Loading...
NPI 1457686586 · Springfield, MA · Ophthalmology Physician
Customize your policy alerts
Get alerted when relevant policies change without checking for updates manually.
Monitor payer policy activity
David Lally is a ophthalmology physician provider located in Springfield, Massachusetts. This profile covers 18 Medicare and 1 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 | David Lally |
| Address | 3640 Main St |
| City | Springfield |
| State | MA |
| ZIP | 01107 |
| Taxonomy | Ophthalmology Physician |
| NPI Enumerated | October 7, 2009 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $3.2M |
| Medicaid | $670 |
Practice is strongly procedure-oriented and retina-focused: the largest Medicare revenue contributors are intravitreal anti-VEGF drugs J0178 ($1.6M, 49.9% of Medicare revenue), J2777 ($558.5K, 17.6%), and J2778 ($358K, 11.3%), and the CPT mix includes high-volume retinal imaging (92134). This combination of high drug-injection billing and advanced retinal imaging is typical of a retina clinic that runs a high-throughput injection and diagnostic-imaging workflow rather than a general ophthalmology or surgery-heavy practice.
Medicare revenue is concentrated: the precomputed top-3 Medicare codes by revenue account for 78.9% of the provider's total Medicare revenue, indicating heavy dependence on a small set of injection drugs and related services for the majority of Medicare billing. For Medicaid, the precomputed top-3 Medicaid codes account for 100.0% of Medicaid revenue, with the Medicaid claims file listing 92134 as the sole reported Medicaid code.
Payer mix is effectively single-payer dominated: lifetime Medicare revenue is $3.2M compared with negligible Medicaid revenue ($668 reported as total lifetime Medicaid revenue). Note that the Medicaid code-level data lists 92134 with $675 and a 100.0% share of Medicaid code revenue, which aligns with an effectively Medicare-driven topline and minimal Medicaid footprint.
Competitive standing on anti-VEGF injections is above median but not singularly dominant: J0178 ranks #401 of 3204 providers nationally (87th percentile) and is described as typical/unremarkable volume for the code, while J2777 (rank #558 of 2039, 73rd percentile) and J2778 (rank #222 of 1208, 82nd percentile) reflect consistently strong participation in these high-revenue injection therapies without being a top national outlier. In aggregate these ranks imply the provider is a significant regional player in anti-VEGF delivery but not an extreme national leader on those drug codes.
Retail retinal imaging is an outsized feature relative to peers: 92134 appears as an extreme outlier on the Medicare side (2.7K claims, $84.9K revenue; rank #526 of 26868, 98th percentile, labeled "extreme outlier, far above typical national volume for this code"). That suggests the practice performs retinal imaging at volumes far above most peers, reinforcing the view of a high-throughput retinal diagnostic and injection service line.
Some evaluation-and-management and new-patient codes are also unusually high relative to national peers: 92004 is reported with $23.1K revenue and ranks in the 96th percentile ("notably above typical national volume for this code"), and 99212 ranks in the 97th percentile with $11.5K revenue ("notably above typical national volume"). These elevated exam-code ranks indicate that, in addition to procedure throughput, the practice manages a steady stream of comprehensive new visits and brief follow-ups at rates above most peers.
Tenure is long enough to establish an established local presence: the NPI was enumerated on 2009-10-07 (~17 years ago), indicating sustained billing activity over more than a decade. That longevity, combined with concentrated Medicare procedure revenue, suggests an entrenched practice model centered on retina services.
Implications for payers and networks: given $3.2M in Medicare revenue concentrated in injection drugs and very high-volume retinal imaging, this provider is likely to be an important partner for payers managing utilization and costs of intravitreal therapies regionally. The virtually absent Medicaid billing ($668 total reported) means Medicaid exposure is minimal and payer-contracting risk or network impact will be driven almost entirely by Medicare-facing service patterns.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
18 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 2,290 | $690 | $1.6M |
| J2777 | Injection, faricimab‑svoa, 0.1 mg | 19,260 | $30 | $558.5K |
| J2778 | Injection, ranibizumab, 0.1 mg | 1,990 | $180 | $358K |
| 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. | 1,990 | $100 | $191.3K |
| J3590 | Unclassified biologics | 50 | $1,900 | $89.1K |
| 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. | 2,740 | $30 | $84.9K |
| 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… | 690 | $90 | $64.1K |
| J3490 | Unclassified drugs | 40 | $1,680 | $64K |
| J7312 | Injection, dexamethasone, intravitreal implant, 0.1 mg | 280 | $160 | $44.5K |
| 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… | 360 | $100 | $34.3K |
Showing 1–10 of 18
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 18 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
18 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J0178 | 11 | 90 | 790 | $690 | $826.5K |
| J2777 | 11 | 50 | 7,080 | $30 | $343.1K |
| J2778 | 5 | 30 | 560 | $180 | $200.7K |
| J3590 | 2 | 10 | 40 | $2,100 | $81.7K |
| 67028 | 12 | 120 | 570 | $100 | $80.7K |
| J3490 | 18 | 20 | 60 | $380 | $49.5K |
| J7312 | 2 | 10 | 220 | $160 | $35.7K |
| 92014 | 161 | 1,070 | 160 | $90 | $30.1K |
| J9035 | 20 | 80 | 250 | $50 | $19.7K |
| 99214 | 2,168 | 15,410 | 110 | $80 | $15.6K |
Showing 1–10 of 18
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.
1 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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. | 30 | $30 | $680 |
How this provider's Medicaid billing volume and revenue compare to other Massachusetts providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Massachusetts median
1 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 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. | 114 | 130 | 430 | $10 | $39.3K |
Other providers in the same ZIP code as David Lally, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Center For Human Development, Inc. | MA | Community/Behavioral Health Agency | $0 | $97.1M |
| Viecare Corp | MA | Foster Care Agency | $0 | $35.5M |
| Andventure, LLC | MA | Home Health Agency | $0 | $14.6M |
| Baystate Mri & Imaging Center, LLC | MA | Magnetic Resonance Imaging (MRI) Clinic/Center | $2.6M | $6.7M |
| Radiology & Imaging, Inc. | MA | Diagnostic Radiology Physician | $0 | $5.8M |
| Shilpa Gulati | MA | Ophthalmology Physician | $2.4M | $0 |
| Andrew Lam | MA | Ophthalmology Physician | $1.4M | $0 |
| Hari Mylvaganam | MA | Ophthalmology Physician | $1.3M | $5.1K |
| Pioneer Valley Surgicenter LLC | MA | Ambulatory Surgical Clinic/Center | $429.2K | $614.8K |
| Sidney Kahn Iv | MA | Vascular & Interventional Radiology Physician | $945K | $0 |
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.