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NPI 1447440532 · West Monroe, LA · Ophthalmology Physician
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Ruben Grigorian is a ophthalmology physician provider located in West Monroe, Louisiana. This profile covers 22 Medicare and 7 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 | Ruben Grigorian |
| Address | 108 Regency Pl |
| City | West Monroe |
| State | LA |
| ZIP | 71291 |
| Taxonomy | Ophthalmology Physician |
| NPI Enumerated | July 26, 2007 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $2.4M |
| Medicaid | $57.1K |
This provider is effectively Medicare-dominant: Total Medicare revenue: $2.4M versus Total Medicaid revenue: $57.1K, indicating Medicare is the primary payer by a large margin and Medicaid represents a very small share of lifetime revenue. Analysts should treat this profile as centered on fee-for-service Medicare activity rather than Medicaid-driven volume.
Revenue is highly concentrated in a few high-value Medicare codes: the top 3 Medicare codes by revenue account for 65.6% of this provider's total Medicare revenue, with J0178 alone contributing $1M (42.2% of Medicare revenue, 1.5K claims). This concentration signals dependence on a small set of drug/injection services for most Medicare dollars.
Medicaid revenue is also concentrated into a few services: the top 3 Medicaid codes by revenue account for 68.4% of this provider's total Medicaid revenue, led by 67028 ($17.4K, 30.6% of Medicaid revenue) and 92004 ($11.5K, 20.1%). Medicaid activity appears to be concentrated in procedural and new-patient evaluation codes rather than high-cost injected pharmaceuticals.
Clinical/service-line mix is consistent with a retina-focused ophthalmology practice: high Medicare revenue from intravitreal drug codes J0178 (aflibercept), J2777 (faricimab), J2778 (ranibizumab) and J0179 (brolucizumab) combined with large volumes of retinal imaging codes such as 92134 and fundus photography 92250. The code mix (multiple high-volume injectable biologic codes plus extensive retinal imaging) implies routine intravitreal therapy and diagnostic imaging are core operational services.
National competitive standing is mixed by service line: for drugs like J0178 and J2777 the provider ranks in typical/median national percentiles (J0178 at 74th percentile, J2777 at 59th percentile), indicating unremarkable national market share for those injections. By contrast, retinal imaging and routine office visits are extreme outliers—92134 ranks at the 100th percentile (extreme outlier, far above typical national volume) and 92250 also at the 100th percentile—signaling unusually large imaging throughput compared with peers nationally.
Office evaluation volume is unusually high nationally: 99213 ranks at the 99th percentile (extreme outlier, far above typical national volume) and 99214 ranks notably above typical national volume (93rd percentile). These high E/M percentiles combined with high imaging volumes suggest the practice handles a large established patient panel with frequent monitoring visits.
State-level Medicaid competitiveness appears modest: Medicaid ranks for the provider’s top in-state codes are generally mid-to-low percentiles (for example, 67028 ranks at the 27th percentile in-state and 92004 at the 26th percentile), indicating the provider is not a leading Medicaid performer within Louisiana. Where Medicaid activity exists, it is concentrated in procedures and comprehensive evaluations rather than high-cost biologics.
The provider has long tenure: NPI enumerated (registered): 2007-07-26 (~19 years ago), supporting interpretation of observed patterns as established practice behavior rather than short-term fluctuation. Longitudinal relationships with Medicare and repeat high-volume imaging and E/M billing are consistent with a stable, retina-centered outpatient practice model.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
22 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 1,470 | $680 | $1M |
| J2777 | Injection, faricimab‑svoa, 0.1 mg | 12,600 | $30 | $365.4K |
| J3490 | Unclassified drugs | 90 | $2,130 | $191.6K |
| J2778 | Injection, ranibizumab, 0.1 mg | 980 | $170 | $167.9K |
| 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. | 1,830 | $90 | $157.2K |
| J0179 | Injection, brolucizumab-dbll, 1 mg | 560 | $250 | $137.8K |
| 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. | 4,950 | $10 | $64.3K |
| 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… | 1,060 | $60 | $63.6K |
| 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… | 640 | $90 | $55.3K |
| J2781 | Injection, pegcetacoplan, intravitreal, 1 mg | 270 | $120 | $32.4K |
Showing 1–10 of 22
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 22 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
22 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J0178 | 4 | 50 | 300 | $680 | $371.5K |
| J2777 | 8 | 30 | 6,660 | $30 | $309.4K |
| J2778 | 4 | 10 | 770 | $180 | $208.9K |
| J0179 | 1 | 10 | 560 | $250 | $138K |
| J2781 | 5 | 10 | 830 | $120 | $86K |
| J3490 | 4 | 20 | 50 | $620 | $49.1K |
| 67028 | 2 | 70 | 410 | $80 | $44.3K |
| 67042 | 9 | 20 | 20 | $1,110 | $26.6K |
| 67108 | 5 | 10 | 20 | $1,100 | $22K |
| 99214 | 471 | 6,670 | 110 | $80 | $16.5K |
Showing 1–10 of 22
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.
7 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. | 150 | $120 | $17.4K |
| 92004 | The provider performs a comprehensive level ophthalmological evaluation of a new patient and initiates a diagnostic and treatment program for one or more visits. | 150 | $80 | $11.5K |
| 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. | 840 | $10 | $10.1K |
| 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… | 210 | $40 | $7.3K |
| 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,… | 300 | $20 | $5.9K |
| 92015 | The provider determines the process of determining if a patient's vision is less than 20/20 and by what amount so that corrective lenses or contact lenses can be prescribed and produced. | 350 | $10 | $2.4K |
| 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… | 40 | $60 | $2.4K |
How this provider's Medicaid billing volume and revenue compare to other Louisiana providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Louisiana median
7 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 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… | 2,375 | 3,230 | 1,120 | $30 | $204.3K |
| 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… | 575 | 660 | 1,070 | $60 | $129.3K |
| 92004 | The provider performs a comprehensive level ophthalmological evaluation of a new patient and initiates a diagnostic and treatment program for one or more visits. | 430 | 580 | 610 | $80 | $103.9K |
| 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. | 39 | 50 | 470 | $60 | $95.8K |
| 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. | 55 | 130 | 490 | $10 | $19.4K |
| 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,… | 90 | 210 | 200 | $20 | $17.5K |
| 92015 | The provider determines the process of determining if a patient's vision is less than 20/20 and by what amount so that corrective lenses or contact lenses can be prescribed and produced. | 329 | 520 | 940 | $1 | $9.8K |
Other providers in the same ZIP code as Ruben Grigorian, ranked by combined Medicare and Medicaid revenue.
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