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

Why is the Medicaid comparison limited to Oklahoma 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. Oklahoma (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.

Sandeep Shah (NPI 1154362770)

Field	Value
Entity Type	Individual
Organization	Sandeep Shah
Address	1851 S Kelly Ave Ste A
City	Edmond
State	OK
ZIP	73013
Taxonomy	Retina Specialist (Ophthalmology) Physician
NPI Enumerated	June 8, 2006

Payer Source	Total Paid
Medicare	$3.9M
Medicaid	$0

Key Findings

The provider’s operative service mix is concentrated in intravitreal anti-VEGF therapy and retina-focused diagnostics: J0178 (aflibercept) is the single largest revenue driver with 3.4K claims and $2.3M revenue, and significant volumes are also reported for J2777 (faricimab) and 67028 (intravitreal injection). High utilization of retinal imaging (92134: 3.9K claims, $105.2K) and comprehensive established exams (92014: 1.9K claims, $148.4K) supports a clinical model built around frequent follow‑up injections and imaging for chronic retinal disease. This code mix is typical for a retina specialist whose practice workflow centers on recurring injections, monitoring, and occasional surgical procedures.

Revenue is highly concentrated: the precomputed top 3 Medicare codes account for 82.1% of this provider’s total Medicare revenue. Specifically, J0178 contributes $2.3M (59.5% of Medicare revenue), J2777 contributes $662.9K (17.0%), and 67028 contributes $217.9K (5.6%), indicating that a small set of injection-related codes drive the vast majority of billed Medicare dollars. This concentration implies revenue sensitivity to changes in utilization or reimbursement for these specific agents and services.

This provider is effectively single‑payer on the claims side: lifetime Medicare revenue is $3.9M while Medicaid billing is none — the provider has no Medicaid billing on file. That payer mix means commercial and Medicare policy changes will be the primary levers affecting practice revenue, and the practice has limited direct Medicaid patient exposure or Medicaid-based contracting history. Analysts should treat the entity as Medicare‑dependent for observed public claims activity.

Competitive standing on key injection and monitoring codes is strong at the national level. J0178 ranks #120 of 3204 providers nationally (96th percentile; notably above typical national volume for this code), 67028 ranks #175 of 4255 providers nationally (96th percentile; notably above typical national volume for this code), while J2777 ranks #443 of 2039 providers nationally (78th percentile; typical, unremarkable volume for this code). Additionally, retinal imaging and exam codes are extreme outliers: 92134 ranks #147 of 26868 providers nationally (99th percentile; extreme outlier) and 92014 ranks #311 of 35415 providers nationally (99th percentile; extreme outlier), signaling above‑average throughput for follow‑up diagnostics and visits.

The presence of surgical retina codes and higher‑acuity procedures indicates retained capability for complex care beyond injections. Examples include 67042 (59 claims, $50.3K revenue; ranks #77 of 1087 providers nationally, 93th percentile; typical, unremarkable volume for this code), 67113 (20 claims, $19.9K revenue; ranks #98 of 297 providers nationally, 64th percentile), and 67145 (70 claims, $12.9K revenue; ranks #15 of 861 providers nationally, 98th percentile; extreme outlier). These procedure-level entries show the practice performs occasional surgical interventions and retina repairs in addition to high-volume injection and imaging services.

Several codes are flagged as statistical outliers or notably above typical national volumes, reinforcing a high-frequency, retina-centric practice pattern. Notables include J0178 (notably above typical), 67028 (notably above typical), 92014 and 92134 (both labeled extreme outlier), and 67145 (extreme outlier). For payers and network managers, these labels indicate the provider’s activity for these services is well above typical national peers and may warrant focused contract and utilization review for those specific codes.

Tenure and stability in the dataset support a long-established practice footprint: the NPI was enumerated on 2006-06-08 (~20 years ago). This length of enrollment coupled with concentrated Medicare revenue suggests an established referral base and steady clinical volume in the retina specialty over an extended period. For competitive analysis, longevity strengthens the interpretation that high injection and imaging volumes are an operational norm rather than a short-term anomaly.

