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

Why is the Medicaid comparison limited to Minnesota 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. Minnesota (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.

Emily Birkholz (NPI 1336316108)

Field	Value
Entity Type	Individual
Organization	Emily Birkholz
Address	1630 Adams St
City	Mankato
State	MN
ZIP	56001
Taxonomy	Ophthalmology Physician
NPI Enumerated	May 12, 2008

Payer Source	Total Paid
Medicare	$912.6K
Medicaid	$0

Key Findings

Medicare revenue concentration is highly focused: the provider’s top three Medicare codes (J0178, 66984, 67028) account for 72.2% of total Medicare revenue, with J0178 alone producing $473.3K (51.9% of Medicare revenue), 66984 contributing $115.5K (12.7%), and 67028 contributing $70.1K (7.7%). This concentration indicates that a small set of services drives the majority of billed Medicare dollars for this clinician.

The clinical/service-line mix is consistent with an ophthalmology practice that combines frequent intravitreal injection therapy and cataract surgery: J0178 (aflibercept injection) and J9035 (bevacizumab) appear prominently alongside cataract codes 66984, 66982 and YAG capsulotomy 66821, while diagnostic imaging codes 92134 and 92133 and measurement codes 92136 support procedural care. That mix suggests day-to-day operations centered on office-based injections and surgical cataract workflow supported by high volumes of retinal and anterior-segment diagnostic testing.

Payer mix is effectively single-payer: total Medicare revenue is $912.6K and there is no Medicaid billing on file, so this provider’s publicly reported outpatient revenue activity is solely Medicare-based. Analysts should treat this profile as not participating in Medicaid reimbursement streams rather than as balanced across payers.

Competitive standing is mixed by code: the volume of J0178 is labeled "typical, unremarkable" and ranks #1647 of 3204 providers nationally (49th percentile), while cataract code 66984 ranks #3657 of 15965 (77th percentile; "typical, unremarkable volume for this code"). Conversely, some diagnostic and E/M codes show relatively higher placement—92134 ranks #2259 of 26868 (92th percentile; "typical, unremarkable volume for this code") and 99204 ranks #8728 of 227068 (96th percentile; "notably above typical national volume for this code"), indicating above-typical activity in certain visit types and imaging despite the overall procedural volumes being ordinary.

Procedure-level details point to a high throughput of injection encounters: the record shows 686 claims for J0178 at $690 avg paid/claim and 493 claims for J9035 at $55 avg paid/claim, together representing a substantial share of injection-based revenue and reflecting frequent, recurring treatment visits to support retinal disease management. These claim and payment patterns imply recurring office-based treatment capacity (injection suites, scheduling cadence) is an operational focus for the practice.

Service mix also includes comprehensive and follow-up ophthalmology visits: 92014 (433 claims, $85 avg paid/claim, $36.8K) and E/M codes 99214 (326 claims, $92 avg paid/claim, $30K) and 99213 (447 claims, $63 avg paid/claim, $28.2K) represent regular outpatient evaluation and management activity, with these E/M ranks described as "typical, unremarkable" but positioned in the higher national percentiles (81st–93th) relative to peers. This suggests the provider’s practice model pairs procedural care with substantive office-based follow-up and management.

The provider has established tenure in the Medicare program with NPI enumeration on 2008-05-12 (~18 years ago), which aligns with a mature practice profile and may explain the developed mix of surgery, injections, and diagnostic services in the billing pattern. For contracting and competitive analysis, longevity combined with a concentrated revenue base around injections and cataract workflows is an important contextual factor when comparing to local and national ophthalmology peers.

Medicare: Complete Services Breakdown

The CPT/HCPCS codes generating the most Medicare revenue for this provider.

20 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J0178	Injection, aflibercept, 1 mg	690	$690	$473.3K
66984	The provider inserts an artificial lens after removing an extracapsular cataract by aspiration or use of ultrasonic waves. This procedure is done without the use of an endoscopic laser probe to…	350	$330	$115.5K
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.	760	$90	$70.1K
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…	430	$90	$36.8K
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…	330	$90	$30K
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.	940	$30	$28.3K
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…	450	$60	$28.2K
J9035	Injection, bevacizumab, 10 mg	490	$60	$27.1K
66821	The provider removes the haziness from the capsule of the eye using a laser for a patient with a secondary membranous cataract.	90	$290	$27K
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…	160	$120	$18.6K

Showing 1–10 of 20

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 20 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Minnesota Distribution

Emily Birkholz — 5 of 20 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Minnesota

Full comparison — all codes billed, vs. state median

20 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0178	20	40	580	$690	$743.4K
67028	21	80	420	$90	$64.8K
66984	130	300	190	$50	$56K
66991	13	30	30	$1,460	$53.9K
66982	20	70	30	$610	$23.2K
J9035	8	40	220	$50	$16.9K
66821	31	170	50	$110	$13.8K
92014	50	830	100	$80	$11.9K
99214	470	10,100	70	$80	$8.1K
65855	29	40	30	$170	$6.4K

Showing 1–10 of 20

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Nathan Carpenter	MN	Ophthalmology Physician	$421.5K	$0
Seth Consoer	MN	Ophthalmology Physician	$364.2K	$0
Amy Slama	MN	Optometrist	$173.9K	$0

Nearby Providers

Other providers in the same ZIP code as Emily Birkholz, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Habilitative Services, LLC	MN	Community/Behavioral Health Agency	$0	$134M
Mankato Clinic Ltd	MN	Family Medicine Physician	$0	$39.2M
Mayo Clinic Health System-southwest Minnesota Region	MN	General Acute Care Hospital	$0	$28.5M
Mayo Clinic Health System-southwest Minnesota Region	MN	Multi-Specialty Clinic/Center	$0	$24.3M
Open Door Health Center	MN	Federally Qualified Health Center (FQHC)	$0	$13.5M
County Of Blue Earth	MN	Case Management Agency	$0	$10.8M
Horizon Homes, Inc.	MN	Mental Illness Community Based Residential Treatment Facility	$0	$8.8M
Ms-ac Mankato Ag Senior Living LLC	MN	Assisted Living Facility	$0	$8.3M
Horizon Homes, Inc.	MN	Mental Illness Community Based Residential Treatment Facility	$0	$6.2M
Adult, Child & Family Services, LLC	MN	Psychologist	$0	$5.2M

Emily Birkholz — Billing Profile & Reimbursement Data

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Key Findings

Medicare: Total Revenue Breakdown by CPT/HCPCS Code

Medicare: Complete Services Breakdown

Medicare: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References