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    v1.0.28
    OpenPayerNPI Medicare & MedicaidMiriam Englander-paschalis Ilios
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    Miriam Englander-paschalis Ilios — Billing Profile & Reimbursement Data

    NPI 1184853129 · Boston, MA · Retina Specialist (Ophthalmology) Physician

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    Miriam Englander-paschalis Ilios is a retina specialist (ophthalmology) physician provider located in Boston, Massachusetts. This profile covers 18 Medicare and 0 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.

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    Provider details (source: NPPES NPI Registry)

    FieldValue
    Entity TypeIndividual
    OrganizationMiriam Englander-paschalis Ilios
    Address50 Staniford St
    CityBoston
    StateMA
    ZIP02114
    TaxonomyRetina Specialist (Ophthalmology) Physician
    NPI EnumeratedJuly 13, 2009

    Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)

    Payer SourceTotal Paid
    Medicare$4.5M
    Medicaid$0

    Key Findings

    This provider’s revenue is effectively single‑payer: total Medicare revenue is $4.5M while Medicaid revenue is none (no Medicaid billing on file). The lack of any Medicaid billing on file indicates minimal or no participation in Medicaid-managed care and concentrates payer exposure to Medicare reimbursement dynamics.

    Revenue is highly concentrated: the precomputed top 3 Medicare codes by revenue account for 87.8% of the provider's total Medicare revenue. Those top contributors are J0178 ($3.1M, 69.1%), J2777 ($597.2K, 13.1%), and 67028 ($250.7K, 5.5%), showing the practice’s financial dependence on a small set of high‑revenue services.

    The code mix and volumes identify a retina-focused procedural practice centered on intravitreal drug therapy and retinal imaging. High utilization of J0178 (4.5K claims) and J2777 (20.6K claims), together with substantial claims for 67028 (2.6K claims), 92134 (5.6K claims), and 92014 (2.7K claims), is consistent with repeated office‑based anti‑VEGF/anti‑Ang‑2 injections coupled with diagnostic retinal imaging and frequent follow‑up visits.

    J0178 performance is a national outlier: J0178 ranks #41 of 3204 providers nationally (99th percentile; extreme outlier), indicating exceptionally high Medicare aflibercept volume compared with peers. In contrast, J2777 ranks #506 of 2039 (75th percentile; typical, unremarkable volume), which suggests high faricimab claim counts in absolute terms but not as uniquely dominant versus the national distribution.

    Diagnostic and follow‑up services are also concentrated at unusually high levels: 92134 ranks #19 of 26868 providers (100th percentile; extreme outlier) and 92014 ranks #97 of 35415 providers (100th percentile; extreme outlier). These rankings, together with the high claim counts for those codes, indicate a high‑throughput imaging and follow‑up workflow that supports frequent injection visits.

    Clinical workflow is reflected in the mix of procedures and E/M codes: 67028 (intravitreal injection procedure) and infusion codes (J0178, J2777) drive the bulk of drug/procedural revenue while E/M and imaging codes such as 92014 and 92134 capture ongoing management and diagnostic reimbursement. The presence of 99213 (533 claims, $34.6K revenue; 95th percentile, notably above typical) further supports frequent brief office encounters tied to treatment regimens.

    The provider has an established billing history, with the NPI enumerated on 2009-07-13 (~17 years ago). This tenure aligns with the observed high volumes and suggests a long‑running referral and operational structure capable of supporting sustained injection and imaging throughput.

    Concentration risk is material: one drug code, J0178 ($3.1M, 69.1% of Medicare revenue), dominates revenue, creating sensitivity to changes in clinical practice patterns, drug selection, or reimbursement policies for that agent. At the same time, other codes show mixed competitive standing—some are extreme outliers nationally while a few therapeutic injectables and procedures (e.g., J9035, 67042) are in more typical percentile ranges—indicating both dominance in specific services and some diversification across retinal procedures.

    Medicare: Total Revenue Breakdown by CPT/HCPCS Code

    Medicare revenue breakdown by CPT/HCPCS procedure code.

