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

Why is the Medicaid comparison limited to Washington 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. Washington (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.

Shelly Lee (NPI 1285817288)

Field	Value
Entity Type	Individual
Organization	Shelly Lee
Address	427 S Bernard St
City	Spokane
State	WA
ZIP	99204
Taxonomy	Ophthalmology Physician
NPI Enumerated	December 12, 2007

Payer Source	Total Paid
Medicare	$1.9M
Medicaid	$0

Key Findings

This provider’s Medicare business is the clear revenue source: total Medicare revenue is $1.9M and there is no Medicaid billing on file, so the practice is effectively single‑payer in the public programs reflected here. Analysts should treat Medicare patterns as representative of the provider’s public‑payer activity rather than a dual‑payer mix.

Revenue is highly concentrated in a small set of procedure/drug codes: the precomputed top 3 Medicare codes by revenue account for 82.5% of this provider's total Medicare revenue, with J0178 alone representing 57.4% of Medicare revenue, J2777 14.5%, and J2778 10.6%. That concentration indicates a business model heavily dependent on a few high‑revenue injectable therapies.

The code mix signals a retina‑focused ophthalmology practice built around intravitreal injections and posterior‑segment diagnostics. High‑revenue injection billing such as J0178 (1.6K claims, $690 avg paid/claim, $1.1M revenue) together with procedure code 67028 (1.2K claims, $99 avg paid/claim, $113.9K revenue) and imaging code 92134 (1.6K claims, $30 avg paid/claim, $47.4K revenue) points to routine anti‑VEGF and retina service lines as operational priorities.

On competitive standing the provider is a solid but not dominant national performer for the top drug codes: J0178 ranks #781 of 3204 providers nationally (76th percentile; typical, unremarkable volume), J2778 ranks #405 of 1208 (66th percentile; typical), and J2777 ranks #1057 of 2039 (48th percentile; typical). These percentiles indicate above‑median participation for some anti‑VEGF agents but not at the level of national leaders, suggesting a substantial local/regional presence rather than market dominance.

One notable statistical outlier among diagnostic codes is 92134, which ranks #1432 of 26868 providers nationally (95th percentile; notably above typical national volume). The high percentile for retinal OCT imaging implies heavier reliance on multimodal retinal diagnostics relative to most peers and may reflect a practice emphasis on macular disease management.

Small but high‑unit‑cost billing lines appear intermittently: J3490 (Unclassified drugs) shows only 24 claims but a $1827 avg paid/claim and $43.8K revenue (2.3% of Medicare revenue), while J7312 (dexamethasone intravitreal implant) has 273 claims, $158 avg paid/claim, and $43.1K revenue (2.3%). These patterns suggest occasional use of high‑cost drug items or billing for implants and unclassified agents that contribute meaningfully despite low claim counts.

Evaluation and management revenue is a minor portion of Medicare receipts, consistent with a procedure/drug‑driven practice model: 99214 produced $16.4K (0.9% of Medicare revenue) with 174 claims, 92014 produced $14.8K (0.8%) with 161 claims, and 99204 produced $9.5K (0.5%) with 78 claims. This reinforces that injections and retinal diagnostics, rather than routine office visits, drive the practice’s Medicare income.

The provider has long tenure in the Medicare program with an NPI enumerated on 2007-12-12 (~19 years ago), supporting the interpretation that current billing patterns represent established, sustained service lines rather than a short‑term or newly shifted case mix. Analysts assessing trends should consider this longevity when evaluating stability of the injection‑and‑retina business model.

Medicare: Complete Services Breakdown

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

18 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J0178	Injection, aflibercept, 1 mg	1,550	$690	$1.1M
J2777	Injection, faricimab‑svoa, 0.1 mg	9,360	$30	$271.4K
J2778	Injection, ranibizumab, 0.1 mg	1,090	$180	$198K
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.	1,150	$100	$113.8K
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.	1,580	$30	$47.4K
J3490	Unclassified drugs	20	$1,830	$43.8K
J7312	Injection, dexamethasone, intravitreal implant, 0.1 mg	270	$160	$43.1K
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…	170	$90	$16.4K
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…	160	$90	$14.8K
J7999	Compounded drug, not otherwise classified	220	$70	$14.7K

Showing 1–10 of 18

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 18 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Washington Distribution

Shelly Lee — 1 of 18 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Washington

Full comparison — all codes billed, vs. state median

18 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J2777	31	50	12,780	$30	$599.7K
J0178	23	90	470	$680	$597.2K
J2778	4	30	510	$180	$117.1K
67028	35	110	550	$90	$72.9K
J3490	59	70	70	$50	$51.2K
J7312	7	20	270	$160	$46K
92242	13	20	50	$210	$19.7K
92014	302	790	110	$80	$16.8K
J7999	22	70	150	$70	$15.9K
99214	3,260	10,860	100	$80	$13.6K

Showing 1–10 of 18

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Spokane Eye Clinic Ps	WA	Multi-Specialty Clinic/Center	$0	$8M
Spokane Eye Clinic Ps	WA	Ambulatory Surgical Clinic/Center	$3M	$716.1K
Robert Wirthlin	WA	Ophthalmology Physician	$3.7M	$0
Andrew Cheek	WA	Ophthalmology Physician	$3.5M	$0
Dallin Andersen	WA	Ophthalmology Physician	$3.4M	$0
Loren Jack	WA	Ophthalmology Physician	$3.4M	$0
Ryan Whitted	GA	Ophthalmology Physician	$2.5M	$0
Robert Welch	UT	Retina Specialist (Ophthalmology) Physician	$2.5M	$0
Jessica Weinstein	OR	Retina Specialist (Ophthalmology) Physician	$691.2K	$49.8K
Steven Day	WA	Ophthalmology Physician	$379.5K	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Providence Health & Services - Wa	WA	General Acute Care Hospital	$0	$78.7M
Providence Health & Services Washington	WA	Pulmonary Disease Physician	$0	$78.6M
Multicare Health System	WA	General Acute Care Hospital	$0	$55.1M
New Horizon Care Center, Inc.	WA	Substance Abuse Rehabilitation Facility	$0	$20.2M
Spokane Addiction Recovery Centers	WA	Substance Abuse Rehabilitation Facility	$0	$19M
Spokane Emergency Care Physicians PLLC	WA	Emergency Medicine Physician	$0	$13.9M
Spokane Emergency Physicians, Ps	WA	Emergency Medicine Physician	$0	$13.1M
Providence Health & Services Washington	WA	Clinical Medical Laboratory	$1.6M	$9.3M
Laboratory Corporation Of America	WA	Clinical Medical Laboratory	$1.6M	$6.1M
Integra Imaging, Ps	WA	Diagnostic Radiology Physician	$0	$7.5M

Shelly Lee — 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