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.

Roy Wallace (NPI 1417946203)

Field	Value
Entity Type	Individual
Organization	Roy Wallace
Address	345 23rd Ave N
City	Nashville
State	TN
ZIP	37203
Taxonomy	Retina Specialist (Ophthalmology) Physician
NPI Enumerated	October 14, 2005

Payer Source	Total Paid
Medicare	$5.4M
Medicaid	$0

Key Findings

This provider is effectively a Medicare-only billing entity: total Medicare revenue is $5.4M and there is no Medicaid billing on file. The practice’s revenue is highly concentrated — the precomputed top 3 Medicare codes account for 82.9% of Medicare revenue, indicating dependence on a small set of services for the bulk of payments.

Anti-VEGF intravitreal injections dominate the business profile. J0178 (aflibercept) alone accounts for $3.3M and 60.5% of Medicare revenue, while J2777 (faricimab-svoa) and Q5128 (ranibizumab-eqrn biosimilar) contribute $777.8K (14.3%) and $440.1K (8.1%) respectively; together these three codes make up the precomputed 82.9% concentration, signaling a practice focused on medical retina injection therapy.

Operational patterns show both high-volume injection activity and ancillary diagnostic services. High claim counts and payments for injection codes (J0178: 4.8K claims, $687 avg paid/claim; J2777: 26.8K claims, $29 avg paid/claim) are paired with heavy use of retinal imaging and office visits (92134: 3.7K claims, $104.5K revenue; 92014: 2.4K claims, $191.2K revenue), consistent with a retina clinic that couples repeated anti-VEGF treatment with serial imaging and follow-up visits.

Competitive standing is mixed but includes several national outlier positions. The provider ranks #31 of 3204 for J0178 (99th percentile; extreme outlier), indicating national-level high volume for aflibercept injections; by contrast, J2777 and Q5128 rank at more typical positions (#347 of 2039 and #63 of 373 respectively, both described as typical/unremarkable in volume), showing leadership in one drug but routine participation for others.

Multiple ancillary codes also appear at very high national percentiles, reflecting elevated utilization beyond injections. Codes for comprehensive established visits (92014) and retinal imaging (92134, 92250) are flagged as extreme outliers or well above typical national volume (92014 ranks #139 of 35415, 92134 ranks #175 of 26868, 92250 ranks #467 of 25087), which suggests a high throughput clinic model with substantial diagnostic follow-up tied to the injection service line.

Procedural breadth includes surgical and isolated intravitreal procedures at lower revenue shares but notable relative volume. 67028 (isolated intravitreal injection procedure) produced $264.3K (4.8% of Medicare revenue) and ranks #96 of 4255 (98th percentile; notably above typical), while surgical retina codes such as 67108 and 67228 appear with small revenue shares, indicating some surgical capability in addition to the dominant injection and imaging work.

The provider’s enrollment tenure (NPI enumerated 2005-10-14, ~21 years ago) signals an established practice likely embedded in the local market. That longevity combined with exceptionally high national ranks for select injection and diagnostic codes suggests a sustained, high-volume retina practice rather than a new or transient operation.

For payers, the revenue concentration in a few high-cost injectable drugs represents both a cost and utilization focal point. With J0178 generating $3.3M (60.5% of Medicare revenue) and biosimilar/alternative agents present in the mix (Q5128, Q5124, J2778, J9035 listed at lower volumes), monitoring drug selection, claim patterns, and the clinic’s use of lower-cost alternatives could be important given the provider’s outsized national position on certain injectable codes.

Medicare: Complete Services Breakdown

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

14 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J0178	Injection, aflibercept, 1 mg	4,810	$690	$3.3M
J2777	Injection, faricimab‑svoa, 0.1 mg	26,820	$30	$777.8K
Q5128	Injection, ranibizumab-eqrn (cimerli), biosimilar, 0.1 mg	2,080	$210	$440.1K
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.	3,040	$90	$264.3K
J2778	Injection, ranibizumab, 0.1 mg	1,400	$180	$256.4K
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…	2,420	$80	$191.2K
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.	3,730	$30	$104.5K
Q5124	Injection, ranibizumab-nuna, biosimilar, (byooviz), 0.1 mg	210	$180	$36.5K
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…	320	$110	$34.3K
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,…	790	$30	$20.5K

Showing 1–10 of 14

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 14 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Tennessee Distribution

Roy Wallace — 6 of 14 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

14 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0178	1	80	790	$680	$769.8K
J2777	12	50	15,060	$30	$592.1K
Q5128	8	20	1,190	$210	$394K
J2778	21	40	1,340	$180	$370.2K
Q5124	9	10	690	$180	$137.8K
67028	3	80	1,130	$90	$98.5K
67108	21	30	20	$970	$29.2K
92014	2	810	120	$80	$19.2K
J9035	32	70	140	$50	$17.1K
92134	3	600	60	$30	$8.2K

Showing 1–10 of 14

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Tennessee Retina PC	TN	Retina Specialist (Ophthalmology) Physician	$0	$6M
David Reichstein	TN	Retina Specialist (Ophthalmology) Physician	$4.9M	$141.7K
Carl Awh	TN	Retina Specialist (Ophthalmology) Physician	$4.7M	$0
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 Roy Wallace, 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

Roy Wallace — Billing Profile & Reimbursement Data

Sign up for Roy Wallace — Billing Profile & Reimbursement Data policy alerts

Roy Wallace — Billing Profile & Reimbursement Data

Sign up for Roy Wallace — Billing Profile & Reimbursement Data policy alerts

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