Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • NPI Medicare & Medicaid
    • Healthcare Providers
    • Health Insurance Payers
    • States
    • Service Lines
    • Taxonomy Codes
    Lookup tools
    • Billing Code Lookup
    • CPT Modifier Lookup
    • Provider Taxonomy Code Lookup
    • Healthcare Provider & Facility Lookup
    • Health Insurance Payer Lookup
    • Payer Contact Directory

    Policy & Benchmark Tools

    • Prior Authorization Lookup
    • Coverage Criteria Lookup
    • Timely Filing Lookup
    • Billing Code Reimbursement Rates
    • Payer Comparison Dashboard
    • Facility Comparison Dashboard
    • All tools

    Company

    • About OpenPayer
    • Data Sources
    • Trek Health
    OpenPayerby Trek Health
    LinkedInYouTube

    © 2026 Trek Health. All rights reserved.

    OpenPayer is built and maintained by Trek Health.

    v1.0.28
    OpenPayerNPI Medicare & MedicaidPeter Sonkin
    Ask Trek AI about this page

    Peter Sonkin — Billing Profile & Reimbursement Data

    NPI 1003991167 · Nashville, TN · Retina Specialist (Ophthalmology) Physician

    Customize your policy alerts

    Sign up for Peter Sonkin — Billing Profile & Reimbursement Data policy alerts

    Get alerted when relevant policies change without checking for updates manually.

    Monitor payer policy activity

    Receive email alerts as soon as relevant payer policies are published or updated.

    Peter Sonkin is a retina specialist (ophthalmology) physician provider located in Nashville, Tennessee. This profile covers 15 Medicare and 0 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.

    Table of contents

    Progress1 / 9

    Explore openpayer tools

    • Billing CodesCPT, HCPCS, DRG & more
    • Reimbursement RatesCommercial vs. Medicare rate reports
    • ProvidersHospitals & facilities
    • PayersPlans & market footprint
    • Taxonomy CodesNUCC specialty codes
    • ModifiersCPT modifiers & usage
    • Prior AuthorizationPA policies by payer & drug
    • Timely FilingFiling deadlines by payer
    • Coverage CriteriaMedical necessity by payer
    • Payer ContactsClaims, PA & appeals contacts
    View all tools

    Provider details (source: NPPES NPI Registry)

    FieldValue
    Entity TypeIndividual
    OrganizationPeter Sonkin
    Address345 23rd Ave N
    CityNashville
    StateTN
    ZIP37203
    TaxonomyRetina Specialist (Ophthalmology) Physician
    NPI EnumeratedOctober 26, 2006

    Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)

    Payer SourceTotal Paid
    Medicare$2.2M
    Medicaid$0

    Key Findings

    This provider is a high-volume retina practice driven predominantly by intravitreal anti-VEGF therapy and retina-focused diagnostic services: Total Medicare revenue is $2.2M with J0178 (aflibercept) alone accounting for $1.5M and 66.5% of Medicare revenue, and Q5128 (ranibizumab biosimilar) adding $222.7K (10.0%). The code mix — large counts of injection codes (J0178: 2.2K claims; Q5128: 1K claims; J2777: 2.6K claims) alongside retinal imaging codes such as 92134 (2K claims) and 92250 (799 claims) — is consistent with an outpatient medical-retina operation that pairs frequent injections with routine imaging and established-patient follow-ups.

    Revenue concentration is pronounced: the top 3 Medicare codes drive 83.7% of this provider's Medicare revenue, with J0178 (66.5%), Q5128 (10.0%), and 92014 (7.2%) together creating a narrow revenue base. That concentration implies material exposure to shifts in anti-VEGF utilization patterns or reimbursement for these specific codes, where changes to payment or preferred agents could disproportionately affect overall revenue.

    Payer mix is effectively single-payer Medicare: the record shows Total Medicare revenue: $2.2M and no Medicaid billing on file, so the provider lacks Medicaid-sourced revenue. This limited payer diversification increases dependence on Medicare (and likely Medicare Advantage/commercial coverage not shown here) and may constrain negotiation leverage with payers that serve a broader mix of beneficiaries.

    Competitive standing by code is mixed: for the primary revenue driver J0178 this provider ranks #448 of 3204 nationally (86th percentile), indicating a strong but not dominant national position for aflibercept administration; Q5128 ranks #135 of 373 (64th percentile), a typical volume among providers using that biosimilar; however 92014 (established comprehensive eye exam) ranks #259 of 35415 (99th percentile) and is labeled an "extreme outlier," signaling an unusually high volume of comprehensive established visits compared with national peers.

    Several diagnostic and ancillary services also stand out relative to peers: 92134 (retinal imaging) ranks #1069 of 26868 (96th percentile) and is described as "notably above typical," and 92250 (fundus photography) ranks #451 of 25087 (98th percentile) and is an "extreme outlier." These high percentiles for imaging codes reinforce that the practice pairs high imaging throughput with its injection activity, suggesting integrated Imaging + injection workflow and capacity.

    Operational detail from unit-level claims highlights how payment rates shape revenue: J2777 (faricimab) appears in large claim count (2.6K claims) but contributes only $74.8K (3.4% of Medicare revenue) because of a low average paid/claim ($29), whereas J0178 yields far greater revenue per claim (J0178 avg paid/claim $680). This suggests the practice administers multiple anti-VEGF agents but derives the majority of drug reimbursement from higher-paid agents such as aflibercept.

