Loading...
NPI 1063489383 · Pensacola, FL · Retina Specialist (Ophthalmology) Physician
Customize your policy alerts
Get alerted when relevant policies change without checking for updates manually.
Monitor payer policy activity
Sunil Gupta is a retina specialist (ophthalmology) physician provider located in Pensacola, Florida. This profile covers 23 Medicare and 3 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 | Sunil Gupta |
| Address | 5150 N Davis Hwy |
| City | Pensacola |
| State | FL |
| ZIP | 32503 |
| Taxonomy | Retina Specialist (Ophthalmology) Physician |
| NPI Enumerated | March 6, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $11.4M |
| Medicaid | $36.1K |
SUNIL GUPTA’s billing profile is highly concentrated in intravitreal biologic injections and retina-focused services, consistent with his Retina Specialist taxonomy. The top Medicare codes by revenue are J0178 ($4.6M, 40.2% of Medicare revenue), J2777 ($1.8M, 15.5%), and J2778 ($1.6M, 13.9%), and these specific codes map to high-volume anti-VEGF and novel retina therapeutics delivered via intravitreal injection. This mix indicates an operational model built around frequent in-office injections rather than primary-care or broad ophthalmology services.
Revenue concentration is pronounced for both payers: the top 3 Medicare codes account for 69.7% of total Medicare revenue, and the top 3 Medicaid codes account for 100.0% of total Medicaid revenue. That concentration signals material dependence on a small set of high-value procedures and drugs (notably intravitreal injections), which concentrates both clinical workload and reimbursement risk/opportunity on those service lines.
On Medicare-specific competitive standing, the provider is an outlier for several high-revenue injection codes: J0178 ranks #8 of 3204 providers nationally (100th percentile; extreme outlier) and J2778 ranks #12 of 1208 providers nationally (99th percentile; extreme outlier), while J2777 ranks #65 of 2039 providers nationally (97th percentile; notably above typical national volume). Those rankings indicate SUNIL GUPTA is a major national-volume provider for leading retinal biologics, far above typical national volumes for these codes.
Despite high national standing on Medicare injection codes, the provider’s Medicaid footprint is negligible in scale: total Medicaid revenue is $36.1K versus $11.4M in Medicare, so the practice is effectively Medicare-dominant. Medicaid billing is almost entirely concentrated in 67028 (99.5% of Medicaid revenue, $35.9K), but that Medicaid volume ranks #63 of 77 in-state (18th percentile), indicating only a modest presence among Florida Medicaid retina providers.
Service-line detail beyond injections supports a full-spectrum retina practice: high Medicare volumes appear in procedure and diagnostic codes such as 67028 (5.9K claims, $556K, ranks #3 of 4255, 100th percentile; extreme outlier), 92014 (5.7K claims, $494.3K, ranks #2 of 35415, 100th percentile; extreme outlier) and 92134 (6K claims, $179.3K, ranks #15 of 26868, 100th percentile; extreme outlier). These volumes indicate habitual comprehensive exams, retina imaging, and routine injection procedures performed in-office, implying end-to-end retina care capacity including diagnostics and frequent follow-up visits.
The provider shows significant utilization of newer and high-cost retina therapeutics and related drug billing patterns: J0178 average paid/claim is $683, J2777 average paid/claim is $29, J2778 average paid/claim is $180, and J2781 (pegcetacoplan) contributes $840.6K (7.4% of Medicare revenue) while ranking #3 of 490 providers nationally (100th percentile; extreme outlier). Additionally, J3490 (unclassified drugs) accounts for $974.4K (8.6% of Medicare revenue) and ranks #93 of 2838 providers nationally (97th percentile; typical, unremarkable volume), suggesting material billing for nonstandard or compounded agents alongside branded biologics.
The contrast in per-claim payments between payers for the same procedure is notable: 67028 averages $94 paid/claim on Medicare and $854 paid/claim on Medicaid in this dataset, while 92014 averages $86 on Medicare versus $4 on Medicaid. These disparities, together with the tiny absolute Medicaid revenue, imply different reimbursement dynamics and possible coding/payment variances across payers that materially affect realized revenue per encounter.
SUNIL GUPTA is a long-tenured clinician in this dataset (NPI enumerated on 2006-03-06, ~20 years ago), which aligns with the sustained, high-volume specialist billing pattern observed. The combination of long tenure and repeated extreme-outlier rankings on multiple retina drug and procedure codes suggests an established retina practice with concentrated expertise and case volumes focused on intravitreal therapeutics and retina diagnostics.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
23 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 6,710 | $680 | $4.6M |
| J2777 | Injection, faricimab‑svoa, 0.1 mg | 60,900 | $30 | $1.8M |
| J2778 | Injection, ranibizumab, 0.1 mg | 8,820 | $180 | $1.6M |
| J3490 | Unclassified drugs | 550 | $1,760 | $974.4K |
| J2781 | Injection, pegcetacoplan, intravitreal, 1 mg | 7,010 | $120 | $840.6K |
| 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. | 5,920 | $90 | $556K |
| 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… | 5,750 | $90 | $494.3K |
| J7312 | Injection, dexamethasone, intravitreal implant, 0.1 mg | 1,370 | $160 | $215.7K |
| 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. | 5,980 | $30 | $179.3K |
| 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… | 760 | $60 | $44K |
Showing 1–10 of 23
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 23 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
23 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J0178 | 1 | 250 | 800 | $690 | $817.6K |
| J2777 | 6 | 170 | 12,810 | $30 | $549.2K |
| J2778 | 3 | 110 | 660 | $180 | $234.1K |
| J2781 | 1 | 50 | 500 | $120 | $102K |
| 67028 | 1 | 300 | 710 | $90 | $91.1K |
| J3490 | 16 | 180 | 70 | $280 | $87.5K |
| J7312 | 1 | 40 | 230 | $160 | $45.5K |
| 67042 | 15 | 80 | 20 | $1,180 | $36.5K |
| 67036 | 39 | 70 | 20 | $1,050 | $31.4K |
| 92014 | 1 | 2,180 | 160 | $80 | $28.5K |
Showing 1–10 of 23
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.
3 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | 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. | 40 | $850 | $35.9K |
| 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… | 40 | $1 | $160 |
| 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. | 60 | $0 | $0 |
How this provider's Medicaid billing volume and revenue compare to other Florida providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Florida median
3 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 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… | 792 | 980 | 270 | $60 | $85.1K |
| 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. | 63 | 80 | 320 | $50 | $59.6K |
| 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. | 121 | 170 | 200 | $10 | $10.5K |
Other providers in the same ZIP code as Sunil Gupta, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Baptist Health Care, Inc | FL | General Acute Care Hospital | $0 | $18.4M |
| Interventional Therapeutics Institute, LLC | FL | Ambulatory Surgical Clinic/Center | $2.8M | $7.6K |
| Coyt Rountree | FL | Radiation Oncology Physician | $2.5M | $0 |
| Rami Owera | FL | Medical Oncology Physician | $2.3M | $0 |
| Jamal Joudeh | FL | Medical Oncology Physician | $2.1M | $0 |
| Endoscopy Group LLC | FL | Ambulatory Surgical Clinic/Center | $1.6M | $253.9K |
| The Surgery Center At Woodlands, LLC | FL | Ambulatory Surgical Clinic/Center | $1.8M | $0 |
| Shailesh Patel | FL | Medical Oncology Physician | $1.6M | $0 |
| John Schaub | FL | Medical Oncology Physician | $1.6M | $0 |
| Vivid Pathology PA | FL | Anatomic Pathology & Clinical Pathology Physician | $877.8K | $591K |
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.