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NPI 1295719631 · Norfolk, VA · Ophthalmology Physician
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Alan Wagner is a ophthalmology physician provider located in Norfolk, Virginia. This profile covers 24 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 | Alan Wagner |
| Address | 6160 Kempsville Cir Ste 120b |
| City | Norfolk |
| State | VA |
| ZIP | 23502 |
| Taxonomy | Ophthalmology Physician |
| NPI Enumerated | November 30, 2005 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $3.8M |
| Medicaid | $24.1K |
This provider is effectively Medicare‑driven in scale: Total Medicare revenue is $3.8M compared with $24.1K in Medicaid, indicating Medicare dominates the financial footprint and Medicaid is a very small portion of billed activity. The Medicaid book appears to be focused on eyewear items rather than clinical procedures, while Medicare carries the clinical procedural volume.
Medicare revenue is highly concentrated: the precomputed top 3 Medicare codes account for 73.8% of Medicare revenue, driven by J0178 (48.4%), J2777 (13.4%), and 92014 (11.9%). This concentration signals that a small set of high‑value ophthalmic drugs and comprehensive eye exams produce the bulk of Medicare receipts for this provider.
Clinical mix and service line: the code mix shows a high‑volume medical retina practice centered on intravitreal pharmacotherapy and imaging—J0178 (aflibercept) reports 2.7K claims and $1.8M revenue, 67028 (intravitreal injection) has 3.5K claims and $352.2K revenue, and 92134 (retinal imaging) has 5.4K claims and $166.7K revenue. Combined with a large number of comprehensive established‑patient exams (92014), the profile is consistent with a high‑throughput retina/injection clinic rather than a primarily surgical or refractive practice.
National competitive standing is unusually strong on several volume measures: 92014 ranks #6 of 35415 providers nationally (100th percentile; extreme outlier) and 92134 ranks #29 of 26868 providers nationally (100th percentile; extreme outlier), indicating the provider is a national outlier for exam and retinal imaging volume. J0178 ranks #251 of 3204 (92th percentile; notably above typical national volume), so the provider also bills aflibercept at a markedly higher than typical national volume for that drug.
Drug mix and utilization nuance: the practice bills multiple intravitreal pharmacotherapies—J0178 (aflibercept) and J2777 (faricimab) are the top Medicare drug codes by revenue, and J9035 (bevacizumab) appears with $154.7K revenue and ranks #8 of 1852 providers nationally (100th percentile; extreme outlier). This combination of branded and biosimilar/compounded agents suggests a treatment mix for retinal disease that includes both high‑cost branded products and alternatives, with variable national standing by drug.
Medicaid activity is small and highly concentrated in optical supplies: the precomputed top 3 Medicaid codes account for 98.8% of Medicaid revenue, with V2020 (frames) producing $16.2K (67.0% of Medicaid revenue) and V2103 (single‑vision lenses) producing $6.7K (27.8%). In‑state ranks for these codes are middling (for example, V2020 ranks #173 of 403, 57th percentile), reinforcing that Medicaid revenue reflects eyewear provision rather than high Medicaid procedural volume.
There is some surgical retina activity but at much smaller scale: vitrectomy and related surgery codes such as 67042 (30 claims, $26.6K revenue) and 67036 (31 claims, $21K revenue) are present but account for a small fraction of Medicare revenue compared with injections and imaging. This suggests the practice performs occasional surgical retina cases but is primarily organized around outpatient injection and diagnostic services.
Tenure and practice stability: the provider’s NPI enumerated on 2005-11-30 (~21 years ago), indicating a long‑established presence in the market. The combination of long tenure and concentrated, high‑volume Medicare billing patterns (notably extreme outlier ranks on exam and imaging) points to a stable, high‑throughput ophthalmology/retina operation that is relevant for payer network, utilization, and specialty contracting considerations.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
24 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 2,690 | $690 | $1.8M |
| J2777 | Injection, faricimab‑svoa, 0.1 mg | 17,520 | $30 | $508.1K |
| 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… | 4,920 | $90 | $452.9K |
| 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. | 3,450 | $100 | $352.2K |
| 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. | 5,380 | $30 | $166.7K |
| J9035 | Injection, bevacizumab, 10 mg | 2,710 | $60 | $154.7K |
| J0179 | Injection, brolucizumab-dbll, 1 mg | 370 | $240 | $87.8K |
| J3490 | Unclassified drugs | 30 | $1,770 | $53K |
| 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… | 370 | $120 | $43.4K |
| J2781 | Injection, pegcetacoplan, intravitreal, 1 mg | 300 | $120 | $36.4K |
Showing 1–10 of 24
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 24 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
24 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J0178 | 17 | 80 | 1,400 | $690 | $1.1M |
| J2777 | 25 | 60 | 13,200 | $30 | $517.1K |
| 67028 | 1 | 90 | 1,000 | $90 | $107.1K |
| J2781 | 13 | 20 | 560 | $120 | $86.6K |
| J0179 | 1 | 10 | 230 | $240 | $54.7K |
| J7312 | 17 | 20 | 240 | $160 | $42.5K |
| 67042 | 7 | 20 | 20 | $1,130 | $33.8K |
| 92014 | 1 | 870 | 170 | $80 | $32.8K |
| 67108 | 6 | 20 | 20 | $1,180 | $23.5K |
| 99214 | 12,357 | 12,890 | 140 | $80 | $21K |
Showing 1–10 of 24
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 |
|---|---|---|---|---|
| V2020 | Frames, purchases | 350 | $50 | $16.2K |
| V2103 | Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens | 110 | $60 | $6.7K |
| V2784 | Lens, polycarbonate or equal, any index, per lens | 90 | $10 | $990 |
| V2760 | Scratch resistant coating, per lens | 30 | $10 | $280 |
How this provider's Medicaid billing volume and revenue compare to other Virginia providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Virginia median
4 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| V2103 | Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens | 114 | 170 | 250 | $50 | $42.6K |
| V2020 | Frames, purchases | 173 | 400 | 230 | $40 | $36.6K |
| V2784 | Lens, polycarbonate or equal, any index, per lens | 145 | 230 | 190 | $10 | $6.6K |
| V2760 | Scratch resistant coating, per lens | 29 | 50 | 40 | $10 | $2.2K |
Other providers in the same ZIP code as Alan Wagner, ranked by combined Medicare and Medicaid revenue.
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