    The provider shows high utilization of certain non-injection office codes: 92014 generated $159.4K (7.2% of Medicare revenue) on 2K claims and ranks in the 99th percentile nationally, and 99204 (new patient moderate complexity visits) is "notably above typical" at rank #4478 of 227068 (98th percentile). Together these patterns imply a steady throughput of both new and established clinic visits supporting the injection and imaging volumes rather than isolated procedure-only encounters.

    Tenure and experience are long-standing: the NPI was enumerated on 2006-10-26 (~20 years ago), indicating an established practice presence; combined with the heavy volumes and high percentile rankings on core retina and imaging codes, this suggests a mature clinical operation with sustained Medicare activity over time.

    Medicare: Total Revenue Breakdown by CPT/HCPCS Code

    Medicare revenue breakdown by CPT/HCPCS procedure code.

    View: Bar Chart1 / 2

    Medicare: Complete Services Breakdown

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

    15 rows

    CPT/HCPCS CodeDescriptionClaimsAvg PaidRevenue
    J0178Injection, aflibercept, 1 mg2,180$680$1.5M
    Q5128Injection, ranibizumab-eqrn (cimerli), biosimilar, 0.1 mg1,030$220$222.7K
    92014An ophthalmologist sees an established patient for a comprehensive level eye examination. Generally, a patient is considered to be "established" if the same physician, or any physician in the group…1,970$80$159.4K
    67028The provider injects a medication into the vitreous chamber of the eye as an isolated procedure or a separate procedure unrelated to any other procedure being performed on the eye.1,210$90$106.3K
    J2777Injection, faricimab‑svoa, 0.1 mg2,580$30$74.8K
    J2778Injection, ranibizumab, 0.1 mg350$180$62.5K
    92134The provider performs computerized diagnostic imaging of the retina in the posterior segment (back part) of the eye, interprets the data, and provides a report. The service may be on one or both eyes.1,960$30$54.9K
    99204The 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…210$110$22.1K
    92250Code 92250 describes the taking of fundus photographs, that is, photographs of the posterior segment of the inner aspect of the eye, to document alterations in the optic nerve head, retinal vessels,…800$30$20K
    92235The provider uses a special dye, fluorescein that causes the blood vessels in the one or both eyes to stand out in photographic images taken with the use of multiframe timing, or serial images, taken…90$90$8.6K

    Showing 1–10 of 15

    Medicare: Competitive Analysis & Benchmarks

    How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 15 CPT/HCPCS codes.

    View: State1 / 2

    Full comparison — all codes billed, vs. state median

    15 rows

    CPT/HCPCS CodeRankProvider CountMedian ClaimsAvg PaidAverage Revenue
    J01781180790$680$769.8K
    J2777475015,060$30$592.1K
    Q512811201,190$210$394K
    J277837401,340$180$370.2K
    6702838801,130$90$98.5K
    920147810120$80$19.2K
    J90355770140$50$17.1K
    921343460060$30$8.2K
    6721031020$380$7.6K
    9201229439060$50$6.3K

    Showing 1–10 of 15

    Related Providers

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

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    Tennessee Retina PCTNRetina Specialist (Ophthalmology) Physician$0$6M
    Roy WallaceTNRetina Specialist (Ophthalmology) Physician$5.4M$0
    David ReichsteinTNRetina Specialist (Ophthalmology) Physician$4.9M$141.7K
    Carl AwhTNRetina Specialist (Ophthalmology) Physician$4.7M$0
    Brandon BusbeeTNRetina Specialist (Ophthalmology) Physician$4.3M$0
    Eric SchneiderTNRetina Specialist (Ophthalmology) Physician$4.1M$0
    Franco RecchiaTNRetina Specialist (Ophthalmology) Physician$3.6M$2.6K
    Akshay ThomasTNRetina Specialist (Ophthalmology) Physician$3.2M$52K
    Everton ArrindellTNRetina Specialist (Ophthalmology) Physician$3M$0
    Jay GloverTNRetina Specialist (Ophthalmology) Physician$2.9M$0

    Nearby Providers

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

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    Hca Health Services Of Tennessee, Inc.TNGeneral Acute Care Hospital$0$45.9M
    Pediatrix Medical Group Of Tennessee, P.C.TNNeonatal-Perinatal Medicine Physician$0$32.3M
    Saint Thomas Medical PartnersTNInternal Medicine Physician$0$21.9M
    Radiology Alliance PCTNDiagnostic Radiology Physician$0$13.2M
    Emergency Medicine Services Of Tn, PCTNEmergency Medicine Physician$0$12.9M
    Tennessee Maternal-fetal Medicine LLCTNSpecialist$0$12.5M
    The Next Door, Inc.TNSubstance Abuse Rehabilitation Facility$0$8.6M
    Tennessee Oncology PLLCTNHematology & Oncology Physician$0$8.5M
    Vcphcs Ix, LLCTNSubstance Use Disorder Rehabilitation Clinic/Center$257.7K$6.6M
    Pediatric Associates Of Davidson County, P.C.TNPediatrics Physician$0$5.8M

    Frequently Asked Questions

    References

    1. 1.Medicare Physician & Other Practitioner by Provider and Service. CMS.gov.Provider-level Medicare Part B utilization and payment data.
    2. 2.NPPES NPI Registry. CMS.gov.National Provider Identifier registry used for provider enumeration and taxonomy metadata.

    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

    Medicare Revenue by CPT/HCPCS Code
    Claims Volume vs. Tennessee Distribution
    Peter Sonkin — 3 of 15 codes billed far more than typical (above p95)
    p5–p95 (all providers)p25–p75MedianThis providerOutlier
    Rank Distribution — Tennessee