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.

Ivonne Herrera (NPI 1992856785)

Field	Value
Entity Type	Individual
Organization	Ivonne Herrera
Address	1350 Middleford Rd
City	Seaford
State	DE
ZIP	19973
Taxonomy	Rheumatology Physician
NPI Enumerated	January 16, 2007

Payer Source	Total Paid
Medicare	$2.7M
Medicaid	$0

Key Findings

This provider reports $2.7M in lifetime Medicare revenue and has no Medicaid billing on file, making their Medicare exposure effectively single‑payer in the public programs dataset. The absence of any Medicaid claims means revenue and utilization insights here are driven entirely by Medicare patterns rather than a mixed Medicare/Medicaid practice profile.

Revenue is highly concentrated in a small number of drug-administration codes: J0897 ($872.6K, 32.1%), J0129 ($341.6K, 12.6%), and J9312 ($229.6K, 8.4%) — the top three Medicare codes together account for 53.1% of this provider’s total Medicare revenue. This concentration indicates a business model where a few high‑volume biologic agents disproportionately drive payments.

The code mix points to an infusion- and injection‑centric rheumatology practice: high-revenue biologic drug codes (J0897, J0129, J9312, J3262, J0717, J1602) dominate the list, and administration/infusion service codes (96401, 96413, 96415, 96365) also appear in the top 25. Combined with substantial office E/M activity (99213, 99214), the pattern is consistent with ongoing, clinic‑based management and repeated in‑office delivery of parenteral biologics and related therapies.

This provider is a clear national outlier on several specific services: J0897 ranks #20 of 10057 providers nationally (100th percentile; extreme outlier, far above typical national volume) and 99213 ranks #588 of 457151 providers (100th percentile; extreme outlier, far above typical national volume). The practice also ranks highly for administration codes such as 96401 (#35 of 3868, 99th percentile; extreme outlier), signaling unusually large volumes of in‑office drug administration compared with peers.

Several commonly used biologic codes register typical or unremarkable participation: for example, J0129 ranks #462 of 1221 providers (62th percentile; typical, unremarkable volume), J9312 ranks #136 of 317 (57th percentile; typical, unremarkable volume), and J3262 ranks #276 of 618 (55th percentile; typical, unremarkable volume). These mid‑percentile placements indicate that, aside from a few exceptional drugs, the provider’s use of many biologics is within the expected national range.

The outpatient visit mix shows substantial longitudinal follow-up: 99213 appears with 2.2K claims ($65 avg paid/claim, $144.8K revenue) and 99214 with 939 claims ($95 avg paid/claim, $89.2K revenue), supporting a workflow of frequent established‑patient visits. The high volume for 99213 (100th percentile; extreme outlier) and elevated ranking for 99214 (97th percentile; notably above typical national volume) reinforce that the provider manages a large panel of returning Medicare patients.

The lack of any Medicaid billing on file means the provider has no measurable Medicaid footprint in the state dataset; payers and networks evaluating in‑state access or Medicaid capacity should treat this practice as lacking Medicaid exposure rather than as a low‑Medicaid performer. Strategic or contracting decisions that depend on Medicaid capacity cannot be supported by this provider’s reported claims.

The NPI was enumerated on 2007-01-16 (~19 years ago), indicating long tenure in the dataset; when combined with the concentrated biologic administration and high visit volumes, this suggests an established clinic operation with mature infusion/administration workflows rather than a new or recently scaled practice. Tenure plus the pattern of extreme outlier volumes for specific drugs may imply institutionalized processes for in‑office biologic delivery and ongoing chronic care management.

Medicare: Complete Services Breakdown

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

28 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J0897	Injection, denosumab, 1 mg	48,480	$20	$872.6K
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)	10,350	$30	$341.6K
J9312	Injection, rituximab, 10 mg	3,650	$60	$229.6K
J3262	Injection, tocilizumab, 1 mg	42,800	$10	$214K
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)	52,800	$1	$211.2K
J1602	Injection, golimumab, 1 mg, for intravenous use	18,800	$10	$188K
J3111	Injection, romosozumab-aqqg, 1 mg	21,000	$10	$168K
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…	2,230	$70	$144.8K
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…	940	$100	$89.2K
96401	The provider administers nonhormonal, antineoplastic chemotherapy drugs subcutaneously or intramuscularly to the patient.	1,230	$60	$73.7K

Showing 1–10 of 28

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 28 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Delaware Distribution

Ivonne Herrera — 3 of 25 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

28 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0129	6	10	11,030	$30	$432.5K
J0717	9	10	98,800	$1	$376.8K
J9312	3	10	5,250	$60	$314K
J3111	4	10	29,930	$10	$245K
J1602	4	10	21,050	$10	$238.8K
J3262	3	10	52,080	$1	$226.2K
J1745	8	10	3,610	$30	$134.3K
J0897	2	60	3,360	$20	$132.9K
96413	6	30	280	$100	$36.6K
99214	131	1,830	150	$80	$25.5K

Showing 1–10 of 28

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Tidalhealth Specialty Care, LLC	MD	Medical Specialty Clinic/Center	$0	$11.7M
Justin Kucinski	MD	Internal Medicine Physician	$6.9M	$0
Tanya Clifford	MD	Nurse Practitioner	$2.9M	$0
Shubha Kollampare	FL	Rheumatology Physician	$2.1M	$0
Rabindra Paul	MD	Infectious Disease Physician	$2.1M	$0
David Chung	MD	Diagnostic Ultrasound Physician	$1.1M	$0
John Mansueti	MD	Radiation Oncology Physician	$960.8K	$0
Osamuyimen Igbinosa	DC	Internal Medicine Physician	$278.3K	$641.7K
Mark Treuth	MD	Interventional Cardiology Physician	$905.6K	$0
Manoj Jain	MD	Radiation Oncology Physician	$695.5K	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Tidalhealth Nanticoke, Inc	DE	General Acute Care Hospital	$0	$19.2M
Dynamic Therapy Services LLC	DE	Physical Therapist	$0	$12.8M
Addiction Medical Facility, LLC	DE	Substance Abuse Rehabilitation Facility	$98.8K	$9M
Tidalhealth Physician Network, Inc.	DE	Family Medicine Physician	$0	$8.7M
Resouces For Human Development, Inc.	DE	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$5.4M
Ambient Medical Care, LLC	DE	Urgent Care Clinic/Center	$0	$3.3M
Lynch, Rodriguez And Keller, PA	DE	Dentist	$0	$3.3M
Tidalhealth Physician Network, Inc.	DE	Family Medicine Physician	$0	$2.9M
Seaford Internal Medicine LLC	DE	Internal Medicine Physician	$0	$2.7M
Alpha Care Medical, LLC	DE	Family Medicine Physician	$0	$2.6M

Ivonne Herrera — 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