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

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

Paul Raphaelian (NPI 1164450201)

Field	Value
Entity Type	Individual
Organization	Paul Raphaelian
Address	5957 Harvey St
City	Norton Shores
State	MI
ZIP	49444
Taxonomy	Retina Specialist (Ophthalmology) Physician
NPI Enumerated	June 29, 2006

Payer Source	Total Paid
Medicare	$1.5M
Medicaid	$0

Key Findings

Medicare revenue is highly concentrated in intravitreal biologic injections: J0178, J2778, and J2777 together account for 83.5% of the provider's total Medicare revenue, with reported revenues of $737.6K (J0178), $335.9K (J2778), and $149.6K (J2777) respectively. This concentration indicates that most of this practice's Medicare earnings come from a small set of retina-specific drug administrations rather than a broad mix of services.

The provider’s procedure and service mix is consistent with an interventional retina specialty practice: high-volume billing for drug injection codes (J0178, J2778, J2777) is paired with 67028 (839 claims, $80.5K revenue) for intravitreal injection as a procedure and 92134 (1.3K claims, $35.8K revenue) for retinal imaging. Together these codes suggest routine cycles of intravitreal therapy supported by diagnostic OCT imaging and procedure-level billing for injections.

Clinical economics reflect drug-level differences: the reported avg paid/claim for J0178 is $683, for J2778 is $180, and for J2777 is $29, which aligns with the revenue distribution where J0178 is the single largest revenue driver ($737.6K) despite similar claim volumes to other injectables. These avg paid/claim figures underscore that the practice’s top-line Medicare dollars are sensitive to which injectable is used per encounter.

Competitive standing on key injectables is mixed: J0178 ranks #1212 of 3204 providers nationally (62th percentile; typical, unremarkable volume for this code), J2778 ranks #242 of 1208 (80th percentile; typical, unremarkable volume), and J2777 ranks #1511 of 2039 (26th percentile; typical, unremarkable volume). In plain terms, this provider has a stronger-than-average national presence for ranibizumab (J2778) but otherwise participates at typical national volumes for the other leading injectables.

Evaluation-and-management volume is an outlier relative to peers: 99214 appears with 1.2K claims, $87 avg paid/claim, $107.1K revenue (7.3% of Medicare revenue) and is labeled an "extreme outlier, far above typical national volume" (rank #6642 of 479517 providers nationally, 99th percentile). This unusually high E/M volume suggests a heavy clinic follow-up and management load or a practice model that documents and bills frequent comprehensive established-patient visits.

The practice performs substantial diagnostic imaging alongside injections: 92134 shows 1.3K claims and $35.8K revenue and is noted at the 93th percentile (typical, unremarkable volume), while 67028 (intravitreal injection procedure) accounts for 839 claims and $80.5K revenue at the 62th percentile. This pattern is consistent with a care pathway of imaging-driven monitoring followed by procedure-based therapeutic injections.

Payer mix is effectively single-payer Medicare: lifetime Medicare revenue is $1.5M and there is no Medicaid billing on file, so the provider’s public-payer exposure is concentrated entirely in Medicare. The absence of Medicaid billing implies limited participation in state program volumes and suggests patient panel demographics and reimbursement exposure are Medicare-heavy.

The provider is a long-tenured clinician on file: the NPI was enumerated 2006-06-29 (~20 years ago), indicating an established presence in the market that is likely to underpin steady referral relationships and sustained Medicare billing patterns over time.

Medicare: Complete Services Breakdown

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

13 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J0178	Injection, aflibercept, 1 mg	1,080	$680	$737.6K
J2778	Injection, ranibizumab, 0.1 mg	1,870	$180	$335.9K
J2777	Injection, faricimab‑svoa, 0.1 mg	5,160	$30	$149.6K
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…	1,230	$90	$107.1K
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.	840	$100	$80.5K
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.	1,280	$30	$35.8K
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…	70	$100	$7.1K
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…	50	$100	$4.9K
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…	30	$80	$2.2K
J3590	Unclassified biologics	30	$70	$2.2K

Showing 1–10 of 13

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 13 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Michigan Distribution

Paul Raphaelian — 1 of 13 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Michigan

Full comparison — all codes billed, vs. state median

13 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0178	30	110	680	$690	$630.2K
J2777	37	60	7,200	$30	$321K
J2778	18	50	730	$180	$240.5K
67028	44	160	440	$90	$57.6K
J3590	69	80	140	$80	$19.6K
92014	878	1,080	100	$80	$14.8K
99214	68	15,470	80	$80	$11.4K
92235	37	100	40	$100	$7.8K
92134	47	820	60	$30	$7.1K
99204	852	6,280	30	$110	$4.2K

Showing 1–10 of 13

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Associated Retinal Consultants, PC	MI	Ophthalmology Physician	$0	$21.1M
Sandeep Randhawa	MI	Retina Specialist (Ophthalmology) Physician	$7M	$0
Scott Pendergast	OH	Retina Specialist (Ophthalmology) Physician	$6M	$0
Ramon Lee	IL	Retina Specialist (Ophthalmology) Physician	$4M	$8.5K
Jeremy Wolfe	MI	Retina Specialist (Ophthalmology) Physician	$3.7M	$0
Christianne Wa	CA	Retina Specialist (Ophthalmology) Physician	$3.5M	$0
Douglas Covert	MI	Retina Specialist (Ophthalmology) Physician	$3.2M	$0
Nathan Farley	MI	Retina Specialist (Ophthalmology) Physician	$3M	$0
Scott Sneed	MI	Retina Specialist (Ophthalmology) Physician	$2.8M	$0
Tamer Mahmoud	MI	Retina Specialist (Ophthalmology) Physician	$2.8M	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Moka Corporation	MI	Intellectual and/or Developmental Disabilities Residential Treatment Facility	$0	$126.2M
Mercy Health Partners	MI	General Acute Care Hospital	$0	$98.1M
Senior Resources Of West Michigan	MI	Case Management Agency	$0	$31.5M
Mgh Family Health Center	MI	Federally Qualified Health Center (FQHC)	$0	$24.4M
Hackley Community Care Center Inc	MI	Federally Qualified Health Center (FQHC)	$0	$23.1M
Orthopaedic Associates Of Muskegon, PC	MI	Orthopaedic Surgery Physician	$0	$7.1M
Port City Pediatrics	MI	Pediatrics Physician	$0	$5.9M
Radiology Muskegon PC	MI	Diagnostic Radiology Physician	$0	$5.9M
Mercy Specialty Services	MI	Internal Medicine Physician	$0	$5.3M
Muskegon Sc, LLC	MI	Ambulatory Surgical Clinic/Center	$967.6K	$68.1K

Paul Raphaelian — 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