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

Why is the Medicaid comparison limited to South Dakota 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. South Dakota (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.

Prema Abraham (NPI 1063492940)

Field	Value
Entity Type	Individual
Organization	Prema Abraham
Address	2800 3rd St
City	Rapid City
State	SD
ZIP	57701
Taxonomy	Retina Specialist (Ophthalmology) Physician
NPI Enumerated	January 18, 2006

Payer Source	Total Paid
Medicare	$7.1M
Medicaid	$0

Key Findings

PREMA ABRAHAM practices as a retina specialist with a service mix dominated by intravitreal injections and retina-focused diagnostics and surgeries; top billed items are high-volume injectable drug administrations (J2777, J0178, J2781) and related injection procedure codes like 67028. The code mix — large counts for medication injections and retinal imaging/surgical CPTs — is consistent with a clinic that primarily delivers medical retina treatments rather than general ophthalmology office visits.

Medicare drives the provider’s entire reported public-payer revenue base: total Medicare revenue is $7.1M while there is no Medicaid billing on file, making this effectively a single-payer (Medicare) practice in the available data. The absence of Medicaid claims suggests negligible Medicaid-facing volume or nonparticipation in state Medicaid billing.

Revenue is highly concentrated in a few high-cost drug codes: the top three Medicare codes account for 76.6% of the provider’s total Medicare revenue, led by J2777 ($2.7M, 37.1%), J0178 ($2.2M, 30.6%), and J3490 ($641.6K, 9.0%). This concentration indicates the majority of Medicare dollars flow from a small set of biologic and unclassified drug administrations rather than broad E/M or minor procedure diversity.

The provider is a national outlier on multiple medication codes, indicating unusual scale for certain retina therapeutics: J2777 (91.4K claims, $2.7M) ranks #24 of 2039 providers nationally (99th percentile; extreme outlier), and J2781 (4.3K claims, $518.4K) ranks #7 of 490 providers nationally (99th percentile; extreme outlier). J0178 (3.2K claims, $2.2M) also ranks highly at #156 of 3204 providers (95th percentile; notably above typical national volume), so for several high-revenue biologics this provider is a major national-level participant.

Operational throughput for retina-specific procedures and diagnostics is also elevated: 67028 shows 3.7K claims and $347.4K revenue (4.9% of Medicare revenue) and ranks #40 of 4255 providers nationally (99th percentile; extreme outlier), while retinal imaging 92134 has 4.4K claims and $127.3K revenue (1.8%) and ranks #92 of 26868 providers nationally (100th percentile; extreme outlier). These volumes together suggest an integrated clinical model with frequent same-day or follow-up imaging and injection visits supporting high procedural throughput.

The provider uses significant unclassified drug/biologic billing alongside named agents: J3490 (370 claims, $641.6K; 9.0% of revenue) ranks #152 of 2838 providers nationally (95th percentile; typical, unremarkable volume) and J3590 (71 claims, $148.4K; 2.1%) ranks #356 of 631 providers nationally (44th percentile). J7999 compounded drug billing (629 claims, $44K) ranks #108 of 1333 providers nationally (92th percentile), indicating a nontrivial portion of revenue coded to catch-all or compounded drug categories in addition to labeled biologics.

The practice’s financial profile is sensitive to utilization and reimbursement dynamics for specific retina biologics because a large share of Medicare revenue is tied to a few drug codes (top three = 76.6%). Any shifts in drug choice, payer policy, or reimbursement for J2777, J0178, or related injection codes could materially affect overall Medicare revenue given this concentration.

PREMA ABRAHAM’s NPI was enumerated on 2006-01-18 (~20 years ago), reflecting long tenure in the Medicare program; combined with the concentrated, high-volume billing patterns, this suggests an established retina-focused operation with sustained specialty throughput rather than a newly formed practice.

Medicare: Complete Services Breakdown

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

26 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J2777	Injection, faricimab‑svoa, 0.1 mg	91,440	$30	$2.7M
J0178	Injection, aflibercept, 1 mg	3,180	$690	$2.2M
J3490	Unclassified drugs	370	$1,730	$641.6K
J2781	Injection, pegcetacoplan, intravitreal, 1 mg	4,320	$120	$518.4K
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.	3,700	$90	$347.4K
Q5124	Injection, ranibizumab-nuna, biosimilar, (byooviz), 0.1 mg	890	$170	$152.9K
J3590	Unclassified biologics	70	$2,090	$148.4K
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.	4,390	$30	$127.3K
J2778	Injection, ranibizumab, 0.1 mg	500	$180	$91K
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	$90	$48.2K

Showing 1–10 of 26

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 26 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. South Dakota Distribution

Prema Abraham — 8 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — South Dakota

Full comparison — all codes billed, vs. state median

26 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0178	1	10	690	$690	$788.7K
J2777	1	10	21,120	$30	$782K
J2781	1	10	1,340	$120	$241.3K
Q5124	1	10	890	$170	$153.2K
J3490	1	10	60	$1,340	$148.5K
J2778	3	10	550	$180	$123K
67028	1	10	740	$90	$108.5K
J3590	1	10	60	$1,450	$81.2K
J7999	4	10	260	$70	$39.1K
67042	2	10	30	$1,140	$38.6K

Showing 1–10 of 26

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Nathan Steinle	CA	Retina Specialist (Ophthalmology) Physician	$9.5M	$0
Kyle Thompson	ID	Retina Specialist (Ophthalmology) Physician	$4.5M	$0
Douglas Holmes	WY	Retina Specialist (Ophthalmology) Physician	$4.1M	$0
Mitchell Goff	UT	Retina Specialist (Ophthalmology) Physician	$3.8M	$0
Richard Kinsey	TN	Anatomic Pathology & Clinical Pathology Physician	$3.3M	$147.3K
Brendan Girschek	AZ	Ophthalmology Physician	$3.2M	$0
John Bormes	SD	Ophthalmology Physician	$2.6M	$0
John Purviance	WY	Radiation Oncology Physician	$2.5M	$0
Cary Chisholm	TX	Anatomic Pathology & Clinical Pathology Physician	$2.5M	$24.7K
Stacey Wells	AK	Radiation Oncology Physician	$2M	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Behavior Management Systems, Inc.	SD	Community/Behavioral Health Agency	$0	$19.8M
Monument Health Rapid City Hospital, Inc	SD	Multi-Specialty Clinic/Center	$0	$18.7M
Monument Health Rapid City Hospital, Inc.	SD	General Acute Care Hospital	$0	$11.5M
Community Health Center Of The Black Hills Inc	SD	Federally Qualified Health Center (FQHC)	$0	$10.2M
Jrk Services, Inc	SD	Home Health Agency	$0	$10.1M
Black Hills Pediatrics, LLP	SD	Pediatrics Physician	$0	$9.7M
Rapid City Emergency Services PA	SD	Emergency Medicine Physician	$0	$8.2M
Wellspring Inc.	SD	Psychiatry Physician	$0	$7.4M
Radiology Associates Prof, LLC	SD	Diagnostic Radiology Physician	$0	$5.3M
Monument Health Rapid City Hospital, Inc.	SD	Multi-Specialty Clinic/Center	$0	$5.2M

Prema Abraham — 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