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NPI 1326332776 · Idaho Falls, ID · Retina Specialist (Ophthalmology) Physician
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Clinton Ellingson is a retina specialist (ophthalmology) physician provider located in Idaho Falls, Idaho. This profile covers 21 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 | Clinton Ellingson |
| Address | 2100 Providence Way |
| City | Idaho Falls |
| State | ID |
| ZIP | 83404 |
| Taxonomy | Retina Specialist (Ophthalmology) Physician |
| NPI Enumerated | June 2, 2011 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $2.7M |
| Medicaid | $126.5K |
Medicare dominates this provider's payer mix: total Medicare revenue is $2.7M compared with total Medicaid revenue of $126.5K, so the bulk of the practice's billing and revenue comes from Medicare beneficiaries rather than Medicaid. This makes Medicare activity the primary lens for understanding the practice's scale and market impact.
Revenue concentration on Medicare is high: the top three Medicare codes (J0178 39.1%, J2777 19.7%, J2778 13.1%) together account for 71.9% of the provider's Medicare revenue. That concentration indicates a service-line focus where a few intravitreal drug/biologic administrations drive most Medicare receipts.
On Medicare the practice appears to operate primarily as a retina/injectable therapy clinic: the top-paying Medicare codes are J0178, J2777, and J2778, which correspond to aflibercept, faricimab, and ranibizumab injections respectively. These codes’ dominance in revenue is consistent with recurring intravitreal anti‑VEGF/biologic therapy as a core service offering rather than exclusively evaluating patients.
Competitive standing for the top Medicare drug codes is middling to above average nationally: J0178 ranks #782 of 3204 providers (76th percentile), J2777 ranks #583 of 2039 providers (71st percentile), and J2778 ranks #220 of 1208 providers (82nd percentile), each labeled as "typical, unremarkable volume" or similar. In contrast, the retinal imaging code 92134 is a clear outlier on Medicare—ranking #908 of 26868 providers (97th percentile; notably above typical national volume)—which suggests unusually high utilization of diagnostic retinal imaging relative to most peers.
Medicaid revenue is highly concentrated and narrowly based: the top three Medicaid codes (67028 54.7%, J0178 39.4%, 92134 4.3%) account for 98.4% of the provider's Medicaid revenue, with 67028 and J0178 together making up the vast majority. This pattern indicates Medicaid receipts are primarily coming from intravitreal injection procedures and associated drug administration.
The provider is not a dominant Medicaid performer in-state. For Medicaid, 67028 ranks #9 of 11 providers in-state (20th percentile) and J0178 ranks #3 of 3 providers in-state (0th percentile), both described as "typical, unremarkable" in volume; those ranks indicate a modest footprint in the state Medicaid market rather than statewide leadership. Small peer counts for some codes (e.g., only three providers billing J0178 in-state) caution against overinterpreting percentile placement.
Surgical retina activity is present but limited: Medicare includes procedural surgical codes such as 67036, 67041, and 67042 with modest claim counts and revenues (each contributing under 1% of Medicare revenue). The presence of these vitrectomy and membrane-peel codes alongside high-volume injection and imaging codes suggests the practice performs occasional vitreoretinal surgery in addition to a heavier ambulatory injection/imaging caseload.
There is meaningful secondary revenue tied to unclassified/compound drug billing on Medicare: J3490 (Unclassified drugs) accounts for $281.1K (10.3% of Medicare revenue) and ranks #441 of 2838 providers (84th percentile). This elevated share relative to many peers suggests the provider bills a notable amount of nonstandard or unclassified drug products in addition to named biologics, and it may warrant attention when modeling drug-related cost drivers or negotiating pharmacy/drug reimbursements.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
21 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 | 18,420 | $30 | $534.2K |
| J2778 | Injection, ranibizumab, 0.1 mg | 1,990 | $180 | $356.7K |
| J3490 | Unclassified drugs | 160 | $1,770 | $281.1K |
| 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. | 1,500 | $90 | $138.4K |
| J2781 | Injection, pegcetacoplan, intravitreal, 1 mg | 1,080 | $120 | $126.4K |
| 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. | 2,140 | $30 | $59.9K |
| 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… | 540 | $90 | $47.9K |
| 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… | 170 | $110 | $19.4K |
| 67041 | In this procedure, the provider removes scar tissue from the retinal membrane that obscures vision. He removes vitreous humor, the gelatinous material that gives shape to the eye, using a mechanical… | 20 | $820 | $18.8K |
Showing 1–10 of 21
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 21 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
21 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J0178 | 2 | 20 | 670 | $690 | $541.7K |
| J2777 | 3 | 10 | 8,640 | $30 | $454.7K |
| J2778 | 3 | 10 | 1,190 | $180 | $352.5K |
| J3490 | 6 | 10 | 230 | $880 | $174.8K |
| J2781 | 3 | 10 | 990 | $120 | $153.8K |
| 67028 | 5 | 30 | 470 | $90 | $66.6K |
| 67036 | 3 | 10 | 20 | $1,040 | $33.3K |
| 67041 | 2 | 10 | 20 | $1,170 | $22.2K |
| J7999 | 19 | 20 | 200 | $70 | $18.9K |
| 67042 | 6 | 10 | 20 | $1,150 | $18.4K |
Showing 1–10 of 21
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 |
|---|---|---|---|---|
| 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. | 450 | $160 | $69.1K |
| J0178 | Injection, aflibercept, 1 mg | 70 | $770 | $49.9K |
| 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. | 460 | $10 | $5.5K |
| J9035 | Injection, bevacizumab, 10 mg | 20 | $100 | $2K |
How this provider's Medicaid billing volume and revenue compare to other Idaho providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Idaho median
4 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 3 | 10 | 110 | $1,240 | $444.8K |
| 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. | 9 | 10 | 990 | $50 | $87.9K |
| J9035 | Injection, bevacizumab, 10 mg | 6 | 10 | 400 | $60 | $43.6K |
| 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. | 9 | 20 | 690 | $20 | $29.7K |
Other providers in the same ZIP code as Clinton Ellingson, ranked by combined Medicare and Medicaid revenue.
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