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NPI 1053358978 · Phoenix, AZ · Ophthalmology Physician
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Edward Quinlan is a ophthalmology physician provider located in Phoenix, Arizona. This profile covers 13 Medicare and 2 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.
Provider details (source: NPPES NPI Registry)
| Field | Value |
|---|---|
| Entity Type | Individual |
| Organization | Edward Quinlan |
| Address | 1101 E Missouri Ave |
| City | Phoenix |
| State | AZ |
| ZIP | 85014 |
| Taxonomy | Ophthalmology Physician |
| NPI Enumerated | May 31, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $2.6M |
| Medicaid | $7.1K |
Edward Quinlan is an Ophthalmology Physician based in PHOENIX, AZ with an NPI enumerated on 2006-05-31 (~20 years ago), indicating long tenure in Medicare billing. The specialty and length of enrollment are consistent with an established independent or small-group ophthalmology practice focused on retinal procedures and injections rather than a recently established clinician.
Medicare dominates this provider’s payer mix: total Medicare revenue is $2.6M versus total Medicaid revenue of $7.1K, so the practice is effectively Medicare-centric in scale. Because Medicaid receipts are immaterial relative to Medicare, operational and financial sensitivity will primarily reflect changes in Medicare reimbursement and utilization.
Revenue concentration on Medicare is high: the top 3 Medicare codes account for 84.3% of this provider’s total Medicare revenue. Those top three codes are injection-focused (J0178 $1.3M, J2778 $509K, J2777 $356.7K), indicating that anti‑VEGF and intravitreal therapies are the primary revenue drivers rather than routine office evaluation codes.
Clinical/service-line implications from the code mix point to a retina-focused, procedure-driven operation: J0178 (injection, aflibercept) alone generates $1.3M and represents 50.8% of Medicare revenue, while J2778 and J2777 (ranibizumab and faricimab) contribute $509K (19.7%) and $356.7K (13.8%) respectively. High volumes of injection codes (e.g., J0178: 1.9K claims; J2778: 2.8K claims; J2777: 12.3K claims) combined with retinal imaging (92134) suggest an office infrastructure optimized for frequent intravitreal administration and retina diagnostics.
92134 (computerized retinal imaging) is a notable statistical outlier on Medicare: it produced $67.6K (2.6% of Medicare revenue) and ranks in the 97th percentile nationally (labeled an "extreme outlier, far above typical national volume for this code"). That elevated imaging volume supports the interpretation of a high-throughput retina service line and may reflect intensive monitoring protocols that accompany frequent intravitreal therapy.
Competitive standing is mixed by code: for injectable drugs the provider shows above-typical national activity on some products (J0178 ranks #583 of 3204, 82nd percentile; J2778 ranks #130 of 1208, 89th percentile) while other injection codes are closer to median volumes (J2777 ranks #859 of 2039, 58th percentile). In aggregate, the provider is a strong regional participant for certain anti‑VEGF products but not an outsize national leader across all retinal injection codes.
Medicaid activity is minimal and highly concentrated: top Medicaid codes account for 100.0% of Medicaid revenue, with 92134 producing $6.2K (85.9% of Medicaid revenue) and 67028 producing $1K (14.1%). In-state rankings for those Medicaid codes are unremarkable to modest (92134 at the 52nd percentile in-state; 67028 at the 20th percentile), underscoring that Medicaid contributes little to overall volume or competitive positioning.
The business and financial profile carries concentration risk because Medicare injectable drugs and associated procedures dominate revenue (top 3 Medicare codes = 84.3%). Operational considerations—inventory and drug procurement for high-cost injectables (e.g., J0178 with $693 avg paid/claim), scheduling and throughput to manage thousands of injection claims, and reliance on Medicare reimbursement policies—will disproportionately influence revenue stability and margins.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
13 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 1,890 | $690 | $1.3M |
| J2778 | Injection, ranibizumab, 0.1 mg | 2,830 | $180 | $509K |
| J2777 | Injection, faricimab‑svoa, 0.1 mg | 12,300 | $30 | $356.7K |
| 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. | 1,880 | $90 | $170.8K |
| 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. | 2,420 | $30 | $67.6K |
| 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… | 560 | $80 | $43.2K |
| J7999 | Compounded drug, not otherwise classified | 530 | $70 | $38.4K |
| J7312 | Injection, dexamethasone, intravitreal implant, 0.1 mg | 200 | $160 | $31.2K |
| 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… | 290 | $100 | $27.4K |
| 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… | 110 | $110 | $11.8K |
Showing 1–10 of 13
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 13 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
13 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J0178 | 9 | 50 | 780 | $690 | $734.8K |
| J2777 | 20 | 50 | 9,000 | $30 | $525.8K |
| J2778 | 2 | 30 | 550 | $180 | $198K |
| 67028 | 18 | 60 | 1,240 | $90 | $119K |
| J7312 | 18 | 20 | 270 | $160 | $48.9K |
| J7999 | 21 | 50 | 490 | $70 | $46.8K |
| 92014 | 103 | 650 | 140 | $80 | $21.5K |
| 99214 | 2,746 | 10,410 | 120 | $80 | $20.6K |
| 92235 | 34 | 40 | 120 | $100 | $14.3K |
| 92134 | 28 | 540 | 90 | $30 | $10.1K |
Showing 1–10 of 13
Medicaid revenue breakdown by year and by CPT/HCPCS procedure code, including monthly billing trends and the top codes driving revenue.
View: By Year1 / 3
Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.
2 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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. | 420 | $20 | $6.2K |
| 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. | 30 | $40 | $1K |
How this provider's Medicaid billing volume and revenue compare to other Arizona providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Arizona median
2 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 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. | 25 | 30 | 380 | $70 | $266.2K |
| 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. | 32 | 70 | 300 | $20 | $98.9K |
Other providers in the same ZIP code as Edward Quinlan, ranked by combined Medicare and Medicaid revenue.
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