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

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

James Stefater (NPI 1427491000)

Field	Value
Entity Type	Individual
Organization	James Stefater
Address	97 Libbey Industrial Pkwy Ste 100
City	East Weymouth
State	MA
ZIP	02189
Taxonomy	Ophthalmology Physician
NPI Enumerated	April 12, 2013

Payer Source	Total Paid
Medicare	$1.6M
Medicaid	$0

Key Findings

Provider profile and scale: JAMES STEFATER (Ophthalmology Physician, NPI enumerated 2013-04-12 (~13 years ago)) has reported Total Medicare revenue of $1.6M and Total Medicaid revenue of none (no Medicaid billing on file). The absence of Medicaid billing indicates the provider operates effectively as a single-payer Medicare practice in the available data set, concentrating revenue and utilization risk on Medicare patients and programs.

Revenue concentration: this provider’s top three Medicare codes (J0178, J2778, 67028) account for 72.7% of Total Medicare revenue, reflecting a highly concentrated revenue base. In particular, J0178 (1.2K claims, $690 avg paid/claim, $835.6K revenue) alone represents 53.6% of Medicare revenue, indicating that one drug/code is the dominant revenue driver for the practice.

Service-line implications — medical retina focus: the code mix is strongly weighted toward intravitreal pharmacotherapy and retina procedures, with high volumes of J0178, J2778 (982 claims, $185 avg, $181.7K revenue) and Q5124 (710 claims, $157 avg, $111.5K revenue) alongside the intravitreal procedure code 67028 (1.1K claims, $106 avg, $115.5K revenue). This mix is consistent with a practice organized around recurrent anti-VEGF injections and retina management rather than broad general ophthalmology or high-volume surgical subspecialty work.

Diagnostic imaging footprint: the provider reports 92134 at 2K claims, $34 avg paid/claim, $66.8K revenue (4.3% of Total Medicare revenue) and ranks #1068 of 26868 providers nationally (96th percentile; notably above typical national volume for this code). That notably above-typical ranking for retinal imaging suggests intensified use of OCT-based diagnostics to monitor and manage retina disease within the practice workflow.

Competitive standing on drug administration: for the top drug codes the provider ranks in middling national percentiles — J0178 ranks #1088 of 3204 (66th percentile; typical, unremarkable volume), J2778 ranks #435 of 1208 (64th percentile; typical, unremarkable volume), and Q5124 ranks #49 of 122 (60th percentile; typical, unremarkable volume). These placements characterize the provider as a modest but not dominant national participant for anti-VEGF administration, with steady utilization rather than extreme market share.

Procedure and surgical activity: higher-volume retina procedures such as 67028 are material to revenue (7.4% of Total Medicare revenue) while more invasive surgeries (e.g., 67036 with 11 claims, $550 avg, $6.1K revenue) appear at very low counts. This contrast indicates the practice is oriented primarily to office-based, injection- and imaging-driven retina care, with limited surgical case volume.

Payer-mix and contracting implications: with $1.6M in Medicare revenue and no Medicaid billing on file, the provider’s reimbursement exposure and negotiation leverage will be concentrated in Medicare-related fee schedules and payer arrangements. Analysts and network planners should treat this entity as effectively single-payer (Medicare) in the available public claims data when assessing network adequacy, reimbursement sensitivity, and referral relationships.

Tenure and operational signal: the NPI enumeration date of 2013-04-12 (~13 years ago) combined with sustained Medicare billing across high-volume injection and imaging codes suggests an established, continuing retina-focused outpatient practice. The revenue profile and code mix point to stable, recurring treatment patterns (regular injections and OCT monitoring) rather than episodic one-off procedures.

Medicare: Complete Services Breakdown

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

16 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J0178	Injection, aflibercept, 1 mg	1,210	$690	$835.6K
J2778	Injection, ranibizumab, 0.1 mg	980	$190	$181.7K
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.	1,090	$110	$115.5K
Q5124	Injection, ranibizumab-nuna, biosimilar, (byooviz), 0.1 mg	710	$160	$111.5K
J2777	Injection, faricimab‑svoa, 0.1 mg	3,600	$30	$104.4K
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…	800	$100	$81.1K
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.	1,970	$30	$66.8K
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…	310	$70	$22.9K
J9035	Injection, bevacizumab, 10 mg	310	$60	$17.1K
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…	70	$120	$8.2K

Showing 1–10 of 16

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 16 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Massachusetts Distribution

James Stefater — 0 of 16 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Massachusetts

Full comparison — all codes billed, vs. state median

16 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0178	32	90	790	$690	$826.5K
J2777	40	50	7,080	$30	$343.1K
J2778	6	30	560	$180	$200.7K
Q5124	7	10	800	$160	$186K
67028	34	120	570	$100	$80.7K
92014	124	1,070	160	$90	$30.1K
J9035	32	80	250	$50	$19.7K
67036	18	20	20	$960	$17.3K
99214	13,857	15,410	110	$80	$15.6K
92012	106	560	90	$70	$12.4K

Showing 1–10 of 16

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
The General Hospital Corporation	MA	General Acute Care Hospital	$0	$438M
Community Physicians Of Indiana Inc	IN	Family Medicine Physician	$0	$185M
Massachusetts General Physicians Organization Inc	MA	Dermatology Physician	$0	$60.2M
Boston Emergency Physician Foundation, Inc.	MA	Emergency Medicine Physician	$0	$24.3M
Colorado Permanente Medical Group, P.C.	CO	Internal Medicine Physician	$0	$23.2M
David Reed	MA	Retina Specialist (Ophthalmology) Physician	$7.7M	$0
Torsten Wiegand	MA	Retina Specialist (Ophthalmology) Physician	$7.6M	$0
Chirag Shah	MA	Retina Specialist (Ophthalmology) Physician	$5M	$0
Roger Goldberg	CA	Retina Specialist (Ophthalmology) Physician	$4.6M	$0
Miriam Englander-paschalis Ilios	MA	Retina Specialist (Ophthalmology) Physician	$4.5M	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
South Shore Support Services	MA	Home Health Agency	$0	$26.8M
Active Ma, Inc.	MA	Adult Day Care Clinic/Center	$0	$9.3M
Babak Jian Seyedahmadi	MA	Ophthalmology Physician	$4.4M	$0
Mark Dacey	MA	Ophthalmology Physician	$2.1M	$0
Heidi Anderson-dockter	MA	Dermatology Physician	$806.3K	$0
Ramy Rizkalla	MA	Ophthalmology Physician	$627.4K	$1K
Anita Shukla	MA	Ophthalmology Physician	$604.9K	$560
Mary Lisa Mcham	MA	Ophthalmology Physician	$571.6K	$0
Teresa Degiacomo	MA	Dermatology Physician	$537K	$0
Kimberly Hsu	MA	Ophthalmology Physician	$451.8K	$0

James Stefater — Billing Profile & Reimbursement Data

Sign up for James Stefater — Billing Profile & Reimbursement Data policy alerts

James Stefater — Billing Profile & Reimbursement Data

Sign up for James Stefater — 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