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NPI 1336252626 · Great Neck, NY · Ophthalmology Physician
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David Fastenberg is a ophthalmology physician provider located in Great Neck, New York. 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 | David Fastenberg |
| Address | 600 Northern Blvd |
| City | Great Neck |
| State | NY |
| ZIP | 11021 |
| Taxonomy | Ophthalmology Physician |
| NPI Enumerated | August 17, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $4.4M |
| Medicaid | $31.2K |
Practice focus and service mix skew strongly to retina care and intravitreal pharmacotherapy: the largest single Medicare revenue driver is J0178 (aflibercept) with $2.1M revenue (47.1% of this provider's total Medicare revenue) and 3K claims, and other high-revenue Medicare items include long-tail intravitreal injection codes (J2777 and Q5128) and vitreous injection procedure 67028. High-volume diagnostic imaging (92134 with 3.7K claims and $136.3K revenue) plus multiple injection codes indicate an operational model centered on frequent in-office drug delivery and retinal imaging rather than surgery or broad primary ophthalmology visits. This code mix is consistent with a retina-focused ophthalmology practice treating chronic retinal diseases such as wet AMD and diabetic macular edema.
Revenue concentration is pronounced for both payers: top 3 Medicare codes by revenue account for 69.9% of this provider's total Medicare revenue, and the top 3 Medicaid codes by revenue account for 99.2% of this provider's total Medicaid revenue. That concentration signals a business whose financial profile is heavily dependent on a small set of injectable therapies and associated imaging/services, creating sensitivity to changes in drug mix, reimbursement, or utilization patterns for those codes.
Medicare-dominant payer mix: lifetime Medicare revenue is $4.4M versus lifetime Medicaid revenue of $31.2K, so the provider is effectively single-payer driven with Medicare as the primary revenue source. Medicaid activity exists but is a very small share of total lifetime revenue, and Medicaid billing centers on the same procedure types (67028 and 92134), reinforcing that the clinical focus is consistent across payers even as Medicaid revenue scale remains minimal.
National competitive standing on key Medicare codes shows above-typical to extreme positioning on retina services: J0178 ranks #180 of 3204 providers nationally (94th percentile; notably above typical national volume for this code), 67028 ranks #231 of 4255 (95th percentile; notably above typical national volume), and 92134 ranks #185 of 26868 (99th percentile; extreme outlier, far above typical national volume). These ranks indicate this provider is a high-volume national outlier for retinal imaging and certain intravitreal therapies, making them a significant local/national destination for those services.
For several high-revenue drug codes the provider’s volumes are more typical: J2777 has 21.6K claims and $626.4K revenue (14.2% of Medicare revenue) and ranks #476 of 2039 (77th percentile; typical, unremarkable volume), while Q5128 has $376.1K revenue (8.5% of Medicare revenue) and ranks #75 of 373 (80th percentile; typical, unremarkable volume). These patterns suggest the practice mixes some nationally common drug utilization with a few codes where it is unusually concentrated.
Notable billing for non-specific drug code J3490 ($320.1K Medicare revenue, 159 claims, $2013 avg paid/claim) warrants attention for contract or coding review: J3490 accounts for 7.3% of Medicare revenue and ranks #441 of 2838 providers nationally (84th percentile; typical, unremarkable volume). While J3490 can legitimately reflect a range of products or situations, its relatively large dollar impact compared with claim count suggests higher-cost items or consolidated billing under an unclassified code that payers may want to reconcile to specific drug codes.
Medicaid volume mirrors Medicare service mix but at much lower scale and more modest competitive standing: Medicaid 67028 has 415 claims and $18.3K revenue (57.5% of Medicaid revenue) and ranks #132 of 262 in-state (50th percentile; typical, unremarkable volume), and Medicaid 92134 has 1.1K claims and $12.4K revenue (39.0% of Medicaid revenue) and ranks #217 of 728 in-state (70th percentile; typical, unremarkable volume). The Medicaid picture indicates similar clinical services are provided to Medicaid patients but without the high-market-share positioning seen in Medicare for some retina codes.
Tenure and practice stability: the provider’s NPI was enumerated 2006-08-17 (~20 years ago), indicating long-standing enrollment and continuity of billing patterns over multiple Medicare/Medicaid reimbursement cycles. This longevity, combined with concentrated high-volume retina coding, suggests an established retina-focused practice with entrenched utilization behavior rather than a new or transient billing pattern.
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 | 3,030 | $680 | $2.1M |
| J2777 | Injection, faricimab‑svoa, 0.1 mg | 21,600 | $30 | $626.4K |
| Q5128 | Injection, ranibizumab-eqrn (cimerli), biosimilar, 0.1 mg | 1,740 | $220 | $376.1K |
| J3490 | Unclassified drugs | 160 | $2,010 | $320.1K |
| 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. | 2,360 | $110 | $256.8K |
| 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. | 3,680 | $40 | $136.3K |
| J2778 | Injection, ranibizumab, 0.1 mg | 630 | $180 | $115.9K |
| 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… | 1,140 | $80 | $87.5K |
| Q5124 | Injection, ranibizumab-nuna, biosimilar, (byooviz), 0.1 mg | 480 | $180 | $84K |
| 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… | 930 | $80 | $75.2K |
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.
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Full comparison — all codes billed, vs. state median
24 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J0178 | 15 | 230 | 560 | $690 | $693K |
| J2777 | 17 | 120 | 7,740 | $30 | $364.9K |
| Q5128 | 4 | 20 | 1,170 | $220 | $268.3K |
| J2778 | 30 | 70 | 510 | $180 | $131.6K |
| J2781 | 19 | 40 | 520 | $120 | $75.1K |
| Q5124 | 5 | 20 | 310 | $170 | $69.7K |
| 67028 | 9 | 300 | 400 | $100 | $65.9K |
| J3490 | 20 | 120 | 60 | $470 | $50.8K |
| J7312 | 8 | 20 | 270 | $160 | $48K |
| 67210 | 30 | 40 | 40 | $430 | $46.9K |
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.
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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. | 420 | $40 | $18.3K |
| 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. | 1,130 | $10 | $12.4K |
| 92226 | N/A | 100 | $10 | $860 |
| 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… | 10 | $20 | $260 |
How this provider's Medicaid billing volume and revenue compare to other New York providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. New York median
4 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average 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… | 1,366 | 1,460 | 310 | $60 | $88.1K |
| 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. | 132 | 260 | 420 | $70 | $65.6K |
| 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. | 217 | 730 | 370 | $20 | $30K |
| 92226 | N/A | 288 | 400 | 270 | $20 | $12.6K |
Other providers in the same ZIP code as David Fastenberg, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| C And T Homecare Services LLC | NY | In Home Supportive Care Agency | $0 | $847.7M |
| North Shore-lij Medical PC | NY | Urology Physician | $0 | $388.1M |
| First Choice Home Care Inc | NY | Home Health Agency | $0 | $28M |
| Welllife Network Inc. | NY | Clinic/Center | $0 | $22M |
| Regioncare Inc. | NY | Home Infusion Agency | $40.1K | $9.4M |
| Philip Ferrone | NY | Ophthalmology Physician | $3.1M | $10.5K |
| Shahram Shamekh | NY | Internal Medicine Physician | $673.3K | $1.4M |
| Angela Azar | NY | Dermatology Physician | $104.5K | $1.5M |
| Alireza Shirvani | NY | Hospitalist Physician | $1.4M | $178K |
| Stephanie Buck-haskin | NY | Obstetrics & Gynecology Physician | $56.1K | $1.4M |
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