Tenure is long enough to be well-established: the NPI was enumerated on 2011-04-04 (approximately 15 years ago), suggesting sustained presence in the Medicare market and enough history to build the observed high-volume infusion and drug-administration patterns. This tenure supports interpretation that the service mix and volumes reflect established practice patterns rather than a transient billing artifact.