Operational risk and opportunity: the practice’s heavy reliance on J0178 (59.5% of Medicare revenue) and the top-3 codes (82.1% of Medicare revenue) creates both negotiating leverage around retinal drug procurement and exposure to therapy‑specific shifts (e.g., changes in utilization patterns, formulary placement, or reimbursement). The absence of Medicaid revenue reduces exposure to Medicaid rate pressure but may also limit access to that patient segment; contracting teams should consider both the high Medicare dependency and the concentrated drug/service mix when assessing reimbursement strategies.

Medicare: Complete Services Breakdown

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

28 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J0178	Injection, aflibercept, 1 mg	3,390	$690	$2.3M
J2777	Injection, faricimab‑svoa, 0.1 mg	22,860	$30	$662.9K
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.	2,510	$90	$217.9K
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…	1,880	$80	$148.4K
J2778	Injection, ranibizumab, 0.1 mg	790	$180	$144.6K
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.	3,900	$30	$105.2K
J7312	Injection, dexamethasone, intravitreal implant, 0.1 mg	360	$150	$55K
67042	In this procedure, the provider removes vitreous humor, the gelatinous material that gives shape to the eye, using a mechanical cutting tool. He removes the internal limiting membrane of the retina…	60	$850	$50.3K
J9035	Injection, bevacizumab, 10 mg	660	$60	$36.5K
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…	300	$110	$33.7K

Showing 1–10 of 28

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 28 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Oklahoma Distribution

Sandeep Shah — 4 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Oklahoma

Full comparison — all codes billed, vs. state median

28 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0178	2	30	790	$690	$801.2K
J2777	11	20	23,040	$30	$781.1K
J2778	2	10	420	$180	$173.2K
67028	3	40	720	$80	$88.9K
J7312	2	10	340	$150	$54.8K
67042	3	10	30	$980	$37.1K
J9035	8	30	330	$50	$23.5K
67113	2	10	20	$1,090	$21.7K
92235	11	20	60	$100	$19.5K
67108	7	10	20	$1,020	$19.5K

Showing 1–10 of 28

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Brian Phelps	OK	Retina Specialist (Ophthalmology) Physician	$4.1M	$0
Ryan Ridges	OK	Retina Specialist (Ophthalmology) Physician	$3.6M	$0
Michael Hood	OK	Retina Specialist (Ophthalmology) Physician	$3.5M	$0
David Grasic	OK	Retina Specialist (Ophthalmology) Physician	$697.6K	$0
Grant Corning	OK	Ophthalmology Physician	$489.6K	$0
Bradley Britton	OK	Ophthalmology Physician	$417.5K	$0
John Hummel	OK	Ophthalmology Physician	$363.6K	$0
Don Nguyen	OK	Ophthalmology Physician	$329.2K	$0
Meredith Hartman	OK	Ophthalmology Physician	$307K	$0
Whitney Carter	OK	Ophthalmology Physician	$260.3K	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Specialty Care Pediatrics, Inc.	OK	Home Health Agency	$0	$44.8M
Medical Resource Management, LLC	OK	Urgent Care Clinic/Center	$0	$14.9M
Oklahoma Arthritis Center, P.C.	OK	Rheumatology Physician	$0	$10.1M
Craig Carson	OK	Rheumatology Physician	$9.7M	$0
Sand Lily Healthcare, Inc.	OK	In Home Supportive Care Agency	$0	$8.9M
Christopher Fisher	OK	Internal Medicine Physician	$7.6M	$0
Summit Medical Center	OK	General Acute Care Hospital	$0	$7.1M
Ana Kumar	OK	Rheumatology Physician	$4.1M	$0
Pathways Professional Counseling LLC	OK	Community/Behavioral Health Agency	$0	$3.4M
Keshav Panday	OK	Specialist	$3.3M	$0

Sandeep Shah — 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