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NPI 1336196815 · Lexington, KY · Retina Specialist (Ophthalmology) Physician
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Peter Blackburn is a retina specialist (ophthalmology) physician provider located in Lexington, Kentucky. This profile covers 10 Medicare and 5 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 | Peter Blackburn |
| Address | 110 Conn Ter Ste 550 |
| City | Lexington |
| State | KY |
| ZIP | 40508 |
| Taxonomy | Retina Specialist (Ophthalmology) Physician |
| NPI Enumerated | May 28, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $1M |
| Medicaid | $251.2K |
Practice profile and service mix: Billing is dominated by retina-focused procedures and intravitreal biologic therapy, with J2777 (faricimab) generating $633.4K on Medicare and J0178 (aflibercept) generating $164.6K on Medicare alongside high counts of the isolated intravitreal injection procedure 67028 on both payers. Diagnostic retinal imaging (92134) and routine established-patient visits (99213/99214) appear as the supporting outpatient services, which together indicate an outpatient retina practice organized around repeated injections, imaging surveillance, and follow-up E/M care.
Revenue concentration by payer: The provider’s top three Medicare codes account for 84.5% of total Medicare revenue, with J2777 alone constituting 61.5% of Medicare revenue; similarly, the top three Medicaid codes account for 89.9% of total Medicaid revenue. This concentration shows that a very small set of procedure and drug codes drives the bulk of revenue in both payers, increasing exposure to shifts in utilization or reimbursement for those specific services.
Payer mix and scale: The provider reports $1M in total Medicare revenue versus $251.2K in total Medicaid revenue, so Medicare is the materially larger revenue source while the practice maintains active Medicaid billing. The presence of meaningful revenue on both payers indicates the practice serves a mixed beneficiary panel but is not single-payer reliant.
Medicare competitive standing: For the practice’s top Medicare code J2777, the provider ranks #450 of 2039 nationally (78th percentile), indicating a typical, unremarkable national presence for faricimab administration; J0178 ranks lower nationally at the 23rd percentile. The practice’s retinal imaging 92134 is notably above typical national volume (95th percentile) and the intravitreal procedure 67028 sits near the middle of national peers (62nd percentile), together suggesting stronger local imaging and injection throughput relative to many peers.
Medicaid competitive standing (in-state): On Medicaid the provider ranks strongly for procedure and imaging codes — 67028 is #7 of 31 in-state (80th percentile) and 92134 is #6 of 74 in-state (93rd percentile) — indicating the provider is a relatively high-volume in-state performer for intravitreal procedures and retinal imaging. Routine E/M for established patients (99213) is more typical in-state (60th percentile), implying injection and imaging services are the primary differentiators of the provider’s Medicaid footprint.
Statistical outliers and utilization signals: The provider’s Medicare billing for 99213 is labeled an “extreme outlier” (rank #4288 of 457151, 99th percentile) with 1.2K claims and $70.4K in revenue, reflecting exceptionally high established-patient E/M volume against national peers. In parallel, 92134 appears as “notably above typical” on Medicare (95th percentile) and is also high on Medicaid (93rd percentile), reinforcing that follow-up visits and retinal imaging are unusually frequent components of this provider’s mix.
Tenure and continuity: The provider’s NPI was enumerated on 2006-05-28 (~20 years ago), indicating long-standing enrollment and likely sustained practice presence in the Lexington, KY market. Long tenure combined with concentrated service lines suggests an established retina practice rather than a recent entrant.
Operational implications and payer negotiation risk: Heavy dependence on high-cost biologic drug administration (J2777 accounting for $633.4K and 61.5% of Medicare revenue) and a small set of top codes driving 84.5% of Medicare and 89.9% of Medicaid revenue creates both negotiating leverage and revenue concentration risk. Any changes in coverage, reimbursement, or clinical guidelines for these specific biologics, injection procedures, or imaging codes could have outsized impact on the practice’s topline given the current code concentration.
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 |
|---|---|---|---|---|
| J2777 | Injection, faricimab‑svoa, 0.1 mg | 22,620 | $30 | $633.4K |
| J0178 | Injection, aflibercept, 1 mg | 240 | $680 | $164.6K |
| 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. | 840 | $90 | $73.1K |
| 99213 | The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the… | 1,170 | $60 | $70.4K |
| 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. | 1,710 | $30 | $46.2K |
| J3590 | Unclassified biologics | 500 | $50 | $22.4K |
| 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… | 100 | $90 | $9.2K |
| 99203 | The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the provider… | 80 | $80 | $6.3K |
| 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… | 40 | $120 | $4.6K |
| 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 | $30 | $420 |
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.
5 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. | 960 | $110 | $100.8K |
| 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. | 3,180 | $20 | $73K |
| 99213 | The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the… | 1,960 | $30 | $50.9K |
| J3590 | Unclassified biologics | 560 | $40 | $23.3K |
| 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… | 50 | $40 | $1.8K |
How this provider's Medicaid billing volume and revenue compare to other Kentucky providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Kentucky median
5 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 99213 | The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the… | 1,331 | 3,340 | 1,020 | $30 | $296K |
| 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… | 2,076 | 2,460 | 580 | $40 | $245K |
| 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. | 7 | 30 | 350 | $70 | $165.3K |
| 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 | 70 | 210 | $20 | $29.2K |
| J3590 | Unclassified biologics | 5 | 20 | 130 | $10 | $7K |
Other providers in the same ZIP code as Peter Blackburn, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| The Walker House Inc | KY | Community/Behavioral Health Agency | $0 | $6.4M |
| Bluegrass Bracing Inc | KY | Durable Medical Equipment & Medical Supplies | $0 | $4.8M |
| Carlos Serna | KY | Case Manager/Care Coordinator | $0 | $4.3M |
| Simple Solutions LLC | KY | Clinical Social Worker | $0 | $3.7M |
| Hope Center Services, LLC | KY | Professional Counselor | $0 | $3.1M |
| Claire Fraser | KY | Retina Specialist (Ophthalmology) Physician | $540.9K | $172K |
| Stuart Cowley | KY | Pain Medicine (Anesthesiology) Physician | $501.4K | $138.1K |
| John Franklin | KY | Pediatric Ophthalmology and Strabismus Specialist Physician Physician | $8.8K | $282K |
| Paul Pearson | KY | Retina Specialist (Ophthalmology) Physician | $198.8K | $57.2K |
| Eric Higgins | KY | Retina Specialist (Ophthalmology) Physician | $236.9K | $1.2K |
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