    View: Bar Chart1 / 2

    Medicare: Complete Services Breakdown

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

    18 rows

    CPT/HCPCS CodeDescriptionClaimsAvg PaidRevenue
    J0178Injection, aflibercept, 1 mg4,540$690$3.1M
    J2777Injection, faricimab‑svoa, 0.1 mg20,590$30$597.2K
    67028The 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.2,590$100$250.7K
    92014An 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…2,680$90$241.5K
    92134The 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.5,650$30$175K
    99213The 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…530$70$34.6K
    J9035Injection, bevacizumab, 10 mg600$50$32.4K
    67042In 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…30$920$25.6K
    92012For 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…270$70$17.6K
    92004The provider performs a comprehensive level ophthalmological evaluation of a new patient and initiates a diagnostic and treatment program for one or more visits.120$100$12K

    Showing 1–10 of 18

    Medicare: Competitive Analysis & Benchmarks

    How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 18 CPT/HCPCS codes.

    View: State1 / 2

    Full comparison — all codes billed, vs. state median

    18 rows

    CPT/HCPCS CodeRankProvider CountMedian ClaimsAvg PaidAverage Revenue
    J0178390790$690$826.5K
    J27779507,080$30$343.1K
    670285120570$100$80.7K
    9201481,070160$90$30.1K
    6704253020$1,170$25.7K
    J90351180250$50$19.7K
    9921412,78515,410110$80$15.6K
    9201212256090$70$12.4K
    92134567070$30$10.6K
    9921362413,70070$60$8.8K

    Showing 1–10 of 18

    Related Providers

    Other providers that share a Tax Identification Number (TIN) with Miriam Englander-paschalis Ilios, ranked by combined Medicare and Medicaid revenue.

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    The General Hospital CorporationMAGeneral Acute Care Hospital$0$438M
    Community Physicians Of Indiana IncINFamily Medicine Physician$0$185M
    Massachusetts General Physicians Organization IncMADermatology Physician$0$60.2M
    Boston Emergency Physician Foundation, Inc.MAEmergency Medicine Physician$0$24.3M
    Colorado Permanente Medical Group, P.C.COInternal Medicine Physician$0$23.2M
    David ReedMARetina Specialist (Ophthalmology) Physician$7.7M$0
    Torsten WiegandMARetina Specialist (Ophthalmology) Physician$7.6M$0
    Chirag ShahMARetina Specialist (Ophthalmology) Physician$5M$0
    Roger GoldbergCARetina Specialist (Ophthalmology) Physician$4.6M$0
    Babak Jian SeyedahmadiMAOphthalmology Physician$4.4M$0

    Nearby Providers

    Other providers in the same ZIP code as Miriam Englander-paschalis Ilios, ranked by combined Medicare and Medicaid revenue.

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    Massachusetts Eye And Ear InfirmaryMAGeneral Acute Care Hospital$0$68.1M
    Bay Cove Human Services, IncMACommunity/Behavioral Health Agency$630.5K$36.4M
    Jewish Family & Children's ServiceMACase Management Agency$0$12.5M
    Commonwealth Of MassachusettsMACase Management Agency$0$10.4M
    Massachusetts Eye And Ear Associates, Inc.MAOphthalmology Physician$0$6.6M
    Jeffrey HeierMARetina Specialist (Ophthalmology) Physician$3.6M$0
    Adam ChinMAOphthalmology Physician$3.4M$870
    Tina ClearyMARetina Specialist (Ophthalmology) Physician$2.8M$0
    Boston Eye Surgery & Laser Center TrustMAAmbulatory Surgical Clinic/Center$2.1M$415.8K
    Marianeli RodriguezMAOphthalmology Physician$2.4M$0

    Frequently Asked Questions

    References

    1. 1.Medicare Physician & Other Practitioner by Provider and Service. CMS.gov.Provider-level Medicare Part B utilization and payment data.
    2. 2.NPPES NPI Registry. CMS.gov.National Provider Identifier registry used for provider enumeration and taxonomy metadata.

    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

    Medicare Revenue by CPT/HCPCS Code
    Claims Volume vs. Massachusetts Distribution
    Miriam Englander-paschalis Ilios — 5 of 18 codes billed far more than typical (above p95)
    p5–p95 (all providers)p25–p75MedianThis providerOutlier
    Rank Distribution — Massachusetts