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NPI 1104886332 · Kingston, PA · Ophthalmology Physician
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Erik Kruger is a ophthalmology physician provider located in Kingston, Pennsylvania. This profile covers 17 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 | Erik Kruger |
| Address | 703 Rutter Ave |
| City | Kingston |
| State | PA |
| ZIP | 18704 |
| Taxonomy | Ophthalmology Physician |
| NPI Enumerated | March 23, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $2.4M |
| Medicaid | $11.8K |
This provider is effectively Medicare‑focused in scale: lifetime Medicare revenue is $2.4M compared with $11.8K in Medicaid, so Medicaid represents a vanishing share of lifetime billing. The data indicate a single‑payer dominance rather than a balanced payer mix, with Medicare driving nearly all fee revenue.
Medicare revenue is highly concentrated: the precomputed top three Medicare codes account for 86.3% of total Medicare revenue, and J0178 alone represents 70.8% of the provider's Medicare receipts ($1.7M from 2.5K claims at $690 avg paid/claim). This concentration ties the provider’s financial performance closely to intravitreal aflibercept use and reimbursement for that drug.
The provider’s code mix points to an interventional retina practice model: dominant use of intravitreal drugs (J0178, J2778, J2777 and presence of J2781) combined with high imaging volumes (92134) and frequent injection procedure coding (67028) suggests clinic operations built around recurrent injection visits, imaging surveillance, and procedural throughput. Routine comprehensive office visits (92014) are a much smaller share of revenue (2.8% Medicare, 3.1% Medicaid), reinforcing a procedure/drug‑centric workflow.
Competitive standing on specific services is mixed. For J0178 the provider ranks #330 of 3204 providers nationally (90th percentile; typical, unremarkable volume for this code), indicating above‑average national placement for aflibercept throughput while still being characterized as a typical volume pattern; by contrast, retinal imaging 92134 ranks #1221 of 26868 providers nationally (95th percentile; notably above typical national volume), showing comparatively exceptional imaging volume relative to peers.
Medicaid activity is small but mirrors the Medicare service mix: the top three Medicaid codes account for 100.0% of Medicaid revenue, with 92134 at 52.5% and 67028 at 44.4% of Medicaid receipts. In‑state ranks for these Medicaid codes are modest (92134 #91 of 183, 51st percentile; 67028 #72 of 99, 28th percentile), so the provider is not a dominant Medicaid retina supplier within Pennsylvania.
The provider has a long tenure with an NPI enumerated on 2006-03-23 (~20 years ago), indicating an established practice presence and likely stable referral relationships in the local market. That longevity, combined with a concentrated procedure/drug mix, suggests operational consistency over time rather than a newly formed service line.
Operational and supply implications arise from the dominant drug mix: heavy reliance on high‑cost intravitreal agents such as J0178 and measurable volumes of J2778, J2777 and J2781 imply substantial drug procurement, inventory management, and infusion/administration throughput requirements. Payers and network planners should note that changes in drug pricing, reimbursement, or clinical guidelines for anti‑VEGF/future agents could materially affect this provider’s revenue given the concentration in a few injectable therapeutics.
From a payer network and competitive analysis perspective, the provider is a notable Medicare retinal injector and imager but a modest Medicaid participant. High national percentile for 92134 (95th; notably above typical national volume) makes the provider an above‑average resource for retinal imaging among Medicare providers, while Medicaid ranks place the provider nearer the median or below for state Medicaid retina services.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
17 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 2,480 | $690 | $1.7M |
| J2778 | Injection, ranibizumab, 0.1 mg | 1,090 | $180 | $196.9K |
| J2777 | Injection, faricimab‑svoa, 0.1 mg | 6,120 | $30 | $177.5K |
| 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. | 1,660 | $80 | $132.5K |
| 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… | 790 | $90 | $67.5K |
| 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. | 1,800 | $30 | $52.3K |
| J2781 | Injection, pegcetacoplan, intravitreal, 1 mg | 420 | $120 | $50.4K |
| 67228 | In retinopathy, tiny new vessels grow profusely and fibrous tissue proliferates in between the layers of the retina, which may extend into the optic nerve and vitreous, clear gel that fills the space… | 30 | $230 | $7.9K |
| 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… | 60 | $100 | $6.4K |
| 99213 | The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the… | 50 | $60 | $3.2K |
Showing 1–10 of 17
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 17 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
17 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J0178 | 24 | 140 | 830 | $690 | $865.1K |
| J2778 | 33 | 70 | 1,030 | $190 | $417.1K |
| J2777 | 58 | 100 | 7,950 | $30 | $360.2K |
| J2781 | 16 | 20 | 690 | $120 | $109.1K |
| 67028 | 36 | 180 | 600 | $90 | $87.5K |
| J7999 | 88 | 110 | 100 | $120 | $33.3K |
| 92014 | 114 | 1,570 | 130 | $80 | $21K |
| 99214 | 20,341 | 23,230 | 100 | $80 | $14.5K |
| 92012 | 886 | 930 | 80 | $60 | $14K |
| 92235 | 25 | 70 | 40 | $100 | $10K |
Showing 1–10 of 17
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 |
|---|---|---|---|---|
| 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. | 290 | $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. | 110 | $50 | $5.2K |
| 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… | 10 | $30 | $360 |
How this provider's Medicaid billing volume and revenue compare to other Pennsylvania providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Pennsylvania median
3 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. | 72 | 100 | 330 | $70 | $85.4K |
| 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… | 799 | 860 | 240 | $40 | $37K |
| 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 | 180 | 290 | $20 | $24.8K |
Other providers in the same ZIP code as Erik Kruger, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Beyond Behavior Consulting | PA | Behavior Analyst | $0 | $10.3M |
| Keystone Behavior Services, LLC | PA | Community/Behavioral Health Agency | $0 | $6.1M |
| Luzerne Intermediate Unit #18 | PA | Community/Behavioral Health Agency | $0 | $5.7M |
| Bruce Saidman | PA | Hematology & Oncology Physician | $3.4M | $1 |
| David Greenwald | PA | Hematology & Oncology Physician | $2.7M | $590 |
| Surgical Specialty Center Of Northeastern Pennsylvania, LLC | PA | Ambulatory Surgical Clinic/Center | $1.5M | $124.1K |
| Radu Pacurariu | PA | Ophthalmology Physician | $1M | $0 |
| Gateway Surgery Center LLC | PA | Ambulatory Surgical Clinic/Center | $756.7K | $11.8K |
| Dhirendra Kumar | PA | Family Medicine Physician | $638.2K | $0 |
| John Dawsey | PA | Diagnostic Radiology Physician | $461.9K | $0 |
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