Loading...
NPI 1205836947 · Harvey, IL · Retina Specialist (Ophthalmology) Physician
Customize your policy alerts
Get alerted when relevant policies change without checking for updates manually.
Monitor payer policy activity
Jack Cohen is a retina specialist (ophthalmology) physician provider located in Harvey, Illinois. This profile covers 20 Medicare and 11 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 | Jack Cohen |
| Address | 71 W 156th St |
| City | Harvey |
| State | IL |
| ZIP | 60426 |
| Taxonomy | Retina Specialist (Ophthalmology) Physician |
| NPI Enumerated | July 22, 2005 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $3.8M |
| Medicaid | $445.2K |
Specialty and service mix indicate a retina-focused ophthalmology practice: top Medicare revenue drivers are intravitreal anti-VEGF injections J0178 and J2778 plus comprehensive eye exams 92014, and procedure-level codes for vitreous injections 67028 and retinal imaging 92134 further emphasize medical retina treatment and monitoring rather than refractive or routine primary eye care. The presence of both high-volume drug injections and high-volume retinal imaging (92134) suggests this provider operates an office-based retina service line delivering frequent intravitreal therapies and follow-up imaging.
High revenue concentration in Medicare is driven by a narrow set of treatments: the precomputed top three Medicare codes account for 79.9% of total Medicare revenue, signaling dependence on a few high-value services (notably J0178 at $1.8M and J2778 at $921.7K). Business implications are that changes in reimbursement or utilization of these specific drugs would have an outsized impact on the provider’s Medicare revenue stream.
Medicaid revenue is similarly concentrated: the top three Medicaid codes make up 86.8% of total Medicaid revenue, with J0178 contributing $170.8K and 92014 and 67028 together representing substantial shares. This concentration in a small set of service lines under Medicaid mirrors Medicare patterns, indicating the practice offers the same retina-centered services across payers but at a much smaller absolute Medicaid scale ($445.2K total Medicaid revenue versus $3.8M Medicare).
Payer mix and scale: Medicare is the dominant payer for this provider, supplying $3.8M in lifetime revenue compared with $445.2K from Medicaid, so the practice’s volume and financial exposure are primarily Medicare-driven. While both payers show similar service mixes, the difference in scale implies contractual, operational, and risk-management priorities should focus on Medicare reimbursement and utilization trends.
Competitive standing on key Medicare codes is mixed: for J2778 the provider ranks #39 of 1208 nationally (97th percentile) and is characterized as notably above typical volume, indicating regional or niche leadership in ranibizumab administration. For J0178 the provider ranks #274 of 3204 (91th percentile) and is described as typical/unremarkable volume; for 92014 and 92134 the provider is an extreme outlier (100th percentile) with ranks #40 of 35415 and #17 of 26868 respectively, signaling unusually high exam and imaging volumes relative to national peers and suggesting a busy clinic workflow focused on established-patient follow-up and retinal imaging.
State-level Medicaid competitiveness is modest to typical: for J0178 the provider is #25 of 45 in-state (45th percentile), and for 67028 and 92014 ranks place them in the mid-to-upper range in Illinois (65th and 87th percentiles respectively). Those standings indicate the provider is not a dominant statewide injector of aflibercept by Medicaid volume but maintains meaningful procedural and exam throughput relative to state peers.
Statistical outlier signals reinforce operational focus: several codes on the Medicare side are labeled extreme outlier or notably above typical (92014, 92134, J2778, 67028), which in plain terms means this provider delivers far above typical national volumes for comprehensive exams, retinal imaging, and ranibizumab injections. These outlier classifications point to sustained high patient follow-up frequency and therapy administration that likely supports a retina subspecialty practice model.
Tenure and market presence: the NPI was enumerated on 2005-07-22 (~21 years ago), indicating long-standing presence in the local market and time to build referral relationships and a sustained retina practice. That extended tenure, combined with exceptional volumes on several retina-related Medicare codes, supports the view of an established retina-focused practice with consistent patient flow for intravitreal therapy and imaging.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
20 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 2,620 | $680 | $1.8M |
| J2778 | Injection, ranibizumab, 0.1 mg | 5,270 | $180 | $921.7K |
| 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… | 3,300 | $90 | $299.8K |
| 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. | 2,490 | $100 | $243.8K |
| 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. | 5,760 | $30 | $178.7K |
| 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 | $70 | $75.4K |
| 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… | 3,780 | $20 | $71.7K |
| 92004 | The provider performs a comprehensive level ophthalmological evaluation of a new patient and initiates a diagnostic and treatment program for one or more visits. | 460 | $110 | $51.1K |
| 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… | 320 | $100 | $32.1K |
| 67036 | The provider removes vitreous fluid from the eye to access the posterior segment of the eye and introduce surgical instruments through incisions in the pars plana. | 30 | $580 | $18.5K |
Showing 1–10 of 20
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 20 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
20 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J0178 | 12 | 140 | 700 | $690 | $688.4K |
| J2778 | 2 | 20 | 540 | $180 | $214.9K |
| 67028 | 3 | 190 | 400 | $90 | $64.4K |
| 92014 | 2 | 1,420 | 130 | $80 | $24.7K |
| J9035 | 38 | 130 | 140 | $60 | $24.6K |
| 67042 | 21 | 50 | 20 | $870 | $21.8K |
| 67036 | 5 | 30 | 20 | $800 | $17.6K |
| 99214 | 3,630 | 18,540 | 110 | $80 | $17.1K |
| 92134 | 1 | 1,080 | 80 | $30 | $9K |
| 99213 | 163 | 17,390 | 70 | $60 | $8.8K |
Showing 1–10 of 20
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.
11 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 180 | $950 | $170.8K |
| 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… | 3,150 | $40 | $113.4K |
| 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. | 1,050 | $100 | $101.8K |
| 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. | 3,030 | $10 | $33.3K |
| 92004 | The provider performs a comprehensive level ophthalmological evaluation of a new patient and initiates a diagnostic and treatment program for one or more visits. | 200 | $50 | $10.6K |
| 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… | 1,120 | $10 | $6.7K |
| 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… | 280 | $20 | $4.5K |
| 99231 | The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a straightforward or low level of medical… | 80 | $30 | $2.3K |
| 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… | 40 | $20 | $700 |
| J9035 | Injection, bevacizumab, 10 mg | 10 | $50 | $590 |
Showing 1–10 of 11
How this provider's Medicaid billing volume and revenue compare to other Illinois providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Illinois median
11 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 25 | 50 | 200 | $1,100 | $391.2K |
| 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. | 43 | 120 | 540 | $160 | $166.3K |
| 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… | 166 | 1,230 | 450 | $40 | $54.1K |
| 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… | 7,486 | 14,680 | 300 | $50 | $48.7K |
| 92004 | The provider performs a comprehensive level ophthalmological evaluation of a new patient and initiates a diagnostic and treatment program for one or more visits. | 663 | 1,110 | 310 | $50 | $45.3K |
| J9035 | Injection, bevacizumab, 10 mg | 77 | 80 | 290 | $60 | $43.4K |
| 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… | 11,392 | 14,190 | 280 | $20 | $38.9K |
| 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. | 34 | 250 | 510 | $20 | $20.1K |
| 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… | 596 | 670 | 230 | $30 | $16K |
| 99231 | The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a straightforward or low level of medical… | 442 | 840 | 90 | $20 | $13.6K |
Showing 1–10 of 11
Other providers in the same ZIP code as Jack Cohen, ranked by combined Medicare and Medicaid revenue.
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.