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NPI 1457464778 · Great Neck, NY · Ophthalmology Physician
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Kenneth Graham is a ophthalmology physician provider located in Great Neck, New York. This profile covers 26 Medicare and 6 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 | Kenneth Graham |
| Address | 600 Northern Blvd |
| City | Great Neck |
| State | NY |
| ZIP | 11021 |
| Taxonomy | Ophthalmology Physician |
| NPI Enumerated | August 17, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $5.6M |
| Medicaid | $64.5K |
This provider is effectively Medicare-dominated: reported lifetime Medicare revenue is $5.6M compared with $64.5K in Medicaid revenue, indicating Medicare drives the vast majority of billed activity and payments. The Medicaid footprint is present but small in scale relative to Medicare and should be treated as secondary for contracting and utilization analyses.
The code mix and highest-revenue services indicate a retina-focused ophthalmology practice that relies heavily on intravitreal injections and retinal imaging. The top Medicare codes include J0178 (injection, aflibercept), J2777 (faricimab), and 67028 (isolated intravitreal injection), together reflecting frequent anti-VEGF and related intravitreal procedures alongside diagnostic retinal imaging such as 92134.
Medicare revenue is highly concentrated: the precomputed top-3 Medicare codes account for 76.4% of this provider's total Medicare revenue, driven chiefly by J0178 at 59.0%, with J2777 at 11.5% and 67028 at 5.9%. This concentration signals commercial sensitivity to demand and reimbursement for a small set of high-revenue therapeutic injections.
Medicaid revenue is even more concentrated: the precomputed top-3 Medicaid codes account for 98.6% of the provider’s Medicaid revenue, led by 67028 at 52.3%, J0178 at 31.1%, and 92134 at 15.1%. For Medicaid, the practice’s revenue mix shifts toward procedure-level billing of injections and imaging rather than broader evaluation-and-management volume.
National competitive standing on key Medicare codes is prominent for specific services: J0178 ranks #32 of 3204 providers nationally (99th percentile; extreme outlier), 92134 ranks #96 of 26868 providers nationally (100th percentile; extreme outlier), and 67028 ranks #107 of 4255 providers nationally (98th percentile; notably above typical national volume). These ranks indicate the provider is an unusually high-volume national participant for aflibercept injections and retinal imaging compared with peers.
In-state (Medicaid) competitive standing is more modest: 67028 ranks #95 of 262 providers in-state (64th percentile), J0178 ranks #85 of 101 providers in-state (15th percentile), and 92134 ranks #206 of 728 providers in-state (72nd percentile). That pattern suggests the provider’s exceptional Medicare scale does not translate to dominant Medicaid market share, and Medicaid volumes are typical to modest versus state peers.
The provider’s NPI has been enumerated since 2006-08-17 (~20 years ago), indicating long tenure in the market. Coupled with the concentrated, high-volume Medicare injection and imaging activity, this tenure is consistent with an established, specialty retinal practice that has scaled procedural throughput over many years.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
26 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 4,720 | $690 | $3.3M |
| J2777 | Injection, faricimab‑svoa, 0.1 mg | 22,860 | $30 | $640.1K |
| 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. | 2,910 | $110 | $328.4K |
| Q5128 | Injection, ranibizumab-eqrn (cimerli), biosimilar, 0.1 mg | 1,240 | $210 | $264.5K |
| J2778 | Injection, ranibizumab, 0.1 mg | 1,060 | $190 | $195.2K |
| J3490 | Unclassified drugs | 80 | $2,290 | $183K |
| 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. | 4,340 | $40 | $156.4K |
| 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… | 1,410 | $80 | $112.9K |
| 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… | 920 | $80 | $70.5K |
| 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… | 550 | $110 | $62.4K |
Showing 1–10 of 26
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 26 CPT/HCPCS codes.
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Full comparison — all codes billed, vs. state median
26 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J0178 | 3 | 230 | 560 | $690 | $693K |
| J2777 | 14 | 120 | 7,740 | $30 | $364.9K |
| Q5128 | 8 | 20 | 1,170 | $220 | $268.3K |
| J2778 | 15 | 70 | 510 | $180 | $131.6K |
| J2781 | 32 | 40 | 520 | $120 | $75.1K |
| Q5124 | 10 | 20 | 310 | $170 | $69.7K |
| 67028 | 3 | 300 | 400 | $100 | $65.9K |
| J3490 | 48 | 120 | 60 | $470 | $50.8K |
| J7312 | 6 | 20 | 270 | $160 | $48K |
| 92014 | 387 | 2,220 | 160 | $100 | $29.3K |
Showing 1–10 of 26
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.
6 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. | 770 | $40 | $33.7K |
| J0178 | Injection, aflibercept, 1 mg | 40 | $500 | $20.1K |
| 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. | 1,220 | $10 | $9.7K |
| 92226 | N/A | 110 | $1 | $460 |
| 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… | 30 | $20 | $440 |
| 4177F | No Summary found for this code | 10 | $0 | $0 |
How this provider's Medicaid billing volume and revenue compare to other New York providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. New York median
6 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 85 | 100 | 280 | $650 | $369.9K |
| 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… | 1,257 | 1,460 | 310 | $60 | $88.1K |
| 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. | 95 | 260 | 420 | $70 | $65.6K |
| 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. | 206 | 730 | 370 | $20 | $30K |
| 92226 | N/A | 274 | 400 | 270 | $20 | $12.6K |
| 4177F | No Summary found for this code | 17 | 20 | 80 | $1 | $10 |
Other providers in the same ZIP code as Kenneth Graham, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| C And T Homecare Services LLC | NY | In Home Supportive Care Agency | $0 | $847.7M |
| North Shore-lij Medical PC | NY | Urology Physician | $0 | $388.1M |
| First Choice Home Care Inc | NY | Home Health Agency | $0 | $28M |
| Welllife Network Inc. | NY | Clinic/Center | $0 | $22M |
| Regioncare Inc. | NY | Home Infusion Agency | $40.1K | $9.4M |
| Philip Ferrone | NY | Ophthalmology Physician | $3.1M | $10.5K |
| Shahram Shamekh | NY | Internal Medicine Physician | $673.3K | $1.4M |
| Angela Azar | NY | Dermatology Physician | $104.5K | $1.5M |
| Alireza Shirvani | NY | Hospitalist Physician | $1.4M | $178K |
| Stephanie Buck-haskin | NY | Obstetrics & Gynecology Physician | $56.1K | $1.4M |
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