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

Why is the Medicaid comparison limited to South Dakota 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. South Dakota (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.

Ophthalmology Associates 010196 (NPI 1306900634)

Field	Value
Entity Type	Organization
Organization	Ophthalmology Associates 010196
Address	310 8th Ave Nw Ste 507
City	Aberdeen
State	SD
ZIP	57401
Taxonomy	Ophthalmology Physician
NPI Enumerated	December 21, 2006

Payer Source	Total Paid
Medicaid	$100.1K
Medicare	$0

Medicaid: Complete Services Breakdown

Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.

8 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	1,890	$20	$35.9K
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.	1,200	$30	$29.9K
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.	1,860	$10	$16.8K
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…	210	$40	$7.5K
J9035	Injection, bevacizumab, 10 mg	310	$20	$6.9K
J7999	Compounded drug, not otherwise classified	100	$20	$1.7K
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.	20	$50	$750
92136	The provider uses a noninvasive method to measure the patient’s eye or eyes to get information that the provider then uses to calculate the appropriate power for an intraocular lens (IOL). Selecting…	40	$20	$700

Medicaid: Competitive Analysis & Benchmarks

How this provider's Medicaid billing volume and revenue compare to other South Dakota providers billing the same CPT/HCPCS codes.

Claims Volume vs. South Dakota Distribution

Ophthalmology Associates 010196 — 1 of 8 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — South Dakota

Full comparison — all codes billed, vs. South Dakota median

8 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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…	81	130	390	$90	$86.6K
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.	91	110	180	$110	$72.7K
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.	3	10	260	$50	$45.2K
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	30	210	$80	$40.5K
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.	3	20	90	$20	$13K
J7999	Compounded drug, not otherwise classified	4	10	260	$30	$9.5K
92136	The provider uses a noninvasive method to measure the patient’s eye or eyes to get information that the provider then uses to calculate the appropriate power for an intraocular lens (IOL). Selecting…	5	10	150	$20	$7.1K
J9035	Injection, bevacizumab, 10 mg	1	10	310	$20	$6.8K

Related Providers

Other providers that share a Tax Identification Number (TIN) with Ophthalmology Associates 010196, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
John Bormes	SD	Ophthalmology Physician	$2.6M	$0
Alexander Ringeisen	MN	Retina Specialist (Ophthalmology) Physician	$1.1M	$0
Ranjan Malhotra	MO	Ophthalmology Physician	$305K	$0
Andrew Royer	MO	Optometrist	$261.8K	$0
Gregg Berdy	MO	Ophthalmology Physician	$217K	$0
Robert Brusatti	MO	Optometrist	$203.8K	$0
Tyler Heuer	SD	Optometrist	$118.2K	$0
Lucas Schnaidt	SD	Ophthalmology Physician	$42.2K	$0

Nearby Providers

Other providers in the same ZIP code as Ophthalmology Associates 010196, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Adjustment Training Center, Inc.	SD	Developmentally Disabled Services Day Training Agency	$0	$40.3M
Northeastern Mental Health Center	SD	Mental Health Counselor	$0	$10.1M
Vision Care Associates, LLP	SD	Optometrist	$0	$6M
Sanford Health Network	SD	General Acute Care Hospital	$0	$4.4M
Avera St. Luke's	SD	Family Medicine Physician	$0	$2.3M
Sanford Health Network	SD	General Acute Care Hospital	$0	$1.9M
Avera At Home	SD	Home Health Agency	$0	$1.6M
Avera St Lukes	SD	General Acute Care Hospital	$0	$1.5M
Ty Hanson	SD	Dermatology Physician	$1.2M	$0
Fettig And Drake Dds PC	SD	General Practice Dentistry	$0	$1M

Ophthalmology Associates 010196 — Billing Profile & Reimbursement Data

Sign up for Ophthalmology Associates 010196 — Billing Profile & Reimbursement Data policy alerts

Ophthalmology Associates 010196 — Billing Profile & Reimbursement Data

Sign up for Ophthalmology Associates 010196 — Billing Profile & Reimbursement Data policy alerts

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References