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

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

Marc Spirn (NPI 1457325086)

Field	Value
Entity Type	Individual
Organization	Marc Spirn
Address	4060 Butler Pike
City	Plymouth Meeting
State	PA
ZIP	19462
Taxonomy	Ophthalmology Physician
NPI Enumerated	February 13, 2006

Payer Source	Total Paid
Medicare	$6.3M
Medicaid	$0

Key Findings

This provider’s Medicare business is highly concentrated in a small set of high-cost ophthalmic drugs: J0178 ($1.9M, 29.4%), J2778 ($1.3M, 21.0%), and Q5128 ($1.3M, 20.8%) together account for 71.2% of the provider’s total Medicare revenue, against a lifetime Medicare revenue base of $6.3M. That concentration indicates revenue is driven overwhelmingly by intravitreal pharmacologic therapy rather than office E&M or minor procedures.

The code mix is characteristic of a retina-focused ophthalmology practice that delivers frequent in-office injections and advanced retinal imaging: high-volume anti-VEGF and related agents (J0178, J2778, Q5128, J2777) are paired with large counts for retinal imaging (92134 — 5.2K claims, $166K) and vitreous injection as an isolated procedure (67028 — 3.6K claims, $384.7K). These patterns point to a workflow that prioritizes recurring procedural visits for retinal disease management (eg, AMD, DME) rather than predominantly primary-care style office visits.

Several codes show national-level prominence: J2778 ranks #17 of 1208 providers (99th percentile) and Q5128 ranks #8 of 373 providers (98th percentile), which the source describes as notably above typical and extreme outlier volumes respectively. J0178 also ranks well (#244 of 3204, 92th percentile, described as notably above typical), and diagnostic/office codes 92012 and 92134 are labeled as extreme outliers in national volume; collectively these ranks indicate this provider is a major national-volume participant for anti-VEGF therapy and retinal diagnostics.

Payer mix is effectively single-payer Medicare: lifetime Medicare revenue is $6.3M while there is no Medicaid billing on file. That absence of Medicaid activity means the provider’s reimbursement exposure and negotiation dynamics are concentrated entirely within Medicare and any commercial contracts, increasing sensitivity to Medicare reimbursement and drug payment policy changes.

Tenure data show an established practice presence: the provider’s NPI was enumerated/registered 2006-02-13 (~20 years ago). Sustained enumeration over roughly two decades combined with very high volumes on several procedure and drug codes suggests a long-running clinical program and operational stability in delivering retinal services.

Several specific codes are flagged as statistical outliers by the source: Q5128 is described as an “extreme outlier, far above typical national volume,” and 67028, 92012, and 92134 are also labeled “extreme outlier” or at the 100th percentile. These labels indicate usage levels materially above national peers for intravitreal procedures and retinal imaging, consistent with a high-throughput injection and diagnostics model.

The provider’s revenue profile shows relatively modest E&M billing compared to drug and procedure revenue: example E&M/comprehensive visit codes include 92014 ($39.2K), 99204 ($30.4K), and 99214 ($25.9K), while drug and procedure codes generate substantially larger single-code totals such as J0178 ($1.9M) and J2778 ($1.3M). This suggests front-line revenue is delivered through repeat procedural encounters and drug administrations rather than high-volume billable office evaluations.

Operational and purchasing implications are visible from the claims mix: very large claim counts for injection codes (J2777 17.5K claims, J2778 7K claims, Q5128 6K claims, J0178 2.7K claims) imply significant throughput for intravitreal injections, ongoing supply chain needs for biologics/biosimilars, and scheduling capacity for frequent follow-up visits. For payers and partners, these patterns signal a concentrated spend profile in injectable retinal therapies and related imaging that could be targeted for utilization management, network strategy, or site-of-care contracting discussions.

Medicare: Complete Services Breakdown

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

21 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J0178	Injection, aflibercept, 1 mg	2,700	$690	$1.9M
J2778	Injection, ranibizumab, 0.1 mg	7,010	$190	$1.3M
Q5128	Injection, ranibizumab-eqrn (cimerli), biosimilar, 0.1 mg	6,030	$220	$1.3M
J2777	Injection, faricimab‑svoa, 0.1 mg	17,520	$30	$508.1K
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.	3,630	$110	$384.7K
J3490	Unclassified drugs	120	$1,830	$221.1K
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…	2,930	$70	$202.4K
J2781	Injection, pegcetacoplan, intravitreal, 1 mg	1,560	$120	$187.2K
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.	5,190	$30	$166K
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…	400	$100	$39.2K

Showing 1–10 of 21

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 21 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Pennsylvania Distribution

Marc Spirn — 5 of 21 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Pennsylvania

Full comparison — all codes billed, vs. state median

21 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0178	20	140	830	$690	$865.1K
Q5128	5	20	3,830	$220	$838.7K
J2778	4	70	1,030	$190	$417.1K
J2777	22	100	7,950	$30	$360.2K
J2781	3	20	690	$120	$109.1K
67028	8	180	600	$90	$87.5K
J7999	56	110	100	$120	$33.3K
67042	21	50	20	$1,100	$31.9K
J3490	24	110	60	$70	$27.9K
92014	311	1,570	130	$80	$21K

Showing 1–10 of 21

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
The Nemours Foundation	DE	Multi-Specialty Clinic/Center	$0	$172M
The Nemours Foundation	FL	Children's Hospital	$0	$104.9M
The Nemours Foundation	DE	Children's Hospital	$0	$104M
The Nemours Foundation	FL	Multi-Specialty Clinic/Center	$0	$46.2M
Nemours Children's Health, Downtown Orlando, Specialty Care	FL	Multi-Specialty Clinic/Center	$0	$44.4M
Nemours Children's Health, Jacksonville, Specialty Care	FL	Multi-Specialty Clinic/Center	$0	$23.6M
Sedigheh Ebadi	FL	Pediatrics Physician	$0	$10.1M
Children's Health Alliance, LLC	FL	Pediatrics Physician	$0	$9.6M
Alok Bansal	CA	Ophthalmology Physician	$3M	$4.7M
David Reed	MA	Retina Specialist (Ophthalmology) Physician	$7.7M	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Gemma Services	PA	Psychiatric Residential Treatment Facility	$0	$23.8M
Access Services Inc	PA	Community/Behavioral Health Agency	$0	$8.3M
Omesh Gupta	PA	Ophthalmology Physician	$7.1M	$80
Mitchell Fineman	PA	Ophthalmology Physician	$7M	$0
Michael Klufas	PA	Ophthalmology Physician	$7M	$0
Richard Kaiser	PA	Ophthalmology Physician	$6.6M	$0
Allen Chiang	PA	Ophthalmology Physician	$6.6M	$0
Carl Regillo	PA	Ophthalmology Physician	$6.5M	$0
Allen Ho	PA	Ophthalmology Physician	$6.4M	$0
Yoshihiro Yonekawa	PA	Ophthalmology Physician	$6.4M	$0

Marc Spirn — Billing Profile & Reimbursement Data

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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