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NPI 1467807222 · Providence, RI · Retina Specialist (Ophthalmology) Physician
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Jacob Duker is a retina specialist (ophthalmology) physician provider located in Providence, Rhode Island. This profile covers 13 Medicare and 5 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 | Jacob Duker |
| Address | 120 Dudley St Ste 303 |
| City | Providence |
| State | RI |
| ZIP | 02905 |
| Taxonomy | Retina Specialist (Ophthalmology) Physician |
| NPI Enumerated | April 29, 2016 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $304K |
| Medicaid | $20.3K |
Practice profile and service mix: This provider’s Medicare billing is dominated by intravitreal anti-VEGF therapy, with J0178 (aflibercept) generating $203.2K of the $304K Medicare revenue and representing 66.8% of Medicare income; complementary procedural and diagnostic codes (67028 intravitreal injection and 92134 retinal imaging) are also prominent, indicating an outpatient retina specialty focused on injections and retinal imaging. Medicaid billing shows a similar clinical focus: 67028 injections and retinal imaging/photography (92134, 92250) together make up the bulk of Medicaid activity, consistent with a retina-oriented ambulatory practice.
Revenue concentration: Revenue is highly concentrated within a few services for both payers — the top three Medicare codes account for 81.1% of Medicare revenue and the top three Medicaid codes account for 86.0% of Medicaid revenue — signaling reliance on a narrow set of high-value procedural services (notably aflibercept injections and intravitreal procedures).
Payer mix and scale: The provider’s Medicare revenue ($304K) far exceeds Medicaid revenue ($20.3K), so Medicare is the dominant payer financially for this practice; Medicaid activity exists but is comparatively small in dollar terms, making the practice effectively Medicare-driven in scale.
Competitive standing on Medicare for top code: Although J0178 is the single largest revenue driver ($203.2K, 66.8% of Medicare revenue), the provider ranks #2330 of 3204 nationally (27th percentile) for J0178 and is characterized as a typical, unremarkable volume participant for that code — suggesting the practice relies heavily on aflibercept economically but is not a high-volume national leader for that drug.
Competitive standing on imaging and procedures: The provider’s Medicare volume for 92134 (569 claims, $18.2K, 6.0% of Medicare revenue) is reported at the 88th percentile nationally (rank #3200 of 26868) but labeled as typical/unremarkable; other procedure codes such as 67028 (260 Medicare claims, $25.2K, 8.3% of Medicare revenue) are likewise described as typical, indicating the practice’s activity is consistent with many retina specialists rather than being a clear outlier.
In-state Medicaid competitive position: For Medicaid, 67028 is the largest single Medicaid revenue source ($10.3K, 51.0% of Medicaid revenue) but the provider ranks #13 of 14 in-state (8th percentile) for that code, which places them toward the lower end of in-state peers for intravitreal injection volume despite the code’s local revenue importance. 92250 fundus photography is more middling in-state (145 claims, $4.4K, 21.5% of Medicaid revenue; rank #39 of 80, 51st percentile).
Use of alternative drug codes and service breadth: The Medicare file shows some usage of lower-cost biologic bevacizumab (J9035, 113 claims, $6.2K, 2.0% of Medicare revenue), indicating occasional use of a different anti-VEGF agent alongside dominant aflibercept billing; the presence of E/M codes (99204, 99213, 99214) and new patient comprehensive exams (92004) also indicates this retina practice provides evaluation and management in addition to procedure-driven care.
Tenure and stability: The provider’s NPI has been enumerated since 2016-04-29 (approximately 10 years), so this billing profile reflects an established clinician with a multi-year presence in the market rather than a newly registered provider.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
13 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 290 | $690 | $203.2K |
| 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. | 260 | $100 | $25.2K |
| 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. | 570 | $30 | $18.2K |
| 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… | 110 | $130 | $13.3K |
| 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… | 180 | $70 | $12.8K |
| 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… | 110 | $100 | $10.9K |
| J9035 | Injection, bevacizumab, 10 mg | 110 | $60 | $6.2K |
| 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. | 50 | $120 | $5.4K |
| 92235 | The provider uses a special dye, fluorescein that causes the blood vessels in the one or both eyes to stand out in photographic images taken with the use of multiframe timing, or serial images, taken… | 30 | $100 | $3K |
| 67145 | The provider prevents the detachment of the retina in the presence of small tears or thinning of the edges (lattice degeneration) by applying an intense light (such as a laser) to create scar tissue… | 10 | $200 | $2.2K |
Showing 1–10 of 13
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 13 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
13 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J0178 | 11 | 10 | 670 | $690 | $601.6K |
| 67028 | 14 | 20 | 610 | $90 | $58.9K |
| 92014 | 171 | 190 | 120 | $80 | $16.3K |
| 99214 | 881 | 1,950 | 100 | $80 | $11.7K |
| J9035 | 11 | 20 | 160 | $50 | $9.5K |
| 99213 | 391 | 1,950 | 70 | $60 | $7.4K |
| 92134 | 13 | 120 | 50 | $30 | $6.6K |
| 99204 | 35 | 740 | 30 | $110 | $4.6K |
| 92004 | 33 | 120 | 30 | $100 | $4K |
| 92235 | 4 | 10 | 20 | $100 | $3.6K |
Showing 1–10 of 13
Medicaid revenue breakdown by year and by CPT/HCPCS procedure code, including monthly billing trends and the top codes driving revenue.
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Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.
5 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. | 30 | $300 | $10.3K |
| 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,… | 150 | $30 | $4.3K |
| 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. | 140 | $20 | $2.7K |
| 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… | 40 | $70 | $2.3K |
| 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… | 10 | $40 | $520 |
How this provider's Medicaid billing volume and revenue compare to other Rhode Island providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Rhode Island median
5 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average 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. | 13 | 10 | 170 | $230 | $144.3K |
| 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… | 1,402 | 1,730 | 220 | $70 | $75.2K |
| 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… | 1,914 | 2,050 | 300 | $50 | $72.3K |
| 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. | 18 | 20 | 560 | $50 | $61.6K |
| 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,… | 39 | 80 | 140 | $30 | $16.9K |
Other providers in the same ZIP code as Jacob Duker, ranked by combined Medicare and Medicaid revenue.
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