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.

Douglas Covert (NPI 1194897017)

Field	Value
Entity Type	Individual
Organization	Douglas Covert
Address	860 E Front St
City	Traverse City
State	MI
ZIP	49686
Taxonomy	Retina Specialist (Ophthalmology) Physician
NPI Enumerated	November 15, 2006

Payer Source	Total Paid
Medicare	$3.2M
Medicaid	$0

Key Findings

DOUGLAS COVERT’s Medicare billing profile is dominated by retina-focused procedural care: the top revenue drivers are intravitreal biologic injections and related retinal procedures, led by J0178, J2777, and J2778 alongside procedure code 67028 and retinal imaging codes like 92134. The presence of high-volume injectable codes and retinal imaging suggests an office-based retina practice model that centers on anti-VEGF and related biologic therapies.

Revenue concentration is extremely high within a small set of therapies: the precomputed top-3 codes (J0178, J2777, J2778) account for 87.1% of this provider’s total Medicare revenue, with J0178 reported as $1.4M (45.1%), J2777 at $951.8K (29.6%), and J2778 at $399.8K (12.4%). This concentration indicates that the practice’s financial performance is heavily dependent on a few injectable therapeutics.

Payer mix is effectively single-payer Medicare: lifetime Medicare revenue on file is $3.2M and there is none for Medicaid (no Medicaid billing on file), so the provider operates without a Medicaid billing footprint according to available records. The lack of Medicaid claims suggests limited participation in state Medicaid networks or minimal service to Medicaid-enrolled patients.

Competitive standing on the primary injectable drugs is above median but not uniquely dominant: J0178 ranks #488 of 3204 providers nationally (85th percentile; typical, unremarkable volume for this code), J2777 ranks #256 of 2039 (87th percentile; typical, unremarkable volume), and J2778 ranks #193 of 1208 (84th percentile; typical, unremarkable volume). These ranks indicate higher-than-average national volumes for these injectable agents among peers, consistent with a busy retina injector, but they fall short of being top national outliers.

Claims and payment dynamics vary markedly by drug: J0178 shows 2.1K claims with an average paid/claim of $685 producing $1.4M revenue, while J2777 shows 32.8K claims with an average paid/claim of $29 producing $951.8K revenue, and J2778 shows 2.2K claims at $181 avg paid/claim producing $399.8K. This mix—high per-claim payment for J0178 versus very high claim count but low per-claim payment for J2777—suggests the provider’s revenue profile is sensitive to both product mix and reimbursement rates.

The provider shows statistical outlier activity in non-injection services that signal high throughput: 99214 is ranked #4396 of 479517 (99th percentile; extreme outlier, far above typical national volume) with $123.8K revenue, and 92134 is ranked #776 of 26868 (97th percentile; extreme outlier, far above typical national volume) with $64.9K revenue. Those extreme outlier labels for E&M and diagnostic imaging indicate an unusually large volume of office visits and retinal imaging relative to national peers, consistent with heavy follow-up and monitoring typical of retina practices.

Operational tenure is long-standing: the NPI was enumerated on 2006-11-15 (~20 years ago), indicating an established practice presence in Traverse City, MI. This duration supports the observed sustained revenue and high procedural volumes.

From a network and competitive perspective, the practice appears to be a focused Medicare-dependent retina specialist with above-median national volume in key anti-VEGF/routine injection codes and extreme outlier volumes in E&M and imaging; however, absence of Medicaid billing limits evaluation of in-state competitive standing on that payer and could affect access for Medicaid populations. Analysts evaluating contracting or referral strategies should treat this provider as a high-volume Medicare retina injector with concentrated revenue exposure to a few biologic therapies.

Medicare: Complete Services Breakdown

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

16 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J0178	Injection, aflibercept, 1 mg	2,120	$690	$1.4M
J2777	Injection, faricimab‑svoa, 0.1 mg	32,820	$30	$951.8K
J2778	Injection, ranibizumab, 0.1 mg	2,210	$180	$399.8K
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.	1,780	$90	$162.1K
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…	1,410	$90	$123.8K
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.	2,320	$30	$64.9K
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…	280	$80	$20.6K
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…	160	$120	$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…	120	$60	$7.3K
99212	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,…	140	$40	$5.6K

Showing 1–10 of 16

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 16 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Michigan Distribution

Douglas Covert — 4 of 16 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

16 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0178	12	110	680	$690	$630.2K
J2777	3	60	7,200	$30	$321K
J2778	12	50	730	$180	$240.5K
67028	9	160	440	$90	$57.6K
J3590	55	80	140	$80	$19.6K
92014	240	1,080	100	$80	$14.8K
99214	44	15,470	80	$80	$11.4K
92235	88	100	40	$100	$7.8K
92134	15	820	60	$30	$7.1K
92012	287	460	50	$60	$6.8K

Showing 1–10 of 16

Related Providers

Other providers that share a Tax Identification Number (TIN) with Douglas Covert, 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
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
George Williams	MI	Retina Specialist (Ophthalmology) Physician	$2.7M	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Autism Center Of Northern Michigan	MI	Community/Behavioral Health Agency	$0	$19M
Jonathan Timm	MI	Behavior Analyst	$0	$6.2M
North Arrow Aba, LLC	MI	Behavior Analyst	$0	$5.8M
Diane Fiander	MI	Retina Specialist (Ophthalmology) Physician	$2.2M	$0
North Flight Aero Med	MI	Air Ambulance	$772.9K	$716.6K
John Mcmanus	MI	Ophthalmology Physician	$290.4K	$0
Mark Pomaranski	MI	MOHS-Micrographic Surgery Physician	$273K	$0
Brian Heeringa	MI	Surgery Physician	$153.4K	$0
Paula Cahill	MI	Dermatology Physician	$142.6K	$0
Peter Fedor	MI	Ophthalmology Physician	$136.5K	$0

Douglas Covert — 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