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    OpenPayerNPI Medicare & MedicaidAilee Laham
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    Ailee Laham — Billing Profile & Reimbursement Data

    NPI 1477791143 · Knoxville, TN · Retina Specialist (Ophthalmology) Physician

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    Ailee Laham is a retina specialist (ophthalmology) physician provider located in Knoxville, Tennessee. This profile covers 18 Medicare and 0 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.

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    Provider details (source: NPPES NPI Registry)

    FieldValue
    Entity TypeIndividual
    OrganizationAilee Laham
    Address1342 Old Weisgarber Rd
    CityKnoxville
    StateTN
    ZIP37909
    TaxonomyRetina Specialist (Ophthalmology) Physician
    NPI EnumeratedFebruary 3, 2009

    Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)

    Payer SourceTotal Paid
    Medicare$2.5M
    Medicaid$0

    Key Findings

    This provider bills exclusively to Medicare in the available data: Total Medicare revenue is $2.5M and there is no Medicaid billing on file, indicating the practice is effectively single-payer from a claims perspective. The absence of Medicaid activity suggests either limited participation in state plans or no billing relationship with Medicaid-managed care in Tennessee.

    Revenue is heavily concentrated in three codes: the precomputed top-3 codes account for 90.1% of this provider's total Medicare revenue. The three drivers are J2778 ($1.3M, 51.5%), J0178 ($790.5K, 31.7%), and 67028 ($172.7K, 6.9%), showing dependence on a small set of high-yield retinal services and drugs.

    The code mix is consistent with a retina-focused ophthalmology practice that centers on intravitreal anti-VEGF therapy and retina procedures. High revenue from J2778 and J0178 (ranibizumab and aflibercept) together with substantial billing for 67028 (intravitreal injection as an isolated procedure) and 92134 (retinal imaging) indicates routine, procedure-driven outpatient injection sessions supported by diagnostic imaging.

    J2778 is a national standout for this provider: it generates $1.3M (51.5% of the provider's Medicare revenue) and ranks #16 of 1208 providers nationally (99th percentile; notably above typical national volume). This rank signals market-leading volume for ranibizumab at a national level and positions the provider as a major user of that agent among peers.

    Retinal imaging is an extreme outlier: 92134 accounts for $84.7K (3.4% of Medicare revenue) with 3.1K claims and ranks #345 of 26868 providers nationally (99th percentile; extreme outlier). The unusually high imaging volume reinforces the operational model of frequent monitoring and follow-up that typically accompanies anti-VEGF treatment programs.

    By contrast, usage of aflibercept (J0178) appears ordinary relative to peers: J0178 accounts for $790.5K (31.7% of Medicare revenue) with a national rank of #1137 of 3204 providers (64th percentile; typical, unremarkable volume). The mix of a dominant ranibizumab volume alongside a typical aflibercept footprint suggests product preference or patient/population factors rather than uniformly high volume across all anti-VEGF agents.

    Procedural and visit coding shows a high cadence of follow-up care: 67028 (2K claims, $172.7K) ranks #425 of 4255 (90th percentile; typical, unremarkable volume) and 99213 (657 claims, $41.4K) ranks #16249 of 457151 (96th percentile; notably above typical national volume). These patterns point to frequent, lower-complexity office encounters and separated injection visits, consistent with a high-throughput injection clinic model.

    Provider tenure is long-standing in Medicare billing: NPI enumerated 2009-02-03 (~17 years ago). Combined with concentrated high-volume procedure and imaging codes, this suggests an established retina practice with sustained operational focus on intravitreal therapy and monitoring in the Knoxville market.

    Medicare: Total Revenue Breakdown by CPT/HCPCS Code

    Medicare revenue breakdown by CPT/HCPCS procedure code.

    View: Bar Chart1 / 2

    Medicare: Complete Services Breakdown

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

    18 rows

    CPT/HCPCS CodeDescriptionClaimsAvg PaidRevenue
    J2778Injection, ranibizumab, 0.1 mg7,180$180$1.3M
    J0178Injection, aflibercept, 1 mg1,140$690$790.5K
    67028The 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.1,960$90$172.7K
    92134The 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.3,140$30$84.7K
    99213The 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…660$60$41.4K
    92014An 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…490$70$35.6K
    J9035Injection, bevacizumab, 10 mg340$50$17.8K
    99204The 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…140$120$16.4K
    99214The 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…170$90$15.8K
    67108The provider repairs a detached retina using heat produced by a laser beam or by freezing the tissues. He may attach a scleral buckle to simplify the passage of fluid through and behind the retina or…20$850$15.3K

    Showing 1–10 of 18

    Medicare: Competitive Analysis & Benchmarks

    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 CodeRankProvider CountMedian ClaimsAvg PaidAverage Revenue
    J01783080790$680$769.8K
    J27781401,340$180$370.2K
    6702816801,130$90$98.5K
    67108163020$970$29.2K
    92014126810120$80$19.2K
    J90352170140$50$17.1K
    992144,50311,370120$80$16.6K
    92134860060$30$8.2K
    9921333211,03080$50$8K
    92235294050$100$5.7K

    Showing 1–10 of 18

    Related Providers

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

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    James MillerTNRetina Specialist (Ophthalmology) Physician$3.9M$0
    Devon GhodasraTNRetina Specialist (Ophthalmology) Physician$3.6M$0
    Nicholas AndersonTNRetina Specialist (Ophthalmology) Physician$3M$0
    Rohan ShahTNRetina Specialist (Ophthalmology) Physician$2.9M$0
    Scott BarbTNOphthalmology Physician$2.8M$0
    Robert ShulerTNRetina Specialist (Ophthalmology) Physician$2.6M$0
    Tod McmillanTNRetina Specialist (Ophthalmology) Physician$2.5M$0
    Stephen PerkinsTNRetina Specialist (Ophthalmology) Physician$2.3M$0
    Francis DecroosTNRetina Specialist (Ophthalmology) Physician$2.3M$0
    Cristoforo LarzoTNRetina Specialist (Ophthalmology) Physician$2.2M$0

    Nearby Providers

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

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    Omni Community Health, Inc.TNCommunity/Behavioral Health Agency$0$77.7M
    Summit Medical Group, PLLCTNInternal Medicine Physician$0$44.5M
    Allergy Associates, P.A.TNSpecialist$0$26.5M
    Knoxville Pediatric Dentistry, PLLCTNGeneral Practice Dentistry$0$11.2M
    The Florence Crittenton Agency IncTNCommunity/Behavioral Health Agency$0$10.7M
    Bsp Enterprises, LLCTNIn Home Supportive Care Agency$0$8M
    Associated Pain Specialists, PCTNPain Medicine Physician$0$6.8M
    Jeremiah BivinsTNAllergy & Immunology Physician$419.4K$4.6M
    Westbrook Medical Center, PLLCTNFamily Medicine Physician$0$4M
    Pcet Surgery Center LLCTNAmbulatory Surgical Clinic/Center$1.7M$60K

    Frequently Asked Questions

    References

    1. 1.Medicare Physician & Other Practitioner by Provider and Service. CMS.gov.Provider-level Medicare Part B utilization and payment data.
    2. 2.NPPES NPI Registry. CMS.gov.National Provider Identifier registry used for provider enumeration and taxonomy metadata.

    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.

    Medicare Revenue by CPT/HCPCS Code
    Claims Volume vs. Tennessee Distribution
    Ailee Laham — 3 of 18 codes billed far more than typical (above p95)
    p5–p95 (all providers)p25–p75MedianThis providerOutlier
    Rank Distribution — Tennessee