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

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

Carl Awh (NPI 1386729085)

Field	Value
Entity Type	Individual
Organization	Carl Awh
Address	345 23rd Ave N
City	Nashville
State	TN
ZIP	37203
Taxonomy	Retina Specialist (Ophthalmology) Physician
NPI Enumerated	October 25, 2006

Payer Source	Total Paid
Medicare	$4.7M
Medicaid	$0

Key Findings

This provider reports $4.7M in lifetime Medicare revenue and has no Medicaid billing on file, making its public claims footprint effectively single‑payer Medicare; absence of Medicaid activity should be treated as a material feature of the payer mix when benchmarking or planning network outreach. The NPI was enumerated on 2006-10-25 (≈20 years ago), indicating a long-tenured practice that has had time to establish referral and operational patterns within the Medicare population.

Revenue is highly concentrated in a small number of intravitreal drug codes: the precomputed top three Medicare codes account for 73.5% of total Medicare revenue, driven by J0178 (37.7%), J2777 (19.9%), and Q5128 (15.8%). This level of concentration means that changes in utilization, drug pricing, or step-therapy policy for these few agents could materially affect the provider’s Medicare revenue profile.

The CPT/HCPCS mix is consistent with a retina-specialist, procedure‑centric practice focused on intravitreal pharmacotherapy and retinal imaging: high-revenue drug injection codes J0178 (aflibercept), J2777 (faricimab), and Q5128 (ranibizumab biosimilar) dominate the ledger, supported by retinal imaging codes such as 92134 and photography (92250). Lower-frequency surgical codes (e.g., 67042 vitrectomy with membrane peel) appear but represent a small share of revenue, suggesting the practice emphasizes office-based injections and diagnostics more than operative retina surgery.

Competitive standing on the top drug codes is mixed: J0178 ranks #301 of 3204 providers nationally (91th percentile) and is described as a typical, unremarkable volume relative to peers, while J2777 ranks #260 of 2039 (87th percentile) and is also typical. By contrast, Q5128 ranks #27 of 373 providers nationally (93th percentile) and is labeled notably above typical national volume, indicating unusually strong uptake of that ranibizumab biosimilar compared with most peers.

Several non‑drug codes are extreme outliers nationally, reflecting very high volumes of office visits and imaging relative to peers: 92014 (comprehensive established visit) is #237 of 35415 providers (99th percentile; extreme outlier) and 92134 (retinal OCT) is #463 of 26868 providers (98th percentile; extreme outlier). Those rankings indicate this clinician delivers far more comprehensive ophthalmologic follow-up and OCT imaging per Medicare than typical retina specialists, which has implications for utilization management and resource allocation.

Other notable Medicare items include 67028 (intravitreal injection as an isolated procedure) at $221.5K or 4.7% of Medicare revenue, ranking #201 of 4255 providers (95th percentile; notably above typical), and J3490 unclassified drugs at $240.1K (5.1% of Medicare revenue) ranking #544 of 2838 providers (81th percentile; typical). The presence of meaningful J3490 and procedure‑only injection billing suggests occasional use of non‑listed or variable-priced agents and that a portion of injection activity is billed as standalone procedures rather than bundled visits.

Operationally, the claims counts reflect a high-throughput intravitreal injection practice (examples include 2.6K claims for J0178, 32.3K claims for J2777, and 3.5K claims for Q5128), which implies sustained drug procurement, inventory management, and per‑visit billing workflows. For payers and network analysts, these volumes flag areas for focused medical policy review (drug selection, biosimilar adoption, and visit-to-injection billing patterns) and possible opportunities for tailored prior‑authorization or reimbursement arrangements.

Given the combination of long tenure (enumerated 2006-10-25, ≈20 years), heavy reliance on a small set of high-revenue intravitreal codes, and exceptionally high per‑provider volumes for key visit and imaging codes, this provider should be considered a high-volume Medicare retina practice with concentrated revenue exposure to a few pharmacologic therapies and unusually intensive use of comprehensive visits and OCT. Those characteristics are relevant for competitive benchmarking, risk assessment, and payer engagement strategies targeting retina service lines.

