NPI 1417021940 — Billing Profile & Reimbursement Data
NPI 1417021940 · XX · healthcare
Customize your policy alerts
Sign up for NPI 1417021940 — Billing Profile & Reimbursement Data policy alerts
Get alerted when relevant policies change without checking for updates manually.
Monitor payer policy activity
NPI 1417021940 is a healthcare provider located in Unspecified Location. This profile covers 11 Medicare and 0 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services. Note: "XX" is a placeholder CMS uses when a provider's practice-location state wasn't reported — not a traditional US state; claims coded under it are grouped and benchmarked here the same way a traditional state would be.
Provider details (source: NPPES NPI Registry)
| Field | Value |
|---|---|
| Entity Type | Individual |
| Organization | NPI 1417021940 |
| Address | |
| City | |
| State | XX (Unspecified Location) |
| ZIP | |
| Taxonomy | N/A |
| NPI Enumerated | |
| NPI Deactivated | June 25, 2026 |
(source: CMS Medicare & Medicaid claims data)
Key Findings
This provider’s book of business is effectively single‑payer: total Medicare revenue is $398.2K while Medicaid revenue is none (no Medicaid billing on file), so payer-mix analysis should treat Medicare as the sole recorded public revenue source. The absence of any Medicaid billing on file limits conclusions about participation in state programs or dual-eligible caseflow.
Revenue is highly concentrated in a small set of services: the precomputed top three Medicare codes account for 82.9% of this provider’s total Medicare revenue, driven by J0178 ($235.3K, 59.1%), 99214 ($57.5K, 14.5%), and 67028 ($37.1K, 9.3%). That concentration indicates that a few procedures dominate cashflow and will disproportionately affect revenue if utilization or reimbursement for those services changes.
The code mix points to an ophthalmology/medical-retina service line focused on intravitreal anti‑VEGF therapy and retina diagnostics: large volumes and revenue for J0178 (aflibercept injection) and (intravitreal injection) combined with substantial utilization of retinal imaging and documentation codes such as (OCT imaging) and (fundus photography) and office E/M visits (). This pattern is consistent with a practice that performs repeated injection therapy supported by diagnostic imaging and follow-up visits.
Medicare: Total Revenue Breakdown by CPT/HCPCS Code
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
Medicare: Complete Services Breakdown
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
11 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 340 | $690 | $235.3K |
| 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… | 590 | $100 | $57.5K |
| 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. | 430 | $90 | $37.1K |
| 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… | 250 | $90 | $21.8K |
| 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. | 610 | $30 | $19K |
| J9035 | Injection, bevacizumab, 10 mg | 250 | $50 | $13.3K |
| 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,… | 260 | $30 | $7K |
| 92202 | The provider performs an extended ophthalmoscopy, typically with an indirect ophthalmoscope which utilizes a bright light and a hand–held indirect lens rather than the common hand–held one–piece… | 400 | $10 | $4.8K |
| 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… | 20 | $60 | $1.2K |
| 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 | $50 | $540 |
Showing 1–10 of 11
Medicare: Competitive Analysis & Benchmarks
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 11 CPT/HCPCS codes. Note: this provider's state, "XX," is a placeholder CMS uses when a provider's practice-location state wasn't reported — not a traditional US state; the State panel below benchmarks against other providers coded under the same designation.
View: State1 / 2
Full comparison — all codes billed, vs. state median
Frequently Asked Questions
References
- 1.Medicare Physician & Other Practitioner by Provider and Service. CMS.gov.Provider-level Medicare Part B utilization and payment data.
- 2.NPPES NPI Registry. CMS.gov.National Provider Identifier registry used for provider enumeration and taxonomy metadata.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.