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

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

James Howard (NPI 1033110119)

Field	Value
Entity Type	Individual
Organization	James Howard
Address	5169 Cottonwood St Ste 630
City	Salt Lake City
State	UT
ZIP	84107
Taxonomy	Retina Specialist (Ophthalmology) Physician
NPI Enumerated	August 10, 2005

Payer Source	Total Paid
Medicare	$2M
Medicaid	$0

Key Findings

Medicare is effectively this provider's sole public payer: lifetime Medicare revenue is $2M while Medicaid billing is listed as none, indicating a single-payer footprint in public programs that concentrates reimbursement and payer risk on Medicare. Analysts should treat Medicaid exposure as negligible when modeling this provider's public-payor business volume or negotiating state-level network contracts.

Revenue concentration is high within a narrow set of drugs and procedures: the precomputed top‑3 Medicare codes account for 79.5% of total Medicare revenue, signaling that a small number of intravitreal therapies and related services drive the bulk of receipts. That concentration amplifies sensitivity to changes in reimbursement or utilization for those specific codes.

The largest single Medicare revenue contributor is J2777, which accounts for $836.9K (42.6% of total Medicare revenue) and ranks #315 of 2039 providers nationally (85th percentile; typical, unremarkable volume for this code). This places the provider above median national volume for faricimab administration but still within a typical activity range rather than as a dominant national outlier.

J0178 is the second major revenue driver, generating $609.5K (31.1% of total Medicare revenue) across 882 claims with an average paid/claim of $691, and ranks #1407 of 3204 providers nationally (56th percentile; typical, unremarkable volume). The relatively high average payment per claim for J0178 compared with many other codes suggests a materially different reimbursement profile per claim, reflecting the economic importance of this drug to the practice.

The provider shows a notable imaging footprint that exceeds typical national volumes: 92134 produced 1.4K claims and $42.5K (2.2% of total Medicare revenue) and ranks #1624 of 26868 providers nationally (94th percentile; notably above typical national volume). High OCT/retinal imaging utilization is consistent with a retina-focused practice and supports the frequent intravitreal therapy workflow reflected in the drug codes.

There are pockets of both high‑value, low‑volume drug billing and low‑volume surgical activity: J3490 (unclassified drugs) accounts for $113.4K (5.8%) with a high average paid/claim of $1383 across 82 claims, while 67042 (vitrectomy/ILM removal) appears only 16 times for $13.8K (0.7%). These patterns are consistent with a retina specialist whose revenue mix is dominated by intravitreal pharmacotherapy supplemented by occasional surgical procedures and atypical drug charges.

Competitive standing across codes is mixed: pegcetacoplan (J2781) shows relatively strong placement at #133 of 490 providers (73th percentile; typical, unremarkable volume) and Q5128 (ranibizumab biosimilar) sits lower in specialty-specific rankings at #294 of 373 providers (21th percentile). This suggests the provider is a relatively active adopter of several newer retinal therapeutics but is not uniformly dominant across all specialty drug classes.

There are clear statistical outliers on both ends of the distribution: 92134 is identified as 'notably above typical national volume', supporting a high-throughput retinal imaging operation, whereas codes such as 92235 rank at the 7th percentile (typical, unremarkable volume) indicating minimal use of fluorescein angiography relative to peers. Taken together with the NPI tenure (NPI enumerated: 2005-08-10 (~21 years ago)), the profile is of an established retina practice with concentrated pharmacologic treatment volume and strong diagnostic imaging activity but limited Medicaid engagement.

Medicare: Complete Services Breakdown

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

15 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J2777	Injection, faricimab‑svoa, 0.1 mg	28,860	$30	$836.9K
J0178	Injection, aflibercept, 1 mg	880	$690	$609.5K
J3490	Unclassified drugs	80	$1,380	$113.4K
J2781	Injection, pegcetacoplan, intravitreal, 1 mg	930	$120	$111.8K
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.	1,100	$100	$105.9K
Q5128	Injection, ranibizumab-eqrn (cimerli), biosimilar, 0.1 mg	250	$220	$53.1K
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.	1,420	$30	$42.5K
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…	510	$80	$42.1K
J7999	Compounded drug, not otherwise classified	320	$70	$22.5K
67042	In this procedure, the provider removes vitreous humor, the gelatinous material that gives shape to the eye, using a mechanical cutting tool. He removes the internal limiting membrane of the retina…	20	$870	$13.8K

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

Claims Volume vs. Utah Distribution

James Howard — 1 of 15 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Utah

Full comparison — all codes billed, vs. state median

15 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0178	12	40	620	$690	$683.2K
J2777	8	20	13,140	$30	$523.9K
J3490	13	30	80	$1,690	$199.5K
J2781	9	20	960	$120	$126.6K
Q5128	3	10	290	$220	$69.1K
67028	12	60	440	$90	$61.7K
67042	7	20	20	$1,100	$26.3K
J7999	4	20	120	$70	$16.9K
92014	38	330	140	$70	$16.6K
92134	12	250	70	$30	$7.6K

Showing 1–10 of 15

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Joel Herring	UT	Retina Specialist (Ophthalmology) Physician	$5.6M	$23.7K
Victoria Knudsen	UT	Retina Specialist (Ophthalmology) Physician	$2.4M	$0
Robert Kwun	UT	Retina Specialist (Ophthalmology) Physician	$2.3M	$0
Kirk Winward	UT	Retina Specialist (Ophthalmology) Physician	$2.2M	$0
Eric Brinton	UT	Retina Specialist (Ophthalmology) Physician	$1.3M	$0
Rick Nordgren	UT	Retina Specialist (Ophthalmology) Physician	$888.1K	$0
Gregory Brinton	UT	Retina Specialist (Ophthalmology) Physician	$673.5K	$0
Retina Associates Of Utah, PLLC	UT	Retina Specialist (Ophthalmology) Physician	$0	$653.5K
Rachael Jacoby	UT	Ophthalmology Physician	$137K	$0
James Kohler	UT	Ophthalmology Physician	$6.8K	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Ihc Health Services, Inc.	UT	General Acute Care Hospital	$0	$68.7M
Ihc Health Services, Inc.	UT	Clinical Medical Laboratory	$2.7M	$17.9M
Alpine Home Medical Equipment LLC	UT	Oxygen Equipment & Supplies (DME)	$0	$18.6M
Ddi Vantage	UT	Developmentally Disabled Services Day Training Agency	$0	$18.4M
Utah Emergency Physicians	UT	Emergency Medicine Physician	$0	$14.5M
Home Caregivers Partnership, LLC	UT	Home Health Agency	$0	$10.4M
Gcs Foundation	UT	Supports Brokerage Agency	$0	$6.2M
Ihc Health Services Inc	UT	Diagnostic Radiology Physician	$0	$6.1M
Project Reality	UT	Mental Health Counselor	$0	$5.1M
Caregiver Support Network, Inc	UT	Home Health Agency	$0	$5M

James Howard — Billing Profile & Reimbursement Data

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James Howard — 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