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

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

Northeast Wisconsin Retina Associates Sc (NPI 1437164175)

Field	Value
Entity Type	Organization
Organization	Northeast Wisconsin Retina Associates Sc
Address	442 N Westhill Blvd Ste A
City	Appleton
State	WI
ZIP	54914
Taxonomy	Retina Specialist (Ophthalmology) Physician
NPI Enumerated	July 30, 2006

Payer Source	Total Paid
Medicaid	$2.4M
Medicare	$0

Medicaid: Complete Services Breakdown

Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.

9 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J0178	Injection, aflibercept, 1 mg	1,990	$660	$1.3M
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.	9,420	$70	$678.5K
J9035	Injection, bevacizumab, 10 mg	6,570	$30	$203.5K
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.	14,230	$10	$199.2K
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…	420	$20	$7.5K
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…	130	$20	$2.8K
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…	240	$10	$2.6K
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…	20	$50	$860
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…	10	$40	$560

Medicaid: Competitive Analysis & Benchmarks

How this provider's Medicaid billing volume and revenue compare to other Wisconsin providers billing the same CPT/HCPCS codes.

Claims Volume vs. Wisconsin Distribution

Northeast Wisconsin Retina Associates Sc — 2 of 9 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Wisconsin

Full comparison — all codes billed, vs. Wisconsin median

9 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0178	Injection, aflibercept, 1 mg	2	10	660	$500	$479.6K
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…	1,456	1,630	270	$40	$205.3K
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…	765	1,760	250	$40	$173.2K
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	30	1,140	$60	$116.9K
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…	16	50	120	$40	$68.3K
J9035	Injection, bevacizumab, 10 mg	2	10	470	$30	$62.4K
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…	237	410	210	$30	$40.3K
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…	304	330	110	$70	$37.7K
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.	1	50	410	$10	$20.9K

Related Providers

Other providers that share a Tax Identification Number (TIN) with Northeast Wisconsin Retina Associates Sc, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Khalid Kahook	WI	Retina Specialist (Ophthalmology) Physician	$1.8M	$390
Michael Possin	WI	Retina Specialist (Ophthalmology) Physician	$1.7M	$360
Rajeev Buddi	WI	Retina Specialist (Ophthalmology) Physician	$1.3M	$0
Anthony Parendo	WI	Retina Specialist (Ophthalmology) Physician	$1.2M	$0
Benjamin Ernst	WI	Retina Specialist (Ophthalmology) Physician	$909.7K	$0
Charles Hejny	WI	Retina Specialist (Ophthalmology) Physician	$834.4K	$0

Nearby Providers

Other providers in the same ZIP code as Northeast Wisconsin Retina Associates Sc, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Options Lab, Inc.	WI	Clinical Medical Laboratory	$440.8K	$12.5M
Tri-county Community Dental Clinic, Inc.	WI	Dental Clinic/Center	$0	$4.9M
Catalpa Health	WI	Community/Behavioral Health Agency	$0	$4M
Appleton Dental Care LLC	WI	Dental Clinic/Center	$0	$1.6M
Pinnacle Cataract And Laser Institute LLC	WI	Ambulatory Surgical Clinic/Center	$994.5K	$481.6K
Options Treatment Programs, Inc	WI	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$1.2M
Micheal Vrabec	WI	Ophthalmology Physician	$380.3K	$0
Douglas Salm	WI	Ophthalmology Physician	$314.9K	$0
Ryan Funk	WI	Otolaryngology Physician	$217.6K	$34K
John Mcmahan	WI	Otolaryngology Physician	$99.7K	$0

Northeast Wisconsin Retina Associates Sc — Billing Profile & Reimbursement Data

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Northeast Wisconsin Retina Associates Sc — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References