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NPI 1285645549 · Des Plaines, IL · Retina Specialist (Ophthalmology) Physician
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Michael Blair is a retina specialist (ophthalmology) physician provider located in Des Plaines, Illinois. This profile covers 26 Medicare and 13 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 | Michael Blair |
| Address | 2454 E Dempster St |
| City | Des Plaines |
| State | IL |
| ZIP | 60016 |
| Taxonomy | Retina Specialist (Ophthalmology) Physician |
| NPI Enumerated | August 11, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $3M |
| Medicaid | $2.6M |
Payer mix and scale: This provider reports $3M in total Medicare revenue and $2.6M in total Medicaid revenue, so Medicare is the slightly larger single payer but the practice operates at meaningful scale across both programs. The NPI was enumerated on 2006-08-11 (~20 years ago), indicating long-standing participation in public payer programs and an established service footprint in DES PLAINES, IL.
Medicare revenue concentration: The provider's Medicare billing is highly concentrated — the top three Medicare codes account for 78.1% of total Medicare revenue. J0178 (aflibercept) alone represents 61.6% of Medicare revenue ($1.8M), with J3490 at 11.7% ($351.1K) and 67028 at 4.8% ($143.3K), indicating most Medicare dollars flow through a small set of injection/drug and procedure codes.
Medicaid revenue concentration: Medicaid revenue is even more concentrated: the top three Medicaid codes account for 89.0% of total Medicaid revenue. J0178 is the dominant Medicaid driver at 57.1% ($1.5M), followed by 67028 at 25.9% ($673.8K) and 92134 at 6.0% ($154.8K), so a very large share of Medicaid flows through aflibercept administration and intravitreal injection procedures.
Business / service-line implications: The code mix (high volumes and revenue for J0178, frequent 67028 procedures, and large counts for 92134 retinal imaging) aligns with a retina-focused practice model that delivers high-volume intravitreal injections and retinal diagnostics. The presence of substantial E/M billing (e.g., 99213) alongside procedure and drug codes suggests a high-throughput clinic workflow that combines drug administration with diagnostic imaging and follow-up visits.
National competitive standing on Medicare: For key services this provider is a high-volume national participant — J0178 ranks #256 of 3204 providers nationally (92th percentile; notably above typical national volume) and 92134 ranks #351 of 26868 providers nationally (99th percentile; extreme outlier). The provider also ranks #4552 of 457151 for 99213 on Medicare (99th percentile; extreme outlier), indicating above-typical national volumes for both injection-related and clinic visit activity.
State-level competitive standing on Medicaid: The provider is a dominant state-level performer for core retina services — J0178 ranks #2 of 45 in-state (98th percentile; notably above typical state volume) and 67028 ranks #5 of 120 in-state (97th percentile; notably above typical state volume). 92134 is an extreme outlier in-state as well (ranks #4 of 250; 99th percentile), showing the practice is a major Medicaid provider for retinal imaging and injection procedures in Illinois.
Operational / payer negotiation implications: Heavy reliance on high-cost drug administration codes like J0178 (aflibercept) for both Medicare and Medicaid means the practice’s revenue base is closely tied to anti-VEGF therapy utilization and reimbursement for drug administration. Because the top 3 codes account for 78.1% of Medicare revenue and 89.0% of Medicaid revenue, payers negotiating rates or utilization controls for injectable retinal therapies and associated injection visits will materially affect this provider’s revenue profile.
