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

Why is the Medicaid comparison limited to Oregon 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. Oregon (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 Lee (NPI 1215932033)

Field	Value
Entity Type	Individual
Organization	Michael Lee
Address	5440 Sw Westgate Dr Ste 217
City	Portland
State	OR
ZIP	97221
Taxonomy	Retina Specialist (Ophthalmology) Physician
NPI Enumerated	June 17, 2005

Payer Source	Total Paid
Medicare	$1.7M
Medicaid	$0

Key Findings

This provider is effectively a single-payer Medicare practice: lifetime Medicare revenue totals $1.7M while there is no Medicaid billing on file, indicating the provider’s patient mix and reimbursement activity are concentrated entirely in Medicare reimbursement streams. Analysts should treat Medicaid-related competitive or access questions as not applicable for this provider in the current dataset.

Revenue concentration is high: the precomputed top three Medicare codes by revenue account for 77.7% of the provider’s total Medicare revenue, signaling that a small set of services—primarily injectable retinal medications—drive most of the practice’s Medicare receipts. This concentration suggests sensitivity to price or utilization changes for those key therapies.

The practice’s case mix and service line are strongly retina-focused. The top revenue code is J0178 (aflibercept) with $865K (51.6% of Medicare revenue), followed by J2777 (faricimab) at $271.4K (16.2%) and J2778 (ranibizumab) at $166.5K (9.9%); these drug-dominated high-revenue codes, together with retinal imaging codes like 92134, indicate routine intravitreal injection therapy and retina imaging as the core clinical activity.

Competitive standing on flagship drug dispensing is mixed: for J0178 the provider ranks #1025 of 3204 (68th percentile), which represents a typical, unremarkable national volume rather than a dominant market position; similarly, J2777 ranks at the 48th percentile and J2778 at roughly the 62nd percentile, so the provider is a modest-to-typical contributor to national utilization of these agents rather than a regional or national leader.

There are notable high-percentile service volumes for certain non-drug codes. The provider ranks in the 96th percentile nationally for 92134 (retinal imaging) and for E/M code 99213, and ranks in the 84th percentile for intravitreal injection code 67028; these "notably above typical" labels suggest high throughput for retinal imaging and routine follow-up visits relative to peers, consistent with a high-volume injection practice workflow.

The provider is also a statistical outlier in compounded drug use: J7999 (compounded drug, not otherwise classified) appears at the 96th percentile nationally, labeled "notably above typical national volume," which may reflect regular use of office-prepared or specialty-compounded ocular products as part of the treatment mix. This is worth noting for inventory, procurement, and pharmacy oversight considerations.

Clinical productivity reflects a procedural, procedure-centric practice rather than a general ophthalmology clinic: high shares of revenue come from injectable biologics and associated retinal imaging, while typical evaluation-and-management codes (99213/99214) generate smaller revenue shares (2.2% and 1.3% respectively), indicating that visits are often centered on procedural treatment and monitoring rather than lengthy non-procedural consultations.

Tenure is long: the provider’s NPI was enumerated on 2005-06-17 (about 21 years ago), indicating established practice presence and potential sustained referral relationships; this longevity supports the observed high-volume imaging and injection practice patterns rather than a newly established entrant profile.

Medicare: Complete Services Breakdown

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

13 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J0178	Injection, aflibercept, 1 mg	1,270	$680	$865K
J2777	Injection, faricimab‑svoa, 0.1 mg	9,360	$30	$271.4K
J2778	Injection, ranibizumab, 0.1 mg	930	$180	$166.5K
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.	1,600	$100	$156.4K
J7999	Compounded drug, not otherwise classified	1,030	$70	$74.2K
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.	1,830	$30	$54.8K
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…	590	$60	$36.8K
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…	210	$100	$21.2K
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…	90	$130	$10.8K
92235	The provider uses a special dye, fluorescein that causes the blood vessels in the one or both eyes to stand out in photographic images taken with the use of multiframe timing, or serial images, taken…	70	$120	$8.6K

Showing 1–10 of 13

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 13 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Oregon Distribution

Michael Lee — 3 of 13 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Oregon

Full comparison — all codes billed, vs. state median

13 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0178	18	60	840	$680	$623.7K
J2777	19	30	10,050	$30	$527.6K
J2778	3	20	400	$180	$87.8K
67028	6	70	580	$90	$72.3K
J7999	1	50	270	$70	$23.4K
92235	14	30	60	$100	$11.1K
99214	1,146	6,070	80	$70	$10.3K
92134	15	390	80	$30	$8.1K
92012	63	170	50	$60	$7.2K
99213	96	5,480	60	$50	$5.7K

Showing 1–10 of 13

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Retina Northwest P.C.	OR	Ophthalmology Physician	$0	$1.8M
Wenlan Zhang	OR	Retina Specialist (Ophthalmology) Physician	$1.5M	$0
Harpal Sandhu	OR	Retina Specialist (Ophthalmology) Physician	$1.4M	$4.5K
Paul Tlucek	OR	Retina Specialist (Ophthalmology) Physician	$1.2M	$0
Apurva Patel	OR	Retina Specialist (Ophthalmology) Physician	$1.2M	$0
Janani Singaravelu	OR	Ophthalmology Physician	$35.1K	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Lifeworks Nw	OR	Mental Health Counselor	$0	$57.6M
Lifeworks Northwest	OR	Addiction (Substance Use Disorder) Counselor	$0	$14.4M

Michael Lee — Billing Profile & Reimbursement Data

Sign up for Michael Lee — Billing Profile & Reimbursement Data policy alerts

Michael Lee — Billing Profile & Reimbursement Data

Sign up for Michael Lee — Billing Profile & Reimbursement Data policy alerts

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