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NPI 1285830323 · Providence, RI · Ophthalmology Physician
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Pranjal Thakuria is a ophthalmology physician provider located in Providence, Rhode Island. This profile covers 10 Medicare and 4 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 | Pranjal Thakuria |
| Address | 150 E Manning St |
| City | Providence |
| State | RI |
| ZIP | 02906 |
| Taxonomy | Ophthalmology Physician |
| NPI Enumerated | June 25, 2007 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $889.5K |
| Medicaid | $81.4K |
PRANJAL THAKURIA’s Medicare billing is heavily weighted toward intravitreal injection therapy and office visits, with J0178 (aflibercept injection) and 99214 (established office visits) together representing the largest shares of Medicare revenue. The top three Medicare codes account for 92.1% of total Medicare revenue, indicating a service mix focused on retinal disease management and frequent follow-up care rather than a broad range of ophthalmic procedures.
Medicare revenue ($889.5K) substantially exceeds Medicaid revenue ($81.4K), making Medicare the dominant payer by scale for this provider. The disparity in absolute revenue suggests the practice’s stable payer mix is Medicare-centric, with Medicaid representing a much smaller portion of lifetime payments.
J0178 drives the single largest Medicare revenue line: 900 claims generated $619.2K (69.6% of Medicare revenue), and the provider ranks in the 57th percentile nationally for this code. That ranking indicates the provider performs a typical, unremarkable volume of aflibercept injections relative to peers, but the sheer dollar share shows clinical focus on anti-VEGF therapy as a primary service line.
99214 is a major activity center across both payers: on Medicare it produced $143.1K (16.1% of Medicare revenue) with the provider an extreme outlier (99th percentile) in national volume for this code, and on Medicaid it produced $50.6K (62.1% of Medicaid revenue) with a 75th percentile in-state ranking. This pattern indicates high visit volume for moderate-complexity established patient E/M encounters and suggests a workflow built around frequent longitudinal management visits.
Retinal imaging (92134) is another core service supporting the injection-driven model: it accounts for $56.7K (6.4% of Medicare revenue) and $27K (33.1% of Medicaid revenue) and ranks notably above typical national volume on Medicare (96th percentile) and near the top in-state on Medicaid (78th percentile). The combination of high imaging and injection volumes is consistent with a practice delivering diagnosis, monitoring, and treatment for retinal disease in-house.
Across payers revenue concentration is acute: the top three Medicare codes make up 92.1% of Medicare revenue and the top three Medicaid codes make up 98.8% of Medicaid revenue. This concentration implies limited revenue diversification — most lifetime payments derive from a small set of procedure types (primarily anti-VEGF injections, E/M visits, and retinal imaging).
Competitive standing is mixed by market and code: nationally the provider is a typical to above-typical volume participant for J0178 and 67028 but is an extreme outlier for 99214 on Medicare, suggesting dominant visit volume relative to peers. In-state for Medicaid the provider ranks highly for 92134 (6 of 24 providers) and shows typical-to-strong positioning for 99214 (75th percentile), indicating a meaningful presence in Rhode Island for retinal imaging and established-office visit care.
Tenure in the Medicare/Medicaid programs is long-standing: the NPI was enumerated on 2007-06-25 (~19 years ago), indicating nearly two decades of billing history that supports observed volume concentration and role as an established ophthalmology physician in Providence.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
10 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 900 | $690 | $619.2K |
| 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… | 1,520 | $90 | $143.1K |
| 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 | $56.7K |
| 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. | 620 | $90 | $54.8K |
| J9035 | Injection, bevacizumab, 10 mg | 160 | $60 | $9K |
| 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… | 20 | $110 | $2.5K |
| 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,… | 50 | $30 | $1.5K |
| 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… | 10 | $120 | $1.3K |
| 92083 | The provider may use one or more methods to determine the extent of a patient's visual field of one or both eyes; he interprets the results and prepares a report. Report this code for an extended… | 20 | $50 | $970 |
| 76512 | The provider uses B–scan ultrasound imaging, with or without a non–qualitative A–scan superimposed, to examine the intraocular and orbital structures. | 10 | $40 | $590 |
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 10 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
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.
4 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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 | $60 | $50.6K |
| 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. | 1,080 | $30 | $27K |
| 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… | 60 | $50 | $2.9K |
| 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. | 10 | $70 | $990 |
How this provider's Medicaid billing volume and revenue compare to other Rhode Island providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Rhode Island median
4 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 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. | 14 | 10 | 170 | $230 | $144.3K |
| 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… | 425 | 1,730 | 220 | $70 | $75.2K |
| 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. | 6 | 20 | 560 | $50 | $61.6K |
| 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… | 147 | 190 | 230 | $40 | $35K |
Other providers in the same ZIP code as Pranjal Thakuria, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| The Miriam Hospital | RI | General Acute Care Hospital | $0 | $138.6M |
| Family Service Of Rhode Island Inc. | RI | Taxi | $0 | $12M |
| Butler Hospital | RI | Psychiatric Hospital | $0 | $9.6M |
| Phoenix Houses Of New England, Inc. | RI | Substance Abuse Rehabilitation Facility | $0 | $7.3M |
| Thomas Mulvey | RI | Pediatric Dentistry | $0 | $6.3M |
| Silver Fern Practice, LLC | RI | Physical Therapist | $0 | $5M |
| Providence Interventional Associates Ii LLC | RI | Ambulatory Surgical Clinic/Center | $1.9M | $8.3K |
| Robert Eden | RI | Pediatrics Physician | $0 | $1.7M |
| Brian Ackerman | RI | Psychiatry Physician | $24.8K | $1.5M |
| Steven Hirsch | RI | Clinical Neuropsychologist | $0 | $1.2M |
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