John Saurino — Billing Profile & Reimbursement Data

This provider has $2.2M in lifetime Medicare revenue and no Medicaid billing on file, making their public payer footprint effectively single-payer (Medicare-only) in the available data. Absence of any Medicaid claims means analyses of state Medicaid market share or in-state payer negotiation leverage cannot be supported from these records.

Revenue concentration is high: the precomputed top 3 Medicare codes account for 69.8% of this provider's total Medicare revenue, indicating most income is driven by a narrow set of services. The largest single contributor is J0178 (aflibercept) at $1.1M (52.0% of Medicare revenue), signaling strong dependence on intravitreal anti-VEGF drug administration.

Service-line and operational implications from the code mix point to a procedure-focused ophthalmology practice centered on retinal care and intravitreal injections: high-volume drug injection codes J0178, J0179, and J2777 together drive the majority of payments, while diagnostic imaging and intermediate/ comprehensive eye exam codes (92134, 92012, 92014) also appear as meaningful revenue sources. This mix suggests a retina-oriented clinic providing ongoing injection therapy plus supportive imaging and E/M visits.

Competitive standing by code shows a mixed profile: for J0178 the provider ranks #722 of 3204 (77th percentile), a typical but not dominant national volume; for J0179 the provider ranks #6 of 64 (92nd percentile), placing them near the top among national peers for that specific drug; for imaging and exam codes the provider is an extreme outlier — 92012 ranks #77 of 17177 (100th percentile) and 92134 ranks #337 of 26868 (99th percentile) — indicating nationally exceptional volume for those diagnostic and E/M services. Overall, the practice is modest-to-strong nationally on injections and top-tier for routine eye exams and retinal imaging.

Tenure: the NPI was enumerated on 2006-06-15 (~20 years ago), indicating long-standing Medicare enrollment and likely established referral relationships and patient panels. That longevity aligns with high cumulative volumes in follow-up-dependent services such as repeated injections and serial imaging.

Several codes are statistical outliers relative to national peers: 92012 and 92134 are labeled "extreme outlier, far above typical national volume," and 99204 and 92202 are also noted as extreme outliers; these labels point to substantially higher-than-typical billing activity for intermediate/comprehensive exams and extended ophthalmoscopy services. Such concentration of outlier-level diagnostic/E/M activity alongside high-volume injection therapy suggests a workflow optimized for frequent follow-up visits and imaging-driven retinal care.

Clinical breadth beyond injections is present but limited: surgical retina codes (e.g., 67113 at $34.1K and 67141 at $3.1K) and laser procedures (67210, 67220, 67228) appear at much smaller volumes and typical-to-notably-above peers, indicating the provider performs some retinal procedures but that the primary revenue engine remains injectable therapeutics plus diagnostics. This pattern is consistent with a retina-focused ambulatory practice rather than a high-volume surgical retina center.

Payer mix implications for strategic positioning: because Medicare comprises the entirety of recorded public-payer revenue, the provider’s exposure to Medicare reimbursement trends and anti-VEGF drug pricing/coverage policies is concentrated; without Medicaid claims, the provider likely has limited direct participation in state Medicaid networks or treats Medicaid patients through other clinicians or settings not reflected in these filings.