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NPI 1417170432 · Gilbert, AZ · Retina Specialist (Ophthalmology) Physician
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David Goldenberg is a retina specialist (ophthalmology) physician provider located in Gilbert, Arizona. This profile covers 27 Medicare and 5 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 | David Goldenberg |
| Address | 3303 E Baseline Rd Ste 108 |
| City | Gilbert |
| State | AZ |
| ZIP | 85234 |
| Taxonomy | Retina Specialist (Ophthalmology) Physician |
| NPI Enumerated | April 10, 2007 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $4.7M |
| Medicaid | $15.8K |
DAVID GOLDENBERG is a retina specialist (Ophthalmology) physician with an NPI enumerated on 2007-04-10, indicating roughly 19 years of potential Medicare/Medicaid billing history and established tenure in the market. This long enrollment window is consistent with a sustained specialist practice that reports a mix of intravitreal injections, diagnostic imaging, and both office and surgical ophthalmology services.
Medicare revenue dwarfs Medicaid for this provider: lifetime Medicare revenue is $4.7M versus lifetime Medicaid revenue of $15.8K, indicating the practice is effectively Medicare-driven rather than Medicaid-focused. The Medicaid contribution to total reported lifetime revenue is therefore minimal compared with Medicare, consistent with a specialty practice whose patient panel and reimbursement mix favor Medicare.
Revenue concentration on Medicare is high: the precomputed top 3 Medicare codes account for 81.2% of the provider’s total Medicare revenue, showing strong dependence on a narrow set of high-value intravitreal drug and related procedure codes. Those leading codes include J0178, J2777, and J2778 (aflibercept, faricimab-svoa, and ranibizumab products), indicating intravitreal anti-VEGF and related biologic therapies are the dominant service line driving Medicare dollars.
The provider’s Medicare billing mix and national rank indicate unusually high volume for several injection and diagnostic codes. J0178 accounts for $1.9M (40.9% of Medicare revenue) and ranks #223 of 3204 (93rd percentile) and J2777 contributes $1.2M (26.0% of Medicare revenue) and ranks #152 of 2039 (93rd percentile); both are described as notably above typical or typical but at high percentiles, signaling this clinician is a major regional source of these intravitreal injections compared with national peers. Additionally, 92134 (retinal imaging) and 99213 (office visits) are labeled as extreme outliers at the 100th percentile, reflecting very high utilization of retinal imaging and routine follow-up visits relative to the national provider population.
Surgical and procedure activity is also present but less dominant: codes such as 67028 ($291.7K, 6.2% of Medicare revenue; rank #71 of 4255, 98th percentile) and vitreoretinal surgery codes 67042 and 67036 appear in the top Medicare services, indicating the practice performs office-based intravitreal injections frequently and also conducts a smaller volume of surgical vitreoretinal procedures. These surgical items are high unit-value services but represent a minority share of total Medicare revenue compared with intravitreal drug billing.
On Medicaid the revenue picture mirrors the Medicare service mix but at much lower scale, with the precomputed top 3 Medicaid codes accounting for 81.5% of Medicaid revenue and 67028, 92134, and J9035 together contributing most Medicaid dollars. 67028 alone is 41.6% of Medicaid revenue, showing the same intravitreal injection procedural focus but at modest in-state volume where ranks (e.g., 67028 rank #21 of 31) position the provider as a mid- to lower-tier Medicaid participant for those services.
Competitive standing differs by payer: for Medicare the provider is a high-volume national performer for several codes (multiple codes at or near the top percentiles, including extreme outlier designations), which suggests a dominant role in delivering anti-VEGF therapies and retinal imaging to Medicare beneficiaries. For Medicaid the provider’s ranks are modest in-state (for example 67028 rank #21/31 and J9035 rank #20/22), indicating limited Medicaid market share and lower competitive impact among Arizona Medicaid providers.
The practice shows concentrated dependence on a few high-revenue drug codes and imaging procedures, which implies exposure to shifts in anti-VEGF utilization, payer policy, or drug mix. With top 3 Medicare codes responsible for 81.2% of Medicare revenue and top 3 Medicaid codes responsible for 81.5% of Medicaid revenue, revenue risk is concentrated in intravitreal pharmacologic therapy and associated imaging/visit services rather than spread across a broader set of small-value codes.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
27 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 2,780 | $690 | $1.9M |
| J2777 | Injection, faricimab‑svoa, 0.1 mg | 42,060 | $30 | $1.2M |
| J2778 | Injection, ranibizumab, 0.1 mg | 3,690 | $180 | $667K |
| 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. | 3,280 | $90 | $291.7K |
| 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. | 4,460 | $30 | $120.3K |
| 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… | 1,810 | $60 | $108.8K |
| J7999 | Compounded drug, not otherwise classified | 1,190 | $70 | $83.2K |
| Q5128 | Injection, ranibizumab-eqrn (cimerli), biosimilar, 0.1 mg | 340 | $220 | $75K |
| 67042 | In this procedure, the provider removes vitreous humor, the gelatinous material that gives shape to the eye, using a mechanical cutting tool. He removes the internal limiting membrane of the retina… | 60 | $860 | $53.1K |
| 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… | 470 | $110 | $51.3K |
Showing 1–10 of 27
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 27 CPT/HCPCS codes.
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Full comparison — all codes billed, vs. state median
27 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J0178 | 3 | 50 | 780 | $690 | $734.8K |
| J2777 | 5 | 50 | 9,000 | $30 | $525.8K |
| Q5128 | 10 | 20 | 520 | $220 | $207.5K |
| J2778 | 1 | 30 | 550 | $180 | $198K |
| 67028 | 3 | 60 | 1,240 | $90 | $119K |
| J7312 | 23 | 20 | 270 | $160 | $48.9K |
| J7999 | 9 | 50 | 490 | $70 | $46.8K |
| 67042 | 5 | 40 | 30 | $1,160 | $46.5K |
| 67036 | 15 | 30 | 30 | $1,030 | $37.9K |
| 67108 | 12 | 20 | 20 | $1,230 | $33.2K |
Showing 1–10 of 27
Medicaid revenue breakdown by year and by CPT/HCPCS procedure code, including monthly billing trends and the top codes driving revenue.
View: By Year1 / 3
Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.
5 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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. | 100 | $70 | $6.6K |
| 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. | 230 | $20 | $3.9K |
| J9035 | Injection, bevacizumab, 10 mg | 50 | $50 | $2.4K |
| 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… | 60 | $30 | $2K |
| 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… | 20 | $50 | $920 |
How this provider's Medicaid billing volume and revenue compare to other Arizona providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Arizona median
5 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| J9035 | Injection, bevacizumab, 10 mg | 20 | 20 | 530 | $160 | $369.7K |
| 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. | 21 | 30 | 380 | $70 | $266.2K |
| 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… | 64 | 90 | 380 | $50 | $192.2K |
| 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. | 38 | 70 | 300 | $20 | $98.9K |
| 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… | 1,004 | 1,160 | 150 | $90 | $96.5K |
Other providers in the same ZIP code as David Goldenberg, ranked by combined Medicare and Medicaid revenue.
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