Coding mix and secondary drivers: On Medicare, J3490 (unclassified drugs) is a notable secondary revenue source at 11.7% ($351.1K) and ranks #335 of 2838 nationally (88th percentile; typical, unremarkable volume), suggesting some revenue comes from miscellaneous drug billing alongside labeled drug codes. Other codes with high claim counts but smaller per-claim payments (for example J2777 and J9035) contribute to the overall clinical footprint but do not dominate revenue, indicating a mix of drug types and dosing patterns in the practice’s case mix.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
26 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 2,670 | $690 | $1.8M |
| J3490 | Unclassified drugs | 200 | $1,770 | $351.1K |
| 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. | 1,390 | $100 | $143.3K |
| J2777 | Injection, faricimab‑svoa, 0.1 mg | 4,860 | $30 | $140.9K |
| J2781 | Injection, pegcetacoplan, intravitreal, 1 mg | 900 | $120 | $108K |
| 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. | 3,120 | $30 | $96.7K |
| 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… | 1,150 | $70 | $74.8K |
| 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… | 480 | $60 | $30.8K |
| 67113 | The provider repairs a complicated detached retina. He removes vitreous humor, the gelatinous material that gives shape to the eye, and peels the retinal membrane. He reattaches the retina with… | 20 | $1,080 | $22.6K |
| J7312 | Injection, dexamethasone, intravitreal implant, 0.1 mg | 130 | $160 | $21.1K |
Showing 1–10 of 26
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 26 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
26 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J0178 | 10 | 140 | 700 | $690 | $688.4K |
| J2777 | 62 | 90 | 9,180 | $30 | $451K |
| J2781 | 2 | 10 | 600 | $120 | $86.8K |
| 67028 | 35 | 190 | 400 | $90 | $64.4K |
| J7312 | 25 | 30 | 240 | $160 | $45.1K |
| 67041 | 10 | 10 | 20 | $1,140 | $26.3K |
| 92014 | 491 | 1,420 | 130 | $80 | $24.7K |
| J9035 | 105 | 130 | 140 | $60 | $24.6K |
| 67042 | 39 | 50 | 20 | $870 | $21.8K |
| J3490 | 14 | 140 | 50 | $210 | $19.4K |
Showing 1–10 of 26
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.
13 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 1,260 | $1,180 | $1.5M |
| 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. | 3,400 | $200 | $673.8K |
| 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. | 7,740 | $20 | $154.8K |
| 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… | 2,960 | $30 | $88.9K |
| J9035 | Injection, bevacizumab, 10 mg | 1,140 | $70 | $75.3K |
| 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… | 1,500 | $40 | $60K |
| 92250 | Code 92250 describes the taking of fundus photographs, that is, photographs of the posterior segment of the inner aspect of the eye, to document alterations in the optic nerve head, retinal vessels,… | 640 | $40 | $22.4K |
| 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… | 440 | $30 | $13.3K |
| 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… | 170 | $60 | $10.5K |
| 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… | 520 | $20 | $10.3K |
Showing 1–10 of 13
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
13 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 2 | 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. | 5 | 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… | 619 | 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… | 2,407 | 14,680 | 300 | $50 | $48.7K |
| J9035 | Injection, bevacizumab, 10 mg | 20 | 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… | 1,332 | 14,190 | 280 | $20 | $38.9K |
| 99232 | The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or… | 4,303 | 4,800 | 210 | $30 | $29.3K |
| 92250 | Code 92250 describes the taking of fundus photographs, that is, photographs of the posterior segment of the inner aspect of the eye, to document alterations in the optic nerve head, retinal vessels,… | 76 | 310 | 140 | $30 | $25.5K |
| 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. | 4 | 250 | 510 | $20 | $20.1K |
| 92226 | N/A | 34 | 50 | 430 | $20 | $19.5K |
Showing 1–10 of 13
Other providers in the same ZIP code as Michael Blair, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| City Of Desplaines | IL | Land Ambulance | $784.7K | $13.1M |
| Access Community Health Network | IL | Federally Qualified Health Center (FQHC) | $0 | $11.9M |
| Med Rush Clinical Lab Inc | IL | Clinical Medical Laboratory | $2.4M | $9.3M |
| Presence Home Care | IL | Home Health Agency | $0 | $7.3M |
| Alan Hirsch | IL | Neurology Physician | $50.8K | $3.8M |
| Srikanth Ravindran | IL | Family Medicine Physician | $198.8K | $3.4M |
| North Maine Fire Protection District | IL | Land Ambulance | $163.2K | $3.3M |
| George Wyhinny | IL | Retina Specialist (Ophthalmology) Physician | $2.9M | $33.9K |
| John Galasso | IL | Retina Specialist (Ophthalmology) Physician | $1.6M | $1.2M |
| Daniel Alter | IL | Retina Specialist (Ophthalmology) Physician | $2.7M | $9K |
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