Physician

Toni O Pacioles, MD

According to 2025 Medicare claims, Toni Pacioles, MD (NPI: 1396959995) practices hematology/oncology in the Huntington-Ashland, WV-KY-OH market, with the plurality of this provider's patient population coming from Cabell, WV. This provider's primary affiliated billing organization is CABELL HUNTINGTON HOSPITAL INC (NPI: 1104901784; TIN: 550675666) and primary practice location at 25701-4114.

Pacioles' data goes back to 2015 and runs through 2024. For example, in 2024, this provider had 470 traditional Medicare patients, billed 1,763 HCPCS/CPT codes, and received $141,416 in Medicare payments. The top billing code was 99223 (Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes). Part D data shows 1,758 prescription claims across 309 beneficiaries totaling $6,101,102 in drug costs, led by Xtandi (Enzalutamide). 2023 DME data shows 98 claims. Open Payments data shows 5 records totaling $87. You can download detailed data with all billing codes (2015-2024). For more recent data, please contact us.

Over the past 10 years, this provider's Medicare Part B carrier billing did not follow a clear longitudinal pattern. Concurrently, Part D prescription costs have moved sharply higher in recent years, from $470,325 to $6,101,102. In contrast, DME billing represents a smaller volume and moved up and down with repeated peaks and valleys, starting at $4,138 and ending at $880.

Part B Carrier Billing Trend

Medicare payment trend, with N of patients and claim lines in the table.

Year	Patients	Clm Lines	Payment
2015	269	799	$50,982
2016	401	1,721	$150,983
2017	449	2,199	$217,353
2018	459	2,205	$200,480
2019	536	2,952	$282,519
2020	442	2,346	$222,272
2021	417	2,025	$205,497
2022	418	1,644	$147,354
2023	447	1,711	$137,835
2024	470	1,763	$141,416

Part D Events Trend

Drug cost trend, with N of patients and prescription claims in the table.

Year	Patients	Claims	Drug Cost
2015	120	535	$470,325
2016	172	1,050	$1,014,420
2017	211	1,082	$994,869
2018	204	1,251	$1,569,653
2019	238	1,632	$3,098,748
2020	213	1,431	$3,125,389
2021	243	1,269	$2,972,127
2022	263	1,550	$4,473,978
2023	305	1,587	$5,667,529
2024	309	1,758	$6,101,102

DME Billing Trend

Medicare payment trend, with N of patients and DME claim records in the table.

Year	Patients	Claims	Payment
2015	N/R	27	$3,363
2016	11	147	$7,026
2017	N/R	304	$23,856
2018	N/R	180	$12,311
2019	51	322	$18,485
2020	N/R	210	$11,793
2021	N/R	263	$16,888
2022	N/R	299	$9,201
2023	N/R	98	$13,213
2024	N/R	N/R	N/R

* / # = suppressed by CMS; 0 = reported zero; N/R = not reported or blank.

Top 5 Part B carrier billing codes in 2024

By total payments.

Code	Description	Patients	Clm Lines	Total Payment
99223	Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	54	59	$139
99205	New patient office or other outpatient visit with a high level of medical decision making, if using time, 60 minutes or more	85	85	$130
99215	Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more	104	323	$108
99214	Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	321	834	$71
99213	Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more	101	139	$44

Top 5 Part D drugs in 2024

By total drug costs.

Drug	Generic	Claims	Total Day Supply	Total Drug Cost
Xtandi	Enzalutamide	54	1,620	$697,165
Ibrance	Palbociclib	35	980	$535,706
Lenalidomide	Lenalidomide	43	1,106	$528,492
Revlimid	Lenalidomide	20	560	$421,071
Promacta	Eltrombopag Olamine	26	780	$399,350

Top 5 DME services in 2024

No connected or detailed DME service-level records for 2024.

Open Payments Summary in 2024

Category	Definition	Records	Total Reported Amount	Top Related Entity
General Payments	Reported payment or transfer-of-value amount.	5	$87	Merck Sharp & Dohme LLC
Research Payments	Reported research-related payment or transfer-of-value amount.	0	$0	N/R
Ownership / Investment Interests	Reported value of ownership or investment interests.	0	$0	N/R

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FAQ

What Medicare data is available for Toni O. Pacioles, MD?

Tedicare shows public-source Medicare data for Toni O. Pacioles, MD (NPI 1396959995), including provider identity, specialty, market context, Medicare Part B activity, Part D prescribing, DME records, Open Payments where available, billing organization details, and ACO affiliation signals where available. Profile data covers 2015-2024, with current attribution based on 2025 claims where available.

Does Toni O. Pacioles, MD have ACO affiliation data?

No ACO affiliation record is shown in the available Tedicare data for this profile.

What billing organization is linked to Toni O. Pacioles, MD?

Toni O. Pacioles, MD is linked to CABELL HUNTINGTON HOSPITAL INC (billing NPI 1104901784) in the available physician profile data.

Does Toni O. Pacioles, MD have Open Payments data?

Toni O. Pacioles, MD has 5 connected Open Payments records in the available 2024 summary data.

Can I download physician-level Medicare data from Tedicare?

Yes. Tedicare provides sample physician export data and paid custom physician data exports for research, planning, outreach, and market analysis. Exports can include physician profile fields, market and specialty context, billing organization details, ACO affiliation signals where available, and Medicare utilization data.