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

Why is the Medicaid comparison limited to Ohio 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. Ohio (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 Novak (NPI 1265437867)

Field	Value
Entity Type	Individual
Organization	Michael Novak
Address	3401 Enterprise Pkwy
City	Beachwood
State	OH
ZIP	44122
Taxonomy	Retina Specialist (Ophthalmology) Physician
NPI Enumerated	June 20, 2005

Payer Source	Total Paid
Medicare	$2.5M
Medicaid	$0

Key Findings

Practice profile and service mix: MICHAEL NOVAK is a retina specialist (Ophthalmology) whose Medicare billing is dominated by intravitreal drug therapy and retina imaging/office visits, with top codes including J0178 (aflibercept injections), J2777 (faricimab), and J2781 (pegcetacoplan). The presence of high-volume injection codes alongside advanced imaging codes such as 92134 and fundus photography (92250) indicates a procedure-focused retina practice that provides regular intravitreal pharmacologic therapy and diagnostic retinal imaging.

Revenue concentration within Medicare: Total Medicare revenue is $2.5M and the precomputed top-3 Medicare codes account for 76.8% of that total, indicating a high concentration of income from a narrow set of intravitreal drug administrations. This concentration suggests the provider’s financial performance is heavily dependent on a small number of high-revenue ophthalmic drug codes.

Payer mix / single-payer reliance: The provider reports $2.5M in lifetime Medicare revenue and has no Medicaid billing on file, making the practice effectively single-payer (Medicare) in the dataset and implying limited or no participation in state Medicaid programs. That imbalance is important for payer-network planning and risk analyses because Medicare beneficiaries represent essentially the entire public-payer footprint recorded here.

Competitive standing on headline drug codes: For J0178 (aflibercept) the provider ranks #645 of 3204 nationally (80th percentile), and for J2777 (faricimab) ranks #555 of 2039 (73rd percentile), which positions the clinician as a solid, typical-volume national participant for these high-revenue intravitreal agents rather than a market leader. The ranks and percentiles indicate routine, expected volumes for a retina practice of this size rather than extreme specialization or unusually high national prominence.

Notable above-typical service volumes: Several non-drug codes show above-typical national volume: 99214 (office E/M) ranks in the 96th percentile and 92134 (retinal imaging) ranks in the 97th percentile, indicating the provider sees a comparatively high volume of established patient visits and diagnostic retinal imaging relative to national peers. These elevated percentiles suggest a busy clinic with substantial follow-up and imaging throughput that supports ongoing intravitreal treatment programs.

Moderate volumes on select specialty drugs and unclassified drug usage: J2781 (pegcetacoplan) ranks #77 of 490 (84th percentile) and J3490 (unclassified drugs) ranks #882 of 2838 (68th percentile), reflecting meaningful but not dominant use of less common or less standardized retinal therapeutics and some use of unclassified drug billing. This pattern may reflect treatment of niche retinal conditions or billing for miscellaneous biologics in addition to the main anti-VEGF/anti-complement agents.

Surgical procedures and tertiary care signals: The provider bills for procedures such as 67042 (vitrectomy with membrane peel) and 67028 (intravitreal injection as an isolated procedure), with 67042 showing lower national rank (31st percentile) but 67028 contributing materially to revenue (5.0% of Medicare revenue). This mix indicates the practice performs both routine injections and occasional surgical retina procedures, consistent with a retina specialist who manages a range of medical and surgical retinal conditions.

Tenure and experience: The NPI was enumerated on 2005-06-20 (~21 years ago), indicating long-term enrollment and likely extended clinical experience in ophthalmology. This tenure supports the sustained Medicare billing profile and the development of a stable referral base for retina services.

Medicare: Complete Services Breakdown

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

23 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J0178	Injection, aflibercept, 1 mg	1,780	$690	$1.2M
J2777	Injection, faricimab‑svoa, 0.1 mg	19,320	$30	$560.3K
J2781	Injection, pegcetacoplan, intravitreal, 1 mg	1,230	$120	$147.6K
J3490	Unclassified drugs	90	$1,540	$138.3K
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.	1,550	$80	$127.2K
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…	790	$80	$65.5K
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.	2,250	$30	$60.6K
J2778	Injection, ranibizumab, 0.1 mg	230	$180	$41.2K
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…	530	$70	$34.6K
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…	370	$80	$30.2K

Showing 1–10 of 23

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 23 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Ohio Distribution

Michael Novak — 6 of 23 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Ohio

Full comparison — all codes billed, vs. state median

23 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0178	25	100	840	$680	$729K
J2777	13	70	9,480	$30	$353.3K
J2781	7	20	1,040	$120	$152.4K
J2778	14	20	370	$180	$73.1K
J3490	31	50	100	$560	$73.1K
67028	22	150	470	$90	$64K
J3590	55	100	200	$100	$30K
67042	35	50	20	$960	$29.7K
92014	178	1,390	100	$70	$12.9K
99214	279	20,010	100	$70	$11.7K

Showing 1–10 of 23

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Retina Associates Of Cleveland, Inc.	OH	Retina Specialist (Ophthalmology) Physician	$0	$11.2M
Scott Pendergast	OH	Retina Specialist (Ophthalmology) Physician	$6M	$0
David Miller	OH	Retina Specialist (Ophthalmology) Physician	$4.8M	$0
Llewelyn Rao	OH	Retina Specialist (Ophthalmology) Physician	$3.7M	$0
Joseph Coney	OH	Retina Specialist (Ophthalmology) Physician	$3.2M	$140
Arnold Nothnagel	OH	Retina Specialist (Ophthalmology) Physician	$2.9M	$0
Shawn Lewis	OH	Retina Specialist (Ophthalmology) Physician	$2.8M	$0
Thomas Hull	OH	Retina Specialist (Ophthalmology) Physician	$2.6M	$0
Hang Pham	OH	Ophthalmology Physician	$2.6M	$0
Jerome Schartman	OH	Retina Specialist (Ophthalmology) Physician	$2.4M	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
University Primary Care Practices Inc	OH	Internal Medicine Physician	$0	$78.7M
Pearl's Hope, LLC	OH	Home Health Agency	$0	$47.8M
Health Care Bridge, Inc	OH	Home Health Agency	$0	$32.3M
Cleveland Clinic Health System - East Region	OH	General Acute Care Hospital	$0	$31.5M
Altimate Care LLC	OH	Home Health Agency	$0	$24M
Signature Health, Inc	OH	Federally Qualified Health Center (FQHC)	$0	$23M
University Hospitals Ahuja Medical Center, Inc	OH	General Acute Care Hospital	$0	$21.1M
Shaker Clinic, LLC	OH	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$15.5M
Psychological & Behavioral Consultants, LLC	OH	Psychiatry Physician	$0	$14.9M
Northeast Home Health Services	OH	Home Health Agency	$0	$11.9M

Michael Novak — 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