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

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

Mitchell Fineman (NPI 1013965276)

Field	Value
Entity Type	Individual
Organization	Mitchell Fineman
Address	4060 Butler Pike
City	Plymouth Meeting
State	PA
ZIP	19462
Taxonomy	Ophthalmology Physician
NPI Enumerated	May 4, 2006

Payer Source	Total Paid
Medicare	$7M
Medicaid	$0

Key Findings

This is a retina-focused ophthalmology practice with operations concentrated on intravitreal drug administration and retinal diagnostics: the top revenue drivers are J0178 (3.5K claims, $690 avg paid/claim, $2.4M revenue, 34.4%), J2778 (7.6K claims, $190 avg paid/claim, $1.4M revenue, 20.5%), and Q5128 (6.3K claims, $217 avg paid/claim, $1.4M revenue, 19.4%). High volumes of these intravitreal injection codes alongside large imaging volumes for 92134 (6.2K claims, $193.3K revenue) and frequent intermediate/comprehensive eye exams (92012 and 92014) indicate an office-based injection and imaging model caring for chronic retinal disease.

Revenue concentration is very high: the precomputed top-3 codes account for 74.3% of this provider's total Medicare revenue, and total Medicare revenue on file is $7M. That concentration means a small set of biologic and biosimilar injection codes dominate financial performance, making overall revenue sensitive to price, utilization, or formulary shifts for those agents.

Payer mix is effectively single-payer Medicare: the profile shows Total Medicare revenue of $7M and no Medicaid billing on file. Because Medicaid activity is recorded as none, comparisons and contracting considerations should be framed primarily against Medicare volumes and national Medicare peers.

Competitive standing on the national Medicare stage is strong for retina therapeutics and related services: J2778 ranks #15 of 1208 providers nationally (99th percentile) and Q5128 ranks #7 of 373 providers nationally (98th percentile, described as an extreme outlier), while J0178 ranks #109 of 3204 (97th percentile, notably above typical national volume). Several non-drug codes also show extreme outlier status for volume — notably 92012 ranks #9 of 17177 providers (100th percentile) and 92134 ranks #11 of 26868 providers (100th percentile) — supporting the view that this provider runs at much higher procedural throughput than typical peers.

The provider bills a mix of labeled, biosimilar, and unclassified biologic drug codes that meaningfully contribute to revenue beyond the top three: J3490 (202 claims, $1848 avg paid/claim, $373.3K revenue, 5.3%) and J3590 (47 claims, $2210 avg paid/claim, $103.9K revenue, 1.5%) together represent material ancillary biologic revenue, while J2781 (2.4K claims, $120 avg paid/claim, $293.4K revenue, 4.2%) shows adoption of newer intravitreal agents. These patterns are consistent with a practice treating complex retinal disease with multiple injectable therapeutics.

Operational footprint and throughput are reflected in high procedure and imaging counts but relatively modest E/M revenue share: 92012 (3.4K claims, $68 avg paid/claim, $232.8K revenue, 3.3%) and 92134 (6.2K claims, $31 avg paid/claim, $193.3K revenue, 2.7%) demonstrate very high visit and imaging volume while standard office visit codes contribute a smaller share of total Medicare revenue. This mix suggests a workflow optimized for short, procedure-driven visits with repeat injections and serial imaging rather than heavy new-patient evaluation revenue.

Tenure in the Medicare program is long-standing: the NPI was enumerated on 2006-05-04 (~20 years ago), indicating stable, long-term participation in Medicare and an established referral and treatment pattern for retinal services. Longevity combined with extreme-volume rankings on multiple retina-related codes supports that this is a mature practice rather than a recent high-volume entrant.

From a payer oversight and network strategy perspective, the combination of extreme national volume ranks for several injection and imaging codes and a 74.3% revenue concentration in the top three codes suggests this provider should be prioritized for contracting discussions, utilization management, and price negotiations for intravitreal agents. Given total Medicare revenue of $7M and no Medicaid activity, those efforts should be targeted within Medicare payment models and prior authorization or step-therapy programs for high-cost injectable agents rather than Medicaid-focused interventions.

Medicare: Complete Services Breakdown

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

19 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J0178	Injection, aflibercept, 1 mg	3,510	$690	$2.4M
J2778	Injection, ranibizumab, 0.1 mg	7,580	$190	$1.4M
Q5128	Injection, ranibizumab-eqrn (cimerli), biosimilar, 0.1 mg	6,300	$220	$1.4M
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.	4,030	$100	$418.7K
J3490	Unclassified drugs	200	$1,850	$373.3K
J2781	Injection, pegcetacoplan, intravitreal, 1 mg	2,450	$120	$293.4K
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…	3,420	$70	$232.8K
92134	The 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.	6,240	$30	$193.3K
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…	1,170	$90	$106.1K
J3590	Unclassified biologics	50	$2,210	$103.9K

Showing 1–10 of 19

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 19 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Pennsylvania Distribution

Mitchell Fineman — 7 of 19 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Pennsylvania

Full comparison — all codes billed, vs. state median

19 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0178	9	140	830	$690	$865.1K
Q5128	4	20	3,830	$220	$838.7K
J2778	3	70	1,030	$190	$417.1K
J2781	1	20	690	$120	$109.1K
67028	3	180	600	$90	$87.5K
J3590	5	10	40	$1,690	$78K
J7999	35	110	100	$120	$33.3K
J3490	11	110	60	$70	$27.9K
92014	42	1,570	130	$80	$21K
99214	4,379	23,230	100	$80	$14.5K

Showing 1–10 of 19

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Alok Bansal	CA	Ophthalmology Physician	$3M	$4.7M
David Reed	MA	Retina Specialist (Ophthalmology) Physician	$7.7M	$0
Omesh Gupta	PA	Ophthalmology Physician	$7.1M	$80
Michael Klufas	PA	Ophthalmology Physician	$7M	$0
Richard Kaiser	PA	Ophthalmology Physician	$6.6M	$0
Allen Chiang	PA	Ophthalmology Physician	$6.6M	$0
Carl Regillo	PA	Ophthalmology Physician	$6.5M	$0
Allen Ho	PA	Ophthalmology Physician	$6.4M	$0
Yoshihiro Yonekawa	PA	Ophthalmology Physician	$6.4M	$0
James Vander	PA	Ophthalmology Physician	$6.3M	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Gemma Services	PA	Psychiatric Residential Treatment Facility	$0	$23.8M
Access Services Inc	PA	Community/Behavioral Health Agency	$0	$8.3M
Marc Spirn	PA	Ophthalmology Physician	$6.3M	$0
Arunan Sivalingam	PA	Ophthalmology Physician	$6M	$0
Sunir Garg	PA	Ophthalmology Physician	$6M	$0
Carl Park	PA	Ophthalmology Physician	$5.5M	$0
Ajay Kuriyan	PA	Ophthalmology Physician	$5.3M	$6.6K
Plymouth Community Ambulance Assn	PA	Land Ambulance	$903.5K	$4.3M
Sonia Mehta	PA	Ophthalmology Physician	$4.9M	$0
Jason Hsu	PA	Ophthalmology Physician	$4.4M	$0

Mitchell Fineman — 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