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 Armed Forces Americas for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to Armed Forces Americas 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. Armed Forces Americas (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.

Michael Nelson (NPI 1124504006)

Field	Value
Entity Type	Individual
Organization	Michael Nelson
Address	670 Boulevard De France
City	Fpo
State	AA (Armed Forces Americas)
ZIP	29909
Taxonomy	Optometrist
NPI Enumerated	July 13, 2018

Payer Source	Total Paid
Medicare	$60K
Medicaid	$0

Key Findings

MICHAEL NELSON is listed as an Optometrist in FPO, AA with an NPI enumerated 2018-07-13 (~8 years ago) and a lifetime Medicare revenue reported as $60K; there is no Medicaid billing on file, so this provider’s public claims activity is effectively single‑payer Medicare. The absence of any Medicaid codes suggests limited or no participation in state Medicaid programs based on available records, which constrains payer diversification.

Revenue is highly concentrated: the precomputed top three Medicare codes (99213, 92014, 92012) account for 66.7% of this provider’s total Medicare revenue. Those three codes individually generate $16.7K (99213), $16.2K (92014), and $7.3K (92012) of the $60K total, indicating a dependence on routine E&M visits and comprehensive/intermediate eye exams for the bulk of Medicare dollars.

The code mix points to a classic outpatient optometry practice model: the largest single contribution is from 99213 (established patient E&M), supported by ophthalmic exam codes 92014 (comprehensive established eye exam) and 92012 (intermediate established eye exam). Imaging and diagnostic procedures are present but secondary—92134 ($2.2K), 92250 ($1.1K), and 92133 ($792) appear as smaller revenue streams—suggesting imaging is used as an adjunct to examination visits rather than being a primary revenue driver.

Claim volumes for the top codes show steady ambulatory visit activity: 99213 has 288 claims, 92014 has 202 claims, and 92012 has 117 claims. These claim counts, combined with the dollar amounts reported, reflect routine, visit‑based throughput rather than procedure‑heavy or surgical practice patterns, consistent with the optometrist taxonomy and the code descriptions provided.

Competitive standing by code is mixed: 99213 ranks #63095 of 457151 providers nationally (86th percentile) and is labeled in the file as "typical, unremarkable volume for this code," indicating a relatively strong national placement for that E&M code without being an extreme outlier. By contrast, 92014 ranks #13013 of 35415 (63th percentile; labeled "typical, unremarkable volume for this code") and 92012 ranks #7117 of 17177 (58th percentile; labeled "typical, unremarkable volume for this code"), portraying the provider as a modest-to-typical participant in ophthalmic exam billing compared with national peers.

From a payer-mix and business-risk perspective, the practice’s entire reported public revenue base here comes from Medicare ($60K) with "none below" for Medicaid; this single‑payer concentration may limit negotiating leverage with other payers and exposes overall revenue to Medicare policy or beneficiary volume shifts. Analysts should treat network and access inferences cautiously given zero Medicaid activity on file and the relatively small absolute Medicare total.

Operationally, the data suggest limited ancillary revenue growth from diagnostics: several imaging codes appear but with small absolute contributions (92134 $2.2K, 92250 $1.1K, 92133 $792). If the practice sought to expand revenue without changing payer mix, increasing utilization of billed diagnostic services or introducing higher‑revenue procedures would be the most direct levers, but current claims indicate these remain secondary to face‑to‑face exam and E&M visits.

Medicare: Complete Services Breakdown

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

11 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	290	$60	$16.7K
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…	200	$80	$16.2K
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…	120	$60	$7.3K
92004	The provider performs a comprehensive level ophthalmological evaluation of a new patient and initiates a diagnostic and treatment program for one or more visits.	60	$80	$5K
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…	60	$80	$4.6K
99203	The provider sees a new 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 provider…	40	$80	$2.8K
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.	80	$30	$2.2K
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…	20	$110	$2K
92083	The provider may use one or more methods to determine the extent of a patient's visual field of one or both eyes; he interprets the results and prepares a report. Report this code for an extended…	40	$40	$1.6K
92250	Code 92250 describes the taking of fundus photographs, that is, photographs of the posterior segment of the inner aspect of the eye, to document alterations in the optic nerve head, retinal vessels,…	50	$20	$1.1K

Showing 1–10 of 11

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 11 CPT/HCPCS codes. Note: this provider's state, "AA," is a US military postal designation for Armed Forces stationed in the Americas (outside the US and Canada) — not a traditional US state; the State panel below benchmarks against other providers coded under the same designation.

View: State1 / 2

Claims Volume vs. Armed Forces Americas Distribution

Michael Nelson — 2 of 11 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Armed Forces Americas

Full comparison — all codes billed, vs. state median

11 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
92014	1	10	200	$80	$16.1K
99213	1	10	160	$60	$8.9K
92012	1	10	120	$60	$7.2K
92004	1	10	60	$80	$5K
99214	1	10	40	$80	$3K
99203	1	10	40	$80	$2.8K
92134	1	10	80	$30	$2.2K
99204	1	10	20	$110	$2K
92083	1	10	40	$40	$1.6K
92250	1	10	50	$20	$1.1K

Showing 1–10 of 11

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Demetrajane Kokinakis	SC	Ophthalmology Physician	$349.2K	$0
Rebecca Epstein	SC	Ophthalmology Physician	$187.4K	$0
Perin Diana	SC	Ophthalmology Physician	$22.6K	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Palmetto Pediatrics Of The Lowcountry	SC	Pediatrics Physician	$0	$7.8M
Lindsay Gamble	SC	Family Nurse Practitioner	$3.7M	$0
Bluffton Okatie Surgery Center, L.L.C.	SC	Ambulatory Surgical Clinic/Center	$1.2M	$0
David Hunter	SC	Ophthalmology Physician	$549.8K	$0
Jeffery Reuben	SC	Specialist	$412.8K	$0
Mikhail Novikov	SC	Nephrology Physician	$391K	$0
Karl Boatright	SC	Orthopaedic Surgery Physician	$349.4K	$0
William Kyle	SC	Internal Medicine Physician	$327.3K	$0
Lauren Lee	SC	Orthopedic Physical Therapist	$246K	$0
Jordan Hickey	SC	Physical Therapist	$229.3K	$0

Michael Nelson — 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