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NPI 1164535472 · Great Neck, NY · Ophthalmology Physician
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Philip Ferrone is a ophthalmology physician provider located in Great Neck, New York. This profile covers 25 Medicare and 7 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 | Philip Ferrone |
| Address | 600 Northern Blvd |
| City | Great Neck |
| State | NY |
| ZIP | 11021 |
| Taxonomy | Ophthalmology Physician |
| NPI Enumerated | August 17, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $3.1M |
| Medicaid | $10.5K |
This provider is effectively Medicare‑dominant: lifetime Medicare revenue is $3.1M versus Medicaid revenue of $10.5K, meaning Medicaid represents a negligible share of overall billings and the practice’s scale is driven almost entirely by Medicare patients. The disparity suggests the provider operates in a payer environment where Medicaid contributes little to revenue and may play a minimal role in patient mix or business planning.
Medicare revenue is highly concentrated: the top three Medicare codes account for 68.7% of Medicare revenue, led by J0178 (37.5%), J2777 (22.5%), and Q5128 (8.7%). Those codes are all intravitreal drug administrations (anti‑VEGF and related agents), indicating that most Medicare income is generated by retina/medical‑retina therapeutic injections rather than broad general ophthalmology services.
The provider’s CPT/HCPCS mix reinforces a retina‑focused operation: high revenue shares from J0178, J2777 and Q5128 combined with procedure codes such as 67028 and 67042 indicate routine intravitreal injection services and occasional vitreoretinal surgery. In addition, strong billing for retinal imaging (92134) and diagnostic procedures (92201/92202) shows integrated imaging support for medical retina management rather than a volume mix dominated by refractive or cataract surgery.
Competitive standing is mixed across codes: injection codes J0178 and J2777 fall in typical national volume ranges (78th and 79th percentiles, respectively), so injection volumes are unremarkable relative to national peers, while 92134 (retinal imaging) and 99213 (established E&M visits) are described as extreme outliers (98th and 99th percentiles), meaning the provider bills retinal imaging and routine office E&M at much higher volumes than most peers. This combination suggests above‑average diagnostic imaging throughput and visit frequency supporting the injection practice, even though drug administration volumes themselves are not exceptional nationally.
Medicaid billing is concentrated in diagnostic and evaluation services: the top three Medicaid codes account for 74.9% of Medicaid revenue, with 92134 at 42.1%, 92014 at 20.6% and 92012 at 12.2%. That distribution indicates Medicaid work largely consists of retinal imaging and routine comprehensive/established eye exams rather than high‑cost intravitreal drug administration.
The provider’s position in the Medicaid market is modest: 92134 ranks in the 46th percentile in‑state (typical volume), while 92014 and 92012 rank at the 11th percentile and several procedures (e.g., 92250) are at very low in‑state percentiles, reflecting limited Medicaid penetration and relatively low competitiveness for office exam codes within the state. Combined with total Medicaid revenue of $10.5K, these metrics point to a minor role in the state Medicaid program.
Tenure and practice stability are notable: the NPI was enumerated on 2006-08-17 (~20 years ago), indicating a long‑established individual practice. Sustained Medicare revenue of $3.1M alongside consistent billing for injection and imaging codes suggests an enduring retina‑oriented clinical operation rather than a recently shifted specialty.
From a business exposure perspective, Medicare income is concentrated in a small set of high‑value drug codes (top three = 68.7%), which makes overall revenue sensitive to changes in utilization, reimbursement, or biosimilar adoption for those agents. At the same time, the large imaging and E&M volumes (extreme outlier flags for 92134 and 99213) provide a complementary revenue base that helps support the injection service line operationally, even as Medicaid contributes minimally.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
25 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 1,670 | $690 | $1.2M |
| J2777 | Injection, faricimab‑svoa, 0.1 mg | 23,760 | $30 | $689K |
| Q5128 | Injection, ranibizumab-eqrn (cimerli), biosimilar, 0.1 mg | 1,230 | $220 | $267.6K |
| J3490 | Unclassified drugs | 120 | $1,810 | $210.4K |
| 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. | 1,520 | $110 | $170.4K |
| 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. | 2,780 | $40 | $100K |
| J2781 | Injection, pegcetacoplan, intravitreal, 1 mg | 800 | $120 | $95.4K |
| 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… | 1,090 | $80 | $86.4K |
| J2778 | Injection, ranibizumab, 0.1 mg | 430 | $190 | $80.2K |
| 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… | 620 | $80 | $49.8K |
Showing 1–10 of 25
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 25 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
25 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J0178 | 48 | 230 | 560 | $690 | $693K |
| J2777 | 13 | 120 | 7,740 | $30 | $364.9K |
| Q5128 | 9 | 20 | 1,170 | $220 | $268.3K |
| J2778 | 42 | 70 | 510 | $180 | $131.6K |
| J2781 | 11 | 40 | 520 | $120 | $75.1K |
| Q5124 | 16 | 20 | 310 | $170 | $69.7K |
| 67028 | 36 | 300 | 400 | $100 | $65.9K |
| J3490 | 29 | 120 | 60 | $470 | $50.8K |
| 92014 | 598 | 2,220 | 160 | $100 | $29.3K |
| 67042 | 12 | 40 | 20 | $1,030 | $22.7K |
Showing 1–10 of 25
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.
7 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. | 310 | $10 | $4.4K |
| 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… | 30 | $90 | $2.1K |
| 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… | 20 | $50 | $1.3K |
| 92226 | N/A | 80 | $10 | $1.1K |
| 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,… | 10 | $70 | $920 |
| 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. | 20 | $20 | $360 |
| 92201 | The provider performs an extended ophthalmoscopy, typically with an indirect ophthalmoscope which utilizes a bright light and a hand–held indirect lens rather than the common hand–held one–piece… | 30 | $10 | $250 |
How this provider's Medicaid billing volume and revenue compare to other New York providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. New York median
7 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 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… | 2,136 | 2,440 | 330 | $70 | $92.6K |
| 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… | 1,288 | 1,460 | 310 | $60 | $88.1K |
| 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. | 243 | 260 | 420 | $70 | $65.6K |
| 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,… | 1,393 | 1,490 | 340 | $40 | $48.7K |
| 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. | 394 | 730 | 370 | $20 | $30K |
| 92226 | N/A | 300 | 400 | 270 | $20 | $12.6K |
| 92201 | The provider performs an extended ophthalmoscopy, typically with an indirect ophthalmoscope which utilizes a bright light and a hand–held indirect lens rather than the common hand–held one–piece… | 264 | 320 | 190 | $20 | $10.7K |
Other providers in the same ZIP code as Philip Ferrone, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| C And T Homecare Services LLC | NY | In Home Supportive Care Agency | $0 | $847.7M |
| North Shore-lij Medical PC | NY | Urology Physician | $0 | $388.1M |
| First Choice Home Care Inc | NY | Home Health Agency | $0 | $28M |
| Welllife Network Inc. | NY | Clinic/Center | $0 | $22M |
| Regioncare Inc. | NY | Home Infusion Agency | $40.1K | $9.4M |
| Shahram Shamekh | NY | Internal Medicine Physician | $673.3K | $1.4M |
| Angela Azar | NY | Dermatology Physician | $104.5K | $1.5M |
| Alireza Shirvani | NY | Hospitalist Physician | $1.4M | $178K |
| Stephanie Buck-haskin | NY | Obstetrics & Gynecology Physician | $56.1K | $1.4M |
| Richard Matano | NY | Vascular Surgery Physician | $1.2M | $0 |
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