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    v1.0.28
    OpenPayerNPI Medicare & MedicaidTod Mcmillan
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    Tod Mcmillan — Billing Profile & Reimbursement Data

    NPI 1023014347 · Knoxville, TN · Retina Specialist (Ophthalmology) Physician

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    Tod Mcmillan is a retina specialist (ophthalmology) physician provider located in Knoxville, Tennessee. This profile covers 14 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.

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    Provider details (source: NPPES NPI Registry)

    FieldValue
    Entity TypeIndividual
    OrganizationTod Mcmillan
    Address1124 E Weisgarber Rd
    CityKnoxville
    StateTN
    ZIP37909
    TaxonomyRetina Specialist (Ophthalmology) Physician
    NPI EnumeratedJune 22, 2005

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

    Payer SourceTotal Paid
    Medicare$2.5M
    Medicaid$0

    Key Findings

    This provider’s Medicare footprint is concentrated and retina-focused: total Medicare revenue is $2.5M with no Medicaid billing on file, indicating an effectively single-payer Medicare practice that does not bill Medicaid. The claim mix and top-paid items are centered on intravitreal drug therapy and retina imaging rather than broad primary care E/M or extensive surgical procedures.

    Revenue concentration is very high: the precomputed top 3 Medicare codes by revenue account for 87.7% of this provider’s Medicare revenue, showing strong dependence on a narrow set of DRUG/INJECTION lines of business. Those three codes are J2778 (43.6%), J0178 (30.8%), and J2777 (13.4%), which together drive the vast majority of reported Medicare dollars.

    Operational profile inferred from top codes: the highest-volume and highest-dollar codes are anti-VEGF intravitreal medications—J2778 (ranibizumab) with 6.1K claims and $1.1M revenue and J0178 (aflibercept) with 1.1K claims and $777.4K revenue—indicating a clinic workflow optimized for frequent in-office injections and follow-up. The presence of substantial counts for 67028 (1.6K claims) and retinal imaging codes like 92134 (1.9K claims) further supports a high-throughput retina practice model focused on medical retinal disease management.

    Competitive standing is mixed across specific services: the provider ranks highly on ranibizumab use (J2778) at #31 of 1208 providers nationally (98th percentile), marking them as a top national performer for that drug. By contrast, aflibercept (J0178) and faricimab (J2777) volumes are described as typical or unremarkable—J0178 ranks #1151 of 3204 (64th percentile) and J2777 ranks #896 of 2039 (56th percentile)—so dominance is concentrated specifically in ranibizumab use rather than uniformly across all anti-VEGF agents.

    Several non-drug services are also notable for above-typical volume: retinal imaging (92134) shows 1.9K claims and ranks #1100 of 26868 providers nationally (96th percentile), and low-level established office visit E/M (99213) shows 525 claims and ranks #24848 of 457151 providers nationally (95th percentile). These placements, described in the source data as “notably above typical national volume,” indicate the practice pairs high injection throughput with correspondingly elevated imaging and routine follow-up visit volumes.

    Service-line risk and revenue sensitivity: because 87.7% of Medicare revenue is concentrated in three codes that are drug/injection–related, the practice’s financial performance is likely sensitive to changes in drug pricing, reimbursement policies, or utilization patterns for those specific agents. High reliance on J2778 (ranibizumab) in particular suggests operational and revenue risk if payer behavior shifts toward alternative agents or site-of-care reimbursement changes.

    Tenure and stability: the provider’s NPI was enumerated on 2005-06-22 (~21 years ago), indicating long-standing participation in Medicare. This length of enrollment is consistent with an established specialty practice and supports the observed accumulated volume and procedural throughput in retina services.

    Local payer implications: with no Medicaid billing on file, the provider offers little to no coverage for Medicaid populations and is effectively single-payer from a public program perspective. For payers or network planners seeking Medicaid access or broad dual-eligibility coverage, this provider would not meaningfully expand Medicaid capacity; conversely, Medicare-focused networks evaluating retina capacity should consider this provider a high-volume ranibizumab and retina-imaging resource.

    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.

    14 rows

    CPT/HCPCS CodeDescriptionClaimsAvg PaidRevenue
    J2778Injection, ranibizumab, 0.1 mg6,120$180$1.1M
    J0178Injection, aflibercept, 1 mg1,130$690$777.4K
    J2777Injection, faricimab‑svoa, 0.1 mg11,640$30$337.6K
    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.1,580$90$144.1K
    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.1,930$30$54.2K
    99213The 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…530$60$33.1K
    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…300$70$22.1K
    67108The provider repairs a detached retina using heat produced by a laser beam or by freezing the tissues. He may attach a scleral buckle to simplify the passage of fluid through and behind the retina or…20$870$15.6K
    99214The 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…120$90$11.1K
    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…90$110$10.5K

    Showing 1–10 of 14

    Medicare: Competitive Analysis & Benchmarks

    How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 14 CPT/HCPCS codes.

    View: State1 / 2

    Full comparison — all codes billed, vs. state median

    14 rows

    CPT/HCPCS CodeRankProvider CountMedian ClaimsAvg PaidAverage Revenue
    J01783180790$680$769.8K
    J2777355015,060$30$592.1K
    J27784401,340$180$370.2K
    6702828801,130$90$98.5K
    67108163020$970$29.2K
    92014201810120$80$19.2K
    992145,74311,370120$80$16.6K
    921343560060$30$8.2K
    9921352111,03080$50$8K
    92235114050$100$5.7K

    Showing 1–10 of 14

    Related Providers

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

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    James MillerTNRetina Specialist (Ophthalmology) Physician$3.9M$0
    Devon GhodasraTNRetina Specialist (Ophthalmology) Physician$3.6M$0
    Nicholas AndersonTNRetina Specialist (Ophthalmology) Physician$3M$0
    Rohan ShahTNRetina Specialist (Ophthalmology) Physician$2.9M$0
    Scott BarbTNOphthalmology Physician$2.8M$0
    Robert ShulerTNRetina Specialist (Ophthalmology) Physician$2.6M$0
    Ailee LahamTNRetina Specialist (Ophthalmology) Physician$2.5M$0
    Stephen PerkinsTNRetina Specialist (Ophthalmology) Physician$2.3M$0
    Francis DecroosTNRetina Specialist (Ophthalmology) Physician$2.3M$0
    Cristoforo LarzoTNRetina Specialist (Ophthalmology) Physician$2.2M$0

    Nearby Providers

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

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    Omni Community Health, Inc.TNCommunity/Behavioral Health Agency$0$77.7M
    Summit Medical Group, PLLCTNInternal Medicine Physician$0$44.5M
    Allergy Associates, P.A.TNSpecialist$0$26.5M
    Knoxville Pediatric Dentistry, PLLCTNGeneral Practice Dentistry$0$11.2M
    The Florence Crittenton Agency IncTNCommunity/Behavioral Health Agency$0$10.7M
    Bsp Enterprises, LLCTNIn Home Supportive Care Agency$0$8M
    Associated Pain Specialists, PCTNPain Medicine Physician$0$6.8M
    Jeremiah BivinsTNAllergy & Immunology Physician$419.4K$4.6M
    Westbrook Medical Center, PLLCTNFamily Medicine Physician$0$4M
    Pcet Surgery Center LLCTNAmbulatory Surgical Clinic/Center$1.7M$60K

    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
    Tod Mcmillan — 1 of 14 codes billed far more than typical (above p95)
    p5–p95 (all providers)p25–p75MedianThis providerOutlier
    Rank Distribution — Tennessee