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

Why is the Medicaid comparison limited to North Carolina 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. North Carolina (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.

Raj Patel (NPI 1164715553)

Field	Value
Entity Type	Individual
Organization	Raj Patel
Address	1701 Old Village Rd
City	Hendersonville
State	NC
ZIP	28791
Taxonomy	Ophthalmology Physician
NPI Enumerated	May 18, 2011

Payer Source	Total Paid
Medicare	$3.9M
Medicaid	$0

Key Findings

Provider profile and payer scale: RAJ PATEL is listed as an Ophthalmology Physician in HENDERSONVILLE, NC with an NPI enumerated 2011-05-18 (~15 years ago). Lifetime Medicare revenue for this provider is $3.9M, and there is no Medicaid billing on file, so the practice is effectively single-payer (Medicare) in the available claims data.

Revenue concentration around intravitreal drug codes: the top three Medicare revenue drivers account for 91.2% of the provider's Medicare receipts, led by J2777 ($2M, 50.3% of Medicare revenue), J0178 ($1.4M, 36.3%), and 67028 ($183.4K, 4.7%). This high concentration indicates the practice’s income is heavily dependent on a small set of retina-targeted procedures and drug administrations.

Treatment and drug utilization pattern: the code mix is dominated by intravitreal biologic injections and retina-directed care — J2777 shows 67.9K claims at $29 avg paid/claim ($2M revenue) and J0178 shows 2.1K claims at $693 avg paid/claim ($1.4M revenue). Taken together, these patterns point to an operational focus on frequent injection-based retinal therapy rather than broad general ophthalmology procedures.

Diagnostic and outpatient visit throughput is unusually high: 92134 has 3.3K claims and is labeled an "extreme outlier, far above typical national volume," while 99213 has 1.2K claims and is also an "extreme outlier, far above typical national volume." These ranks indicate substantially greater imaging and E/M volume relative to national peers, supporting a care model with high visit and diagnostic throughput to manage retina treatment cycles.

Competitive standing for leading drugs: for J2777 the provider ranks #55 of 2039 providers (97th percentile) and is described as "notably above typical national volume," marking the provider as a major national-level user of faricimab. By contrast, J0178 ranks #516 of 3204 (84th percentile) and is a strong but less dominant position, indicating solid use of aflibercept but not the same outlier status as J2777.

Low utilization of older/off-label agents relative to peers: J9035 (bevacizumab) shows 22 claims and ranks #1763 of 1852 providers (4th percentile; typical, unremarkable volume for this code), and J2778 (ranibizumab) shows 139 claims and ranks #1163 of 1208 providers (4th percentile; typical, unremarkable volume for this code). This pattern suggests the provider’s retina drug mix favors faricimab and aflibercept over bevacizumab or ranibizumab within Medicare billing.

Surgical retina activity is present but secondary to injections: 67028 has 2.3K claims ($183.4K revenue) and is ranked #257 of 4255 providers (94th percentile) with the label "notably above typical national volume," while other surgical retina codes such as 67042 and 67108 appear at much lower volumes. The dataset therefore supports a practice that performs some vitreoretinal procedures in addition to a dominant injection-and-imaging service line.

Commercial and operational implications of payer mix: with $3.9M of Medicare revenue and no Medicaid billing on file, the practice is highly exposed to Medicare reimbursement policy and drug-payment dynamics. Business planning and competitive benchmarking should prioritize Medicare drug utilization trends (notably for J2777 and J0178) and capacity for high-frequency imaging/visit workflows given the provider’s extreme outlier status on 92134 and 99213.

Medicare: Complete Services Breakdown

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

17 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J2777	Injection, faricimab‑svoa, 0.1 mg	67,920	$30	$2M
J0178	Injection, aflibercept, 1 mg	2,050	$690	$1.4M
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.	2,290	$80	$183.4K
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.	3,340	$30	$96.9K
J7312	Injection, dexamethasone, intravitreal implant, 0.1 mg	410	$160	$64.8K
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…	1,150	$60	$64.6K
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…	40	$870	$36.5K
J2778	Injection, ranibizumab, 0.1 mg	140	$180	$24.3K
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…	170	$90	$15K
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…	140	$100	$14.4K

Showing 1–10 of 17

Medicare: Competitive Analysis & Benchmarks

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

Claims Volume vs. North Carolina Distribution

Raj Patel — 7 of 17 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — North Carolina

Full comparison — all codes billed, vs. state median

17 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0178	21	100	950	$690	$881K
J2777	1	70	12,990	$30	$503.7K
J2778	43	50	620	$180	$202.2K
67028	6	120	780	$90	$80K
J7312	7	20	390	$160	$56.4K
67042	5	30	20	$990	$23.8K
67108	16	20	10	$960	$15.3K
99214	6,683	18,060	110	$80	$15.1K
J9035	84	90	140	$50	$13.4K
92134	5	790	70	$30	$7.5K

Showing 1–10 of 17

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Spartanburg Medical Center	SC	General Acute Care Hospital	$0	$187.7M
Spartanburg Medical Center	SC	Emergency Medicine Physician	$0	$17.2M
Spartanburg Medical Center	SC	Family Medicine Physician	$0	$17M
Cherokee Medical Center	SC	General Acute Care Hospital	$0	$15.4M
Pelham Medical Center	SC	General Acute Care Hospital	$0	$13.8M
Spartanburg Medical Center	SC	Maternal & Fetal Medicine Physician	$0	$11.5M
Union Medical Center	SC	General Acute Care Hospital	$0	$10.7M
Spartanburg Medical Center	SC	Community Based Hospice Care Agency	$0	$8.9M
Spartanburg Medical Center	SC	Urgent Care Clinic/Center	$0	$6.3M
Spartanburg Medical Center	SC	Pediatrics Physician	$0	$4.8M

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Families First Of North Carolina, LLC	NC	Developmentally Disabled Services Day Training Agency	$0	$11.6M
St. Gerard House	NC	Behavior Analyst	$0	$8.5M
County Of Henderson	NC	Land Ambulance	$1.6M	$1.7M
Robert Park	NC	Ophthalmology Physician	$2.7M	$0
Carolina Mountain Gastroenterology Endoscopy Center	NC	Ambulatory Surgical Clinic/Center	$1M	$103.5K
Margaret Curran	NC	Rheumatology Physician	$991.9K	$0
Werner Brooks	NC	Orthopaedic Surgery Physician	$468K	$0
Clayton Bryan	NC	Ophthalmology Physician	$436.1K	$0
Jonathan Fritz	NC	Ophthalmology Physician	$365.9K	$0
Andrew Rackoff	NC	Gastroenterology Physician	$339.6K	$0

Raj Patel — 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