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    OpenPayerNPI Medicare & MedicaidJames Pate
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    James Pate — Billing Profile & Reimbursement Data

    NPI 1518107671 · Raleigh, NC · Ophthalmology Physician

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    James Pate is a ophthalmology physician provider located in Raleigh, North Carolina. This profile covers 17 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
    OrganizationJames Pate
    Address1101 Dresser Ct
    CityRaleigh
    StateNC
    ZIP27609
    TaxonomyOphthalmology Physician
    NPI EnumeratedMarch 3, 2009

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

    Payer SourceTotal Paid
    Medicare$5.2M
    Medicaid$0

    Key Findings

    This profile is effectively single‑payer at scale: the provider reports Total Medicare revenue of $5.2M and has no Medicaid billing on file, meaning Medicare represents the entirety of recorded public-payer revenue. The top three Medicare codes account for 93.1% of the provider's Medicare revenue, indicating a highly Medicare‑concentrated revenue base.

    Clinical/service-line mix is tightly focused on medical retina interventions and diagnostics. J0178 (aflibercept) accounts for $4.2M in revenue (80.6% of Medicare revenue) across 6.2K claims with an average paid/claim of $687, while procedure and imaging codes such as 67028 (2.8K claims, $283.4K, $100 avg) and 92134 (3.7K claims, $107.4K, $29 avg) further reflect a practice built around intravitreal injections and posterior-segment retinal imaging.

    Revenue concentration is extreme: the precomputed top‑3 share of 93.1% signals that clinical volume and revenue are dominated by a very small set of services, with most revenue tied to anti‑VEGF therapy rather than general ophthalmology E/M or a broader procedure mix. This concentration creates sensitivity to shifts in utilization patterns or reimbursement for the small number of dominant codes.

    On national competitive standing for the primary drug code, the provider is a clear outlier: J0178 ranks #13 of 3204 providers nationally (100th percentile; extreme outlier), indicating a volume and revenue footprint for aflibercept that is far above typical national peers. That rank suggests the provider is functioning as a high-volume injector for this medication relative to other physicians and practices.

    Other code-level standings are mixed: 67028 ranks #116 of 4255 (97th percentile; notably above typical national volume) and 92134 ranks #182 of 26868 (99th percentile; extreme outlier), which together corroborate a high throughput retina service line. By contrast, some injectable drug codes like J2777 (rank #811 of 2039, 60th percentile) and J2778 (rank #640 of 1208, 47th percentile) show more typical or unremarkable national volumes, indicating dominance is concentrated in specific drugs rather than across the entire anti‑VEGF market.

    Operationally, the claim counts imply a workflow optimized for frequent, procedure‑based visits: 6.2K claims for J0178, 3.7K claims for 92134, and 2.8K claims for 67028 point to frequent follow-up injections and same‑visit imaging. This pattern is consistent with an ambulatory retina clinic model that schedules recurrent intravitreal injections and associated diagnostic imaging on a high cadence.

    The absence of Medicaid billing on file is notable for network and access considerations: with no Medicaid revenue reported, the provider either does not participate in Medicaid or does not bill Medicaid patients, which concentrates payer mix on Medicare and commercial payers (commercial not shown here). This absence may limit access for Medicaid beneficiaries in the local market and means payer‑risk analyses should treat the provider as functionally Medicare‑centric.

    The provider has an established NPI tenure, enumerated on 2009-03-03 (~17 years ago), indicating long‑standing Medicare participation and time to build a stable referral base for retina services. That longevity, combined with extreme volume concentration in a few retina codes, suggests an experienced, procedure‑focused practice rather than a general ophthalmology clinic.

    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.

    17 rows

    CPT/HCPCS CodeDescriptionClaimsAvg PaidRevenue
    J0178Injection, aflibercept, 1 mg6,160$690$4.2M
    J2777Injection, faricimab‑svoa, 0.1 mg12,900$30$374.1K
    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.2,830$100$283.4K
    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.3,700$30$107.4K
    J2778Injection, ranibizumab, 0.1 mg590$180$105.6K
    92012For 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…940$60$59.2K
    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…360$90$31.5K
    J9035Injection, bevacizumab, 10 mg430$50$23.4K
    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…120$120$14.3K
    92004The provider performs a comprehensive level ophthalmological evaluation of a new patient and initiates a diagnostic and treatment program for one or more visits.60$90$5.4K

    Showing 1–10 of 17

    Medicare: Competitive Analysis & Benchmarks

    How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 17 CPT/HCPCS codes.

    View: State1 / 2

    Full comparison — all codes billed, vs. state median

    17 rows

    CPT/HCPCS CodeRankProvider CountMedian ClaimsAvg PaidAverage Revenue
    J01782100950$690$881K
    J2777367012,990$30$503.7K
    J27782550620$180$202.2K
    670282120780$90$80K
    92014154880110$80$17.7K
    9921414,50018,060110$80$15.1K
    J90351490140$50$13.4K
    92012430080$60$8.9K
    92235477060$100$8.7K
    92134279070$30$7.5K

    Showing 1–10 of 17

    Related Providers

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

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    Shil PatelVAOphthalmology Physician$6.1M$0
    Nitin GuptaNCOphthalmology Physician$4.7M$0
    John ThordsenNCRetina Specialist (Ophthalmology) Physician$3.5M$0
    Rebecca ManningNCRetina Specialist (Ophthalmology) Physician$3.4M$0
    Matthew ColeTNOphthalmology Physician$3.3M$0
    William ClarkSCOphthalmology Physician$3.3M$0
    Sachin MudvariNCRetina Specialist (Ophthalmology) Physician$3.2M$0
    Daniel BennettNCRetina Specialist (Ophthalmology) Physician$3M$0
    Brian LehpamerNCRetina Specialist (Ophthalmology) Physician$2.9M$0
    David FingerhutTNRetina Specialist (Ophthalmology) Physician$2.8M$0

    Nearby Providers

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

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    The Arc Of North CarolinaNCCommunity/Behavioral Health Agency$0$77.5M
    Voca Corp Of North CarolinaNCCommunity/Behavioral Health Agency$0$62.8M
    Easter Seals Ucp North Carolina & Virginia, Inc.NCCommunity/Behavioral Health Agency$0$58.3M
    Fastmed Urgent Care PCNCUrgent Care Clinic/Center$0$40.4M
    Easter Seals Ucp North Carolina & Virginia, Inc.NCCommunity/Behavioral Health Agency$0$29.3M
    Carter Clinic, P ANCPsychiatry Physician$0$19.4M
    Professional Healthcare, LLCNCNursing Care Agency$0$17.6M
    Healing Interventions, IncNCCommunity/Behavioral Health Agency$0$15.3M
    Kids First Pediatrics Of Raleigh, PLLCNCPediatrics Physician$0$12M
    Raleigh Best Medical Supply And Home Health Care Services, LLCNCHome Health Agency$0$11.9M

    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. North Carolina Distribution
    James Pate — 4 of 17 codes billed far more than typical (above p95)
    p5–p95 (all providers)p25–p75MedianThis providerOutlier
    Rank Distribution — North Carolina