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NPI 1083800502 · Auburn, WA · Retina Specialist (Ophthalmology) Physician
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Rahul Mandiga is a retina specialist (ophthalmology) physician provider located in Auburn, Washington. This profile covers 19 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 | Rahul Mandiga |
| Address | 125 3rd St Ne Ste 200 |
| City | Auburn |
| State | WA |
| ZIP | 98002 |
| Taxonomy | Retina Specialist (Ophthalmology) Physician |
| NPI Enumerated | September 18, 2007 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $1.9M |
| Medicaid | $1.3K |
Provider is effectively Medicare-centric: lifetime Medicare revenue is $1.9M versus total Medicaid revenue of $1.3K, indicating that nearly all billed volume and dollars flow through Medicare and that Medicaid activity is negligible for this NPI. This makes the provider a single-payer (Medicare)-focused practice for practical underwriting and network decisions.
Medicare revenue is highly concentrated in intravitreal drug and injection services: the top 3 Medicare codes (J0178, J2777, 67028) account for 77.4% of the provider's total Medicare revenue. J0178 (aflibercept) alone contributes $825.4K (43.9%), and J2777 (faricimab) contributes $522.2K (27.8%), signaling that high-cost biologic injections are the principal business line.
Clinical mix points to a medical-retina injection practice with diagnostic support: the dominant codes are intravitreal drug codes (J0178, J2777) plus the isolated intravitreal injection procedure 67028, and the provider also bills substantial retinal imaging (92134, $49.8K) and intermediate/comprehensive office visits (92012, 92014). This pattern is consistent with a retina specialist whose revenue depends on high-volume injection therapy supported by OCT imaging and ongoing office management.
Competitive standing on Medicare for the two highest-revenue drug codes is typical rather than dominant: J0178 ranks #1095 of 3204 providers nationally (66th percentile) and J2777 ranks #593 of 2039 providers nationally (71th percentile), both labeled as “typical, unremarkable volume for this code.” In contrast, the provider shows above-typical activity on certain ancillary services — 92134 (OCT) ranks #1561 of 26868 (94th percentile, described as “notably above typical national volume”) and J3490 (unclassified drugs) ranks #185 of 2838 (93th percentile), indicating relative strength in imaging and nonstandard drug billing.
Medicaid activity is minimal and concentrated: the top Medicaid code 67028 accounts for $948 (75.2% of Medicaid revenue) and 92134 accounts for $312 (24.8%), and the precomputed top-3 share is 100.0% of Medicaid revenue. State-level ranks show very limited Medicaid presence: 67028 is #57 of 57 in-state (0th percentile) and 92134 is #91 of 100 (5th percentile), so the provider is not a meaningful Medicaid competitor in Washington.
Operational characteristics suggested by claim-level details: J0178 average paid/claim is $689 (1.2K claims) and J2777 average paid/claim is $29 (18K claims), which together generate the bulk of Medicare revenue. The combination of high total paid-per-claim for aflibercept and a large claim count for faricimab implies a workflow optimized for frequent intravitreal administration and inventory/medication handling, which has implications for drug procurement and revenue variance exposure.
Coding and utilization signals to monitor: J3490 (unclassified drugs) generates $107.3K (5.7% of Medicare revenue) and ranks in the 93th percentile nationwide, so reviewers should note a relatively high reliance on unclassified drug billing compared with peers. Likewise, two evaluation/management and diagnostic codes — 99204 (93th percentile) and 92134 (94th percentile) — are described as “notably above typical,” suggesting above-average use of diagnostic imaging and some higher-level new-patient visits relative to national peers.
Provider tenure is long-established: the NPI was enumerated on 2007-09-18 (~19 years ago), indicating nearly two decades of billing history. That tenure supports the interpretation that current patterns (injection-heavy Medicare revenue and negligible Medicaid) reflect a sustained clinical focus rather than a recent shift in service mix.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
19 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 1,200 | $690 | $825.4K |
| J2777 | Injection, faricimab‑svoa, 0.1 mg | 18,010 | $30 | $522.2K |
| 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. | 1,040 | $110 | $109K |
| J3490 | Unclassified drugs | 330 | $330 | $107.3K |
| J2778 | Injection, ranibizumab, 0.1 mg | 280 | $190 | $52K |
| 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… | 670 | $80 | $50.5K |
| 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. | 1,470 | $30 | $49.8K |
| 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… | 430 | $100 | $44.7K |
| 92235 | The provider uses a special dye, fluorescein that causes the blood vessels in the one or both eyes to stand out in photographic images taken with the use of multiframe timing, or serial images, taken… | 210 | $120 | $24.7K |
| 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… | 130 | $130 | $17.3K |
Showing 1–10 of 19
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 19 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
19 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J2777 | 20 | 50 | 12,780 | $30 | $599.7K |
| J0178 | 31 | 90 | 470 | $680 | $597.2K |
| J2778 | 21 | 30 | 510 | $180 | $117.1K |
| 67028 | 39 | 110 | 550 | $90 | $72.9K |
| J3490 | 2 | 70 | 70 | $50 | $51.2K |
| 67108 | 10 | 20 | 20 | $1,180 | $29.6K |
| 92242 | 20 | 20 | 50 | $210 | $19.7K |
| 92014 | 107 | 790 | 110 | $80 | $16.8K |
| 99214 | 3,643 | 10,860 | 100 | $80 | $13.6K |
| 92012 | 18 | 220 | 70 | $70 | $12.9K |
Showing 1–10 of 19
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 |
|---|---|---|---|---|
| 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. | 10 | $80 | $950 |
| 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. | 10 | $20 | $310 |
How this provider's Medicaid billing volume and revenue compare to other Washington providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Washington 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. | 57 | 60 | 710 | $40 | $81.7K |
| 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. | 91 | 100 | 240 | $10 | $22.2K |
Other providers in the same ZIP code as Rahul Mandiga, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| We Care Daily Clinics LLC | WA | Methadone Clinic | $166.2K | $260.6M |
| Apple Physical Therapy, LLC | WA | Physical Therapist | $0 | $31.3M |
| Healthpoint | WA | Federally Qualified Health Center (FQHC) | $0 | $14.5M |
| Healthpoint | WA | Federally Qualified Health Center (FQHC) | $0 | $3M |
| Eid, Jaber, Jassar, PLLC | WA | Dental Clinic/Center | $0 | $2.7M |
| South Sound Surgery, PLLC | WA | Ambulatory Surgical Clinic/Center | $137.6K | $457K |
| Joshua Frenkel | WA | Ophthalmology Physician | $306.8K | $0 |
| Ashish Trivedi | WA | Specialist | $295.5K | $0 |
| Richard Beller | WA | Ophthalmology Physician | $293.2K | $0 |
| Alan Chen | WA | Specialist | $99.9K | $0 |
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