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NPI 1366559114 · Providence, RI · Ophthalmology Physician
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Gaurav Gupta is a ophthalmology physician provider located in Providence, Rhode Island. This profile covers 12 Medicare and 1 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 | Gaurav Gupta |
| Address | 150 E Manning St |
| City | Providence |
| State | RI |
| ZIP | 02906 |
| Taxonomy | Ophthalmology Physician |
| NPI Enumerated | August 25, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $1.8M |
| Medicaid | $5.8K |
This provider’s billings are strongly centered on intravitreal pharmacologic therapy and retinal diagnostic workups: J0178 (aflibercept injections) alone accounts for $1.5M and 83.6% of the provider’s Medicare revenue with 2.2K claims, complemented by procedure codes for intravitreal injection (67028) and comprehensive ophthalmologic visits (92014). The mix of high-volume injection claims and substantial retinal imaging indicates an operational focus on medical retina care rather than broad-spectrum ophthalmic surgery or primary eye care.
Medicare revenue is highly concentrated: the precomputed top 3 Medicare codes by revenue account for 94.6% of this provider’s total Medicare revenue, underscoring dependence on a small set of high-revenue services (primarily J0178, 67028, and 92014). Such concentration means changes in utilization, reimbursement, or therapy choice for those specific services would materially affect overall Medicare income.
Payer mix is effectively single-payer dominated: total Medicare revenue is $1.8M compared with total Medicaid revenue of $5.8K, so Medicaid represents a negligible share of the provider’s billing footprint. For payer strategy and contracting, this is a Medicare-centric practice with limited exposure or scale in the Medicaid population.
National competitive standing for the top drug code is mixed: J0178 ranks #433 of 3204 providers nationally (86th percentile) and is labeled as typical, unremarkable volume, which means the provider bills this high-revenue drug at a relatively elevated percentile but within an expected range for peers. This positioning implies solid volume in aflibercept injections without being an extreme outlier among national injectors.
Diagnostic and office visit codes show above-typical national intensity for certain services: 92014 ranks #1687 of 35415 providers (95th percentile; notably above typical national volume), and 92134 for Medicare ranks #932 of 26868 providers (97th percentile; notably above typical national volume). Those high percentiles suggest the provider performs substantially more comprehensive established-patient exams and retinal imaging for Medicare beneficiaries than most peers, consistent with a retina-focused practice model.
Medicaid billing is narrowly concentrated and modest in-state: the precomputed top 3 Medicaid codes account for 100.0% of Medicaid revenue, entirely represented by 92134 (206 claims, $5.8K), which ranks #17 of 24 in-state (30th percentile; typical, unremarkable volume). This indicates a low Medicaid footprint in retinal imaging relative to other in-state providers and no meaningful Medicaid revenue diversification.
The provider has an established enrollment history, with NPI enumeration dated 2006-08-25 (~20 years ago), which supports a long-tenured practice presence and a multi-year billing record that payers and competitors can evaluate for trend analysis. Tenure paired with concentrated service lines makes it straightforward to monitor changes in service mix or policy impacts over time.
There is limited use of alternative anti-VEGF billing in the Medicare data: J9035 (bevacizumab) appears but represents only $4.7K (0.3% of Medicare revenue), suggesting a clinical or billing preference for aflibercept (J0178). Given that J0178 drives the majority of revenue, the practice’s financial exposure is sensitive to therapeutic and reimbursement shifts affecting aflibercept utilization and pricing.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
12 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 2,210 | $680 | $1.5M |
| 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. | 1,230 | $90 | $108K |
| 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… | 990 | $90 | $90.2K |
| 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. | 2,120 | $30 | $65.7K |
| 92235 | The provider uses a special dye, fluorescein that causes the blood vessels in the one or both eyes to stand out in photographic images taken with the use of multiframe timing, or serial images, taken… | 110 | $110 | $12.4K |
| 92004 | The provider performs a comprehensive level ophthalmological evaluation of a new patient and initiates a diagnostic and treatment program for one or more visits. | 80 | $110 | $9.1K |
| J9035 | Injection, bevacizumab, 10 mg | 90 | $50 | $4.7K |
| 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… | 20 | $90 | $2K |
| 92250 | Code 92250 describes the taking of fundus photographs, that is, photographs of the posterior segment of the inner aspect of the eye, to document alterations in the optic nerve head, retinal vessels,… | 70 | $30 | $2K |
| 76512 | The provider uses B–scan ultrasound imaging, with or without a non–qualitative A–scan superimposed, to examine the intraocular and orbital structures. | 30 | $40 | $1.3K |
Showing 1–10 of 12
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 12 CPT/HCPCS codes.
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Full comparison — all codes billed, vs. state median
12 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J0178 | 1 | 10 | 670 | $690 | $601.6K |
| 67028 | 3 | 20 | 610 | $90 | $58.9K |
| 92014 | 3 | 190 | 120 | $80 | $16.3K |
| 99214 | 1,734 | 1,950 | 100 | $80 | $11.7K |
| J9035 | 12 | 20 | 160 | $50 | $9.5K |
| 92134 | 1 | 120 | 50 | $30 | $6.6K |
| 92004 | 12 | 120 | 30 | $100 | $4K |
| 92235 | 1 | 10 | 20 | $100 | $3.6K |
| 92083 | 118 | 130 | 30 | $40 | $2.8K |
| 92250 | 64 | 150 | 50 | $30 | $2.3K |
Showing 1–10 of 12
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.
1 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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. | 210 | $30 | $5.8K |
How this provider's Medicaid billing volume and revenue compare to other Rhode Island providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Rhode Island median
1 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 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. | 17 | 20 | 560 | $50 | $61.6K |
Other providers in the same ZIP code as Gaurav Gupta, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| The Miriam Hospital | RI | General Acute Care Hospital | $0 | $138.6M |
| Family Service Of Rhode Island Inc. | RI | Taxi | $0 | $12M |
| Butler Hospital | RI | Psychiatric Hospital | $0 | $9.6M |
| Phoenix Houses Of New England, Inc. | RI | Substance Abuse Rehabilitation Facility | $0 | $7.3M |
| Thomas Mulvey | RI | Pediatric Dentistry | $0 | $6.3M |
| Silver Fern Practice, LLC | RI | Physical Therapist | $0 | $5M |
| Providence Interventional Associates Ii LLC | RI | Ambulatory Surgical Clinic/Center | $1.9M | $8.3K |
| Robert Eden | RI | Pediatrics Physician | $0 | $1.7M |
| Brian Ackerman | RI | Psychiatry Physician | $24.8K | $1.5M |
| Steven Hirsch | RI | Clinical Neuropsychologist | $0 | $1.2M |
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