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

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

Michael Simmons (NPI 1194256479)

Field	Value
Entity Type	Individual
Organization	Michael Simmons
Address	4360 Washington Blvd
City	Ogden
State	UT
ZIP	84403
Taxonomy	Ophthalmology Physician
NPI Enumerated	March 27, 2017

Payer Source	Total Paid
Medicare	$1.2M
Medicaid	$0

Key Findings

This provider’s Medicare footprint is the sole payer presence on file: Total Medicare revenue is $1.2M while Medicaid shows none, so the practice is effectively single‑payer (Medicare) in the claims data and therefore exposed to Medicare reimbursement dynamics rather than a mixed payer strategy. The absence of Medicaid billing may reflect payer population, practice contracts, or site-of-service mix but is clear in the record as presented.

Revenue is highly concentrated in a tiny set of drug and injection codes: the precomputed top 3 Medicare codes by revenue account for 90.6% of this provider’s Medicare receipts, driven primarily by intravitreal drug administration and unclassified drug billing. That concentration indicates the practice’s commercial activity is centered on medication delivery (injections and drug billing) rather than office visits or imaging as primary revenue lines.

J0178 is the single largest revenue driver: 832 claims at $680 avg paid/claim produced $565.8K in revenue (48.8% of this provider’s total Medicare revenue); the code ranks #1470 of 3204 providers nationally (54th percentile), which the source labels as typical or unremarkable volume. This positions the provider as a modest, steady participant in aflibercept administration rather than an outlier or dominant national operator for that drug.

J3490 (Unclassified drugs) is the next biggest contributor with 193 claims at $2172 avg paid/claim producing $419.2K (36.1% of Medicare revenue) and ranks #350 of 2838 providers nationally (88th percentile). That relatively high national percentile combined with a large average payment per claim makes J3490 a notable strength for this provider; because J3490 covers heterogeneous, high-cost items, this suggests revenue sensitivity to which specific drugs or billable products are being reported under that unclassified code.

J2777 shows a contrasting pattern: 2.3K claims at $29 avg paid/claim produced $66.1K (5.7% of Medicare revenue) but ranks #1934 of 2039 providers nationally (5th percentile). The combination of high claim volume and low average payment per claim yields modest revenue here, and the very low national rank indicates the provider is not a national leader for faricimab billing despite the large claim count.

Non-drug clinical and diagnostic codes compose only a small share of revenue: 67028 generated $54.9K (4.7%), 92134 generated $18.1K (1.6%), and 99214 generated $18K (1.6%). These figures show that office evaluation/management and posterior-segment imaging are present but secondary to medication administration in this practice’s revenue mix.

Competitive standing across the profile is mixed: the provider is relatively strong for J3490 (88th percentile) while remaining average for J0178 (54th percentile) and weak for J2777 (5th percentile). Taken together, the data portray a specialized ophthalmology practice with a national-level strength in high-dollar unclassified drug billing, routine participation in aflibercept injections, and limited market share for faricimab compared with peers.

Administrative tenure and scale: the NPI was enumerated on 2017-03-27 (~9 years ago), and the provider has accumulated $1.2M in lifetime Medicare revenue over that period. That tenure indicates several years of billing history to assess trends, but the absence of Medicaid activity means competitive or utilization comparisons should focus primarily on Medicare dynamics.

Medicare: Complete Services Breakdown

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

10 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J0178	Injection, aflibercept, 1 mg	830	$680	$565.8K
J3490	Unclassified drugs	190	$2,170	$419.2K
J2777	Injection, faricimab‑svoa, 0.1 mg	2,280	$30	$66.1K
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.	560	$100	$54.9K
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.	580	$30	$18.1K
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…	190	$100	$18K
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…	160	$70	$11K
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…	40	$120	$5K
99203	The provider sees a new 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 provider…	10	$90	$1.2K
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,…	40	$30	$1.1K

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 10 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Utah Distribution

Michael Simmons — 0 of 10 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Utah

Full comparison — all codes billed, vs. state median

10 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0178	13	40	620	$690	$683.2K
J2777	24	20	13,140	$30	$523.9K
J3490	5	30	80	$1,690	$199.5K
67028	25	60	440	$90	$61.7K
99214	974	4,080	80	$80	$11.6K
92134	31	250	70	$30	$7.6K
99213	775	3,680	60	$50	$6.4K
99204	523	1,790	30	$100	$4.1K
99203	1,134	1,360	30	$70	$2.7K
92250	109	190	60	$20	$2.3K

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
North Memorial Health Care	MN	Ambulance	$0	$112.8M
Fairview Health Services	MN	General Acute Care Hospital	$0	$90.4M
Regions Hospital	MN	General Acute Care Hospital	$0	$44.4M
Fairview Express Care	MN	Specialist	$0	$33.1M
North Memorial Health Care	MN	General Acute Care Hospital	$0	$32.5M
Fairview Health Services	MN	General Acute Care Hospital	$0	$30M
Fairview Health Services	MN	Emergency Medicine Physician	$0	$26.6M
Fairview Health Services	MN	General Acute Care Hospital	$0	$17.2M
University Of Minnesota Health Clinics And Surgery Center, Inc.	MN	Clinic/Center	$0	$16.3M
Regions Hospital	MN	Emergency Medicine Physician	$0	$15.1M

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Ihc Health Services Inc	UT	General Acute Care Hospital	$0	$54.1M
Ivy Lane Pediatrics, LLC	UT	Home Health Agency	$0	$37M
Ogden Clinic PC	UT	Family Medicine Physician	$0	$8.3M
Ihc Health Services Inc	UT	Durable Medical Equipment & Medical Supplies	$0	$5.1M
Utah Hematology Oncology PC	UT	Hematology & Oncology Physician	$0	$4.6M
Mt Ogden Utah Surgical Center LLC	UT	Ambulatory Surgical Clinic/Center	$1.2M	$1.3M
South Ogden Operations, LLC	UT	Assisted Living Facility	$0	$2.4M
Lisa Leishman	UT	Ophthalmology Physician	$1.6M	$419.9K
Sutton Clinical Services LLC	UT	Mental Health Counselor	$0	$1.8M
Ogden Clinic Specialty Services LLC	UT	Sports Medicine (Family Medicine) Physician	$0	$1.7M

Michael Simmons — Billing Profile & Reimbursement Data

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Michael Simmons — 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