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NPI 1295729010 · Silverdale, WA · Ophthalmology Physician
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Adrian Omalley is a ophthalmology physician provider located in Silverdale, Washington. This profile covers 22 Medicare and 1 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 | Adrian Omalley |
| Address | 9800 Levin Rd Nw |
| City | Silverdale |
| State | WA |
| ZIP | 98383 |
| Taxonomy | Ophthalmology Physician |
| NPI Enumerated | September 8, 2005 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $3M |
| Medicaid | $0 |
This provider is effectively a Medicare-only biller: lifetime Medicare revenue is $3M while Medicaid revenue is $0, indicating near-total dependence on Medicare reimbursement for observed activity. That payer mix concentrates financial exposure on Medicare policy and reimbursement changes rather than on state Medicaid dynamics.
Revenue is highly concentrated in a few high-cost retinal injection codes: the precomputed top-3 Medicare codes account for 69.8% of total Medicare revenue, led by J0178 at 50.7% of Medicare revenue. The dominance of these three codes signals that anti-VEGF and related intravitreal drug treatments are the primary revenue drivers for this practice.
The code mix and volumes point to a retina-focused ophthalmology practice that delivers frequent intravitreal injections and associated diagnostics. High-volume drug codes include J0178 (2.2K claims, $686 avg paid/claim, $1.5M revenue), J2777 (13.5K claims, $29 avg paid/claim, $391.5K revenue), and Q5128 (827 claims, $217 avg paid/claim, $179.5K revenue), together reflecting a clinic workflow oriented around recurring injection treatments and biologic drug administration.
While injection codes are the revenue backbone, diagnostic and office-service volume is unusually high: 92134 has 3.2K claims and $99.6K revenue and ranks as an extreme outlier (99th percentile), and 92012 has 1.2K claims and $72.8K revenue and is also an extreme outlier (98th percentile). These atypically high volumes for retinal imaging and intermediate eye exams suggest robust clinic throughput and regular monitoring visits that support the high injection caseload.
Competitive standing on individual drug codes is mixed: J0178 ranks #429 of 3204 providers (87th percentile) and is described as typical/unremarkable for the code despite its large revenue share, while J2777 (#771 of 2039, 62th percentile) and Q5128 (#162 of 373, 57th percentile) are similarly characterized as typical, unremarkable volumes. In contrast, the provider is a clear outlier for imaging and exam codes (e.g., 92134 and 92012), indicating stronger relative market presence in clinic-based diagnostics than in national drug-injection benchmarking.
The practice exhibits exposure to biologic drug reimbursement dynamics because a majority of revenue comes from high-cost drug billing lines. Beyond J0178, additional drug-related lines such as J3490 ($138.5K, 76 claims) and J2778 ($131.6K, 735 claims) contribute materially, meaning changes in drug pricing, biosimilar uptake, or coverage policies could materially affect revenue.
Surgical and procedure volumes are present but secondary to injection and diagnostic services: 67028 shows 1.8K claims and $178.8K revenue (6.0% of Medicare revenue) and ranks #504 of 4255 (88th percentile), while other surgical codes like 67042 and 67036 appear at much lower volumes. This mix indicates the provider offers some vitreoretinal procedures but operates primarily as an injection-and-clinic monitoring practice.
The provider has a long-established billing history with NPI enumeration on 2005-09-08 (~21 years ago), which supports the interpretation of entrenched service patterns rather than a transient or newly established practice profile. Longevity combined with consistent high imaging and injection volumes suggests stable operational workflows and patient follow-up practices that sustain recurring treatment cycles.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
22 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 2,220 | $690 | $1.5M |
| J2777 | Injection, faricimab‑svoa, 0.1 mg | 13,500 | $30 | $391.5K |
| Q5128 | Injection, ranibizumab-eqrn (cimerli), biosimilar, 0.1 mg | 830 | $220 | $179.5K |
| 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. | 1,820 | $100 | $178.8K |
| J3490 | Unclassified drugs | 80 | $1,820 | $138.5K |
| J2778 | Injection, ranibizumab, 0.1 mg | 740 | $180 | $131.6K |
| J2781 | Injection, pegcetacoplan, intravitreal, 1 mg | 960 | $120 | $115.2K |
| 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. | 3,210 | $30 | $99.6K |
| 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… | 1,210 | $60 | $72.8K |
| 92004 | The provider performs a comprehensive level ophthalmological evaluation of a new patient and initiates a diagnostic and treatment program for one or more visits. | 300 | $110 | $32.3K |
Showing 1–10 of 22
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 22 CPT/HCPCS codes.
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Full comparison — all codes billed, vs. state median
22 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J2777 | 24 | 50 | 12,780 | $30 | $599.7K |
| J0178 | 9 | 90 | 470 | $680 | $597.2K |
| Q5128 | 3 | 10 | 520 | $220 | $136.6K |
| J2778 | 8 | 30 | 510 | $180 | $117.1K |
| J2781 | 5 | 10 | 650 | $120 | $88.6K |
| 67028 | 13 | 110 | 550 | $90 | $72.9K |
| J3490 | 28 | 70 | 70 | $50 | $51.2K |
| 67042 | 16 | 40 | 30 | $1,190 | $39.2K |
| 67108 | 7 | 20 | 20 | $1,180 | $29.6K |
| 67036 | 15 | 20 | 20 | $1,140 | $28.6K |
Showing 1–10 of 22
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.
1 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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. | 20 | $0 | $0 |
How this provider's Medicaid billing volume and revenue compare to other Washington providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Washington median
1 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 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. | 84 | 100 | 240 | $10 | $22.2K |
Other providers in the same ZIP code as Adrian Omalley, ranked by combined Medicare and Medicaid revenue.
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