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 Oregon for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to Oregon 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. Oregon (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.

Justin Spaulding (NPI 1013259167)

Field	Value
Entity Type	Individual
Organization	Justin Spaulding
Address	1408 E Barnett Rd
City	Medford
State	OR
ZIP	97504
Taxonomy	Glaucoma Specialist (Ophthalmology) Physician
NPI Enumerated	March 26, 2013

Payer Source	Total Paid
Medicare	$959.7K
Medicaid	$0

Key Findings

This provider’s Medicare-only revenue base is modest in scale, with total Medicare revenue reported as $959.7K and no Medicaid billing on file; the practice is effectively single-payer (Medicare) in the claims data available. The absence of Medicaid billing suggests payer mix and access are concentrated on Medicare beneficiaries rather than a dual Medicare/Medicaid panel.

Revenue is highly concentrated in a few codes: the precomputed top 3 Medicare codes account for 61.0% of this provider's total Medicare revenue, driven primarily by J0178 ($370.9K, 39.0% of Medicare revenue, 536 claims, $692 avg paid/claim), 66984 ($131.6K, 13.8% of Medicare revenue, 376 claims, $350 avg paid/claim), and 92014 ($77.9K, 8.2% of Medicare revenue, 916 claims, $85 avg paid/claim). This concentration indicates that intravitreal biologic injections and cataract surgery are the major revenue drivers.

The procedural and diagnostic mix aligns with a surgical ophthalmology practice that also delivers high-volume intravitreal therapy: anti-VEGF injections are the single largest revenue line (J0178 is 39.0% of Medicare revenue), cataract surgery CPT 66984 is the second-largest line, and high-volume E/M and diagnostic services (92014 and related testing codes) support ongoing medical management. Additional ophthalmic procedures such as intravitreal injection as an isolated procedure (67028), capsulotomy (66821), and intraocular lens-related codes appear throughout the top billings, reinforcing a combined surgical and medical retina/cataract service line.

Competitive standing by code is mixed: J0178 ranks #1853 of 3204 nationally (42th percentile; typical, unremarkable volume), indicating a moderate national presence for aflibercept injections, while cataract surgery 66984 ranks #3490 of 15965 (78th percentile; typical, unremarkable volume) reflecting a stronger relative position for cataract procedures. In contrast, established-patient comprehensive visits (92014) rank #1996 of 35415 (94th percentile; notably above typical national volume), and several testing codes (e.g., 92083 at the 97th percentile, 92136 at the 95th percentile, 92133 at the 97th percentile, and 92025 at the 98th percentile) are notably above typical national volumes, which suggests robust clinic throughput and diagnostic capacity relative to peers.

There are specific statistical outliers in the E/M mix that warrant attention: 99204 is flagged as an "extreme outlier" (rank #742 of 227068, 100th percentile) with 350 claims ($38.2K revenue, $109 avg paid/claim), implying an unusually high volume of high-complexity new-patient visits relative to national peers. This pattern could reflect referral intake of complex cases or coding concentration on higher-level new patient E/M encounters, and it is distinct from the injection/cataract revenue concentration.

Glaucoma-related interventions are present but represent a smaller share of revenue: codes such as 66175 ($16.2K, 31 claims) and 66174 ($9.1K, 23 claims) appear in the top codes along with trabeculoplasty 65855 ($5.2K, 33 claims), indicating that glaucoma procedures are part of the service mix but not the primary revenue engine. These entries are consistent with the listed taxonomy (Glaucoma Specialist) but show that cataract and retina services dominate in Medicare billings.

High utilization of imaging and ancillary services supports clinical management and surgical planning: OCT and retina imaging codes (92134: 763 claims, $16.8K, 90th percentile; 92136: 595 claims, $16.7K, 95th percentile; 92133: 495 claims, $12.4K, 97th percentile) and testing/biometry (92025: 415 claims, $8.7K, 98th percentile) are all notably above typical volumes, suggesting the practice performs extensive objective testing in support of diagnosis, monitoring, and preoperative planning. This diagnostic intensity complements the high injection and surgical volumes reported.

The provider has an established billing history dating to NPI enumeration on 2013-03-26 (~13 years ago), which indicates sustained activity over a multi-year period. Combined with the revenue concentration in injections and cataract surgery plus elevated diagnostic/test volumes and an extreme outlier for high-level new-patient E/M, the pattern is consistent with a well-established subspecialty ophthalmology practice focused on surgical and injection-based services within the Medicare population.

Medicare: Complete Services Breakdown

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

32 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J0178	Injection, aflibercept, 1 mg	540	$690	$370.9K
66984	The provider inserts an artificial lens after removing an extracapsular cataract by aspiration or use of ultrasonic waves. This procedure is done without the use of an endoscopic laser probe to…	380	$350	$131.6K
92014	An 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…	920	$90	$77.9K
99204	The 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…	350	$110	$38.1K
J2778	Injection, ranibizumab, 0.1 mg	200	$180	$35.5K
66821	The provider removes the haziness from the capsule of the eye using a laser for a patient with a secondary membranous cataract.	160	$220	$34.5K
92012	For this CPT code, an Ophthalmologist sees an established patient for an intermediate level eye examination. Generally, a patient is considered to be "established" if the same physician, or any…	550	$60	$33.6K
67028	The 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.	350	$90	$31.6K
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…	320	$90	$28.2K
92083	The provider may use one or more methods to determine the extent of a patient's visual field of one or both eyes; he interprets the results and prepares a report. Report this code for an extended…	500	$40	$21.8K

Showing 1–10 of 32

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 32 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Oregon Distribution

Justin Spaulding — 8 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Oregon

Full comparison — all codes billed, vs. state median

32 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0178	38	60	840	$680	$623.7K
J2778	18	20	400	$180	$87.8K
66984	21	260	70	$540	$82.7K
67028	48	70	580	$90	$72.3K
66991	4	20	20	$1,680	$47.2K
66175	2	10	30	$810	$26.6K
66174	2	10	20	$1,090	$23.9K
J7999	41	50	270	$70	$23.4K
66982	15	60	20	$720	$20.8K
92014	6	440	110	$80	$16K

Showing 1–10 of 32

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Cataract And Laser Institute Of Southern Oregon PC	OR	Ophthalmology Physician	$0	$2M
Allison Jarstad	OR	Ophthalmology Physician	$248.8K	$0
Tina Rutar	OR	Pediatric Ophthalmology and Strabismus Specialist Physician Physician	$100.4K	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Asante	OR	General Acute Care Hospital	$0	$29.7M
Addictions Recovery Center, Inc.	OR	Substance Abuse Rehabilitation Facility	$0	$29.2M
Asante Physician Partners	OR	Family Medicine Physician	$0	$27.2M
Mercy Flights Incorporated	OR	Ambulance	$3.6M	$19.4M
Providence Health & Services - Oregon	OR	General Acute Care Hospital	$0	$20.9M
Crc Health Oregon, LLC	OR	Methadone Clinic	$193K	$13M
James Kolby Robinson, Dmd	OR	Pediatric Dentistry	$0	$11.6M
Valley Immediate Care, LLC	OR	Urgent Care Clinic/Center	$0	$9.4M
Lincare Inc	OR	Durable Medical Equipment & Medical Supplies	$0	$7.1M
Southern Oregon Pediatrics, LLP	OR	Pediatric Hospice and Palliative Medicine Physician	$0	$6.5M

Justin Spaulding — 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