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

Why is the Medicaid comparison limited to New Jersey 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. New Jersey (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.

Sumit Shah (NPI 1346439213)

Field	Value
Entity Type	Individual
Organization	Sumit Shah
Address	10 Plum St Ste 600
City	New Brunswick
State	NJ
ZIP	08901
Taxonomy	Retina Specialist (Ophthalmology) Physician
NPI Enumerated	October 17, 2007

Payer Source	Total Paid
Medicare	$4.1M
Medicaid	$0

Key Findings

This NPI identifies a retina specialist whose Medicare activity is dominated by intravitreal pharmacologic therapy and retina-specific diagnostics: the top billed drugs are J0178, J2778, and J2777 and high-volume retina imaging and injection procedure codes such as 92134 and 67028 are also prominent. The code mix (frequent anti-VEGF biologic codes plus retinal imaging and office exam codes) is consistent with a practice focused on medical retina care for conditions like AMD and diabetic macular edema, with both procedural and diagnostic throughput.

Revenue is heavily concentrated in a few drug codes: the precomputed top-3 Medicare codes account for 67.1% of this provider's total Medicare revenue, with J0178 reported at $1.6M (39.7%), J2778 at $593.7K (14.4%), and J2777 at $537.7K (13.0%). These three codes together form the bulk of the reported $4.1M in Total Medicare revenue and therefore drive operational and reimbursement sensitivity to changes in anti-VEGF utilization or pricing.

Payer mix is effectively single‑payer Medicare: Total Medicare revenue: $4.1M while there is no Medicaid billing on file (none below — this provider has no Medicaid billing on file). That concentrated exposure means the practice’s revenue profile will track Medicare policy and utilization patterns closely and offers little direct Medicaid revenue diversification.

For the top injection codes the provider sits at above‑median national activity but is described as within typical ranges: J0178 ranks #356 of 3204 (89th percentile; typical, unremarkable volume), J2778 ranks #101 of 1208 (92th percentile; typical, unremarkable volume), and J2777 ranks #581 of 2039 (71th percentile; typical, unremarkable volume). In plain terms, the practice is a substantial, active injector nationally but not an extreme outlier among high‑volume anti‑VEGF prescribers.

Several encounter and diagnostic codes are statistical outliers versus national peers, indicating unusually high clinic and diagnostic throughput: 92014 ranks #141 of 35415 (100th percentile; extreme outlier) and 92134 ranks #559 of 26868 (98th percentile; extreme outlier), while 67028 ranks #161 of 4255 (96th percentile; notably above typical national volume). This combination of extreme exam and imaging volumes alongside procedural injections suggests a high-volume retinal clinic with heavy patient flow.

Ancillary and unclassified drug codes contribute materially and show high per‑claim payments: J3590 accounts for $311.6K (7.5%) with an avg paid/claim of $2134, and J3490 contributes $58.3K (1.4%) with an avg paid/claim of $1768. These relatively high avg paid/claim figures indicate episodic use of expensive biologics or unclassified therapies that meaningfully supplement anti‑VEGF revenue.

The provider’s national rank patterns are mixed across service lines: while injection drug codes are described as typical or unremarkable relative to peers, the provider’s extremely high ranks for general ophthalmology exam and retinal imaging place it among the most active practices nationally for those services. Practically, that means the clinic may capture substantial follow‑up and monitoring revenue in addition to drug reimbursement.

The NPI has been enumerated since 2007-10-17 (~19 years ago), which together with lifetime Medicare revenue of $4.1M suggests a long‑standing, established practice footprint. Longevity combined with the high exam and imaging volumes supports the interpretation of a stable referral base and sustained medical retina service line presence.

Medicare: Complete Services Breakdown

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

19 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J0178	Injection, aflibercept, 1 mg	2,400	$680	$1.6M
J2778	Injection, ranibizumab, 0.1 mg	3,180	$190	$593.7K
J2777	Injection, faricimab‑svoa, 0.1 mg	18,540	$30	$537.7K
J3590	Unclassified biologics	150	$2,130	$311.6K
Q5128	Injection, ranibizumab-eqrn (cimerli), biosimilar, 0.1 mg	1,350	$220	$290.3K
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.	2,570	$100	$256.7K
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…	2,410	$100	$250.3K
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.	2,690	$40	$96.7K
J3490	Unclassified drugs	30	$1,770	$58.3K
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…	380	$80	$30.2K

Showing 1–10 of 19

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 19 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. New Jersey Distribution

Sumit Shah — 6 of 19 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — New Jersey

Full comparison — all codes billed, vs. state median

19 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0178	5	90	880	$690	$693.6K
J2777	10	60	8,820	$30	$319K
J2778	1	40	1,140	$180	$240.8K
J3590	4	20	50	$2,180	$156.6K
Q5128	2	20	650	$210	$139K
67028	2	100	810	$100	$91.1K
92014	13	1,130	160	$100	$34.9K
J3490	89	120	70	$230	$30.2K
67036	19	20	20	$950	$19.9K
92012	175	800	140	$70	$18.5K

Showing 1–10 of 19

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Associated Retinal Consultants LLC	DE	Ophthalmology Physician	$0	$25.2M
Rohit Lakhanpal	MD	Retina Specialist (Ophthalmology) Physician	$6.1M	$0
Vinod Voleti	NJ	Retina Specialist (Ophthalmology) Physician	$4.1M	$0
Newman Sund	MD	Ophthalmology Physician	$4M	$0
Eric Suan	MD	Ophthalmology Physician	$3.8M	$0
Matthew Speicher	MD	Ophthalmology Physician	$3.7M	$0
Howard Fine	NJ	Retina Specialist (Ophthalmology) Physician	$3.6M	$0
Timothy Polk	MD	Ophthalmology Physician	$3.5M	$0
Jonathan Prenner	NJ	Retina Specialist (Ophthalmology) Physician	$3.4M	$0
David Kim	NJ	Retina Specialist (Ophthalmology) Physician	$3.4M	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Children's Specialized Hospital	NJ	Children's Rehabilitation Hospital	$0	$200M
Robert Wood Johnson University Hospital, Inc	NJ	General Acute Care Hospital	$0	$198.3M
Saint Peter's University Hospital	NJ	General Acute Care Hospital	$0	$185.5M
Diya Care Inc	NJ	Home Health Agency	$0	$139.8M
Golden Path Adult Day Health Care Inc.	NJ	Adult Day Care Clinic/Center	$0	$17.7M
New Brunswick Board Of Education	NJ	Local Education Agency (LEA)	$0	$12.7M
Care We Love, LLC	NJ	Home Health Agency	$0	$11.2M
Damon House Inc.	NJ	Substance Abuse Rehabilitation Facility	$0	$9.8M
Southern Bank Emergency Physicians LLC	NJ	Emergency Medicine Physician	$0	$9.2M
New Brunswick Counseling Center	NJ	Substance Use Disorder Rehabilitation Clinic/Center	$174.7K	$9M

Sumit Shah — 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