Medicare: Complete Services Breakdown

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

18 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J0178	Injection, aflibercept, 1 mg	2,560	$700	$1.8M
J2777	Injection, faricimab‑svoa, 0.1 mg	32,340	$30	$937.9K
Q5128	Injection, ranibizumab-eqrn (cimerli), biosimilar, 0.1 mg	3,450	$220	$745.6K
Q5124	Injection, ranibizumab-nuna, biosimilar, (byooviz), 0.1 mg	1,360	$180	$246.7K
J3490	Unclassified drugs	130	$1,810	$240.1K
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.	2,430	$90	$221.5K
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…	2,010	$80	$161K
J2778	Injection, ranibizumab, 0.1 mg	550	$180	$98.1K
J2781	Injection, pegcetacoplan, intravitreal, 1 mg	770	$120	$91.8K
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.	2,860	$30	$80.1K

Showing 1–10 of 18

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 18 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Tennessee Distribution

Carl Awh — 4 of 18 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Tennessee

Full comparison — all codes billed, vs. state median

18 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0178	7	80	790	$680	$769.8K
J2777	9	50	15,060	$30	$592.1K
Q5128	2	20	1,190	$210	$394K
J2778	32	40	1,340	$180	$370.2K
Q5124	2	10	690	$180	$137.8K
67028	6	80	1,130	$90	$98.5K
J2781	7	20	560	$120	$82.5K
J3490	16	60	70	$400	$41.9K
67042	7	40	20	$1,020	$34.5K
J3590	8	10	50	$300	$21.7K

Showing 1–10 of 18

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Tennessee Retina PC	TN	Retina Specialist (Ophthalmology) Physician	$0	$6M
Roy Wallace	TN	Retina Specialist (Ophthalmology) Physician	$5.4M	$0
David Reichstein	TN	Retina Specialist (Ophthalmology) Physician	$4.9M	$141.7K
Brandon Busbee	TN	Retina Specialist (Ophthalmology) Physician	$4.3M	$0
Eric Schneider	TN	Retina Specialist (Ophthalmology) Physician	$4.1M	$0
Franco Recchia	TN	Retina Specialist (Ophthalmology) Physician	$3.6M	$2.6K
Akshay Thomas	TN	Retina Specialist (Ophthalmology) Physician	$3.2M	$52K
Everton Arrindell	TN	Retina Specialist (Ophthalmology) Physician	$3M	$0
Jay Glover	TN	Retina Specialist (Ophthalmology) Physician	$2.9M	$0
Peter Sonkin	TN	Retina Specialist (Ophthalmology) Physician	$2.2M	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Hca Health Services Of Tennessee, Inc.	TN	General Acute Care Hospital	$0	$45.9M
Pediatrix Medical Group Of Tennessee, P.C.	TN	Neonatal-Perinatal Medicine Physician	$0	$32.3M
Saint Thomas Medical Partners	TN	Internal Medicine Physician	$0	$21.9M
Radiology Alliance PC	TN	Diagnostic Radiology Physician	$0	$13.2M
Emergency Medicine Services Of Tn, PC	TN	Emergency Medicine Physician	$0	$12.9M
Tennessee Maternal-fetal Medicine LLC	TN	Specialist	$0	$12.5M
The Next Door, Inc.	TN	Substance Abuse Rehabilitation Facility	$0	$8.6M
Tennessee Oncology PLLC	TN	Hematology & Oncology Physician	$0	$8.5M
Vcphcs Ix, LLC	TN	Substance Use Disorder Rehabilitation Clinic/Center	$257.7K	$6.6M
Pediatric Associates Of Davidson County, P.C.	TN	Pediatrics Physician	$0	$5.8M

Carl Awh — 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