Why are Medicare and Medicaid shown separately instead of combined?

They come from two different CMS data sources with no shared claim identifier, so they can't be reconciled into one number without double-counting or guessing. Every table and chart on this page keeps them fully separate.

Why is there no private/commercial revenue figure?

Private and commercial payer data comes from Transparency in Coverage files, which only publish negotiated rates — not claims or utilization volume. Without a volume figure, no revenue number can be computed for any provider from that data.

What does "Rank" mean in the Competitive Analysis & Benchmarks tables?

For a given CPT/HCPCS code, it's this provider's position by claims volume among all providers billing that same code at that geography level (State, National, or Wisconsin for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to Wisconsin only?

Medicaid is administered per-state with no single national fee schedule, so a state or national comparison the way Medicare has one isn't available. Wisconsin (this provider's own state) is the only grouping that's conceptually meaningful.

Why are the numbers rounded to the nearest 10?

To avoid implying more precision than the underlying data supports at a single-provider level. Ratios are kept precise since they're a relative comparison, not a volume or dollar figure.

How current is this data?

The Medicare and Medicaid tables are both single current snapshots, not refreshed on a recurring schedule yet.

Benjamin Ernst (NPI 1518162247)

Field	Value
Entity Type	Individual
Organization	Benjamin Ernst
Address	442 N Westhill Blvd Ste A
City	Appleton
State	WI
ZIP	54914
Taxonomy	Retina Specialist (Ophthalmology) Physician
NPI Enumerated	June 21, 2007

Payer Source	Total Paid
Medicare	$909.7K
Medicaid	$0

Key Findings

This provider is effectively single‑payer: Total Medicare revenue is $909.7K and there is no Medicaid billing on file, indicating Medicare is the dominant — and effectively sole — public payer for this practice. The absence of Medicaid activity suggests limited exposure to state-plan payment dynamics and a revenue base concentrated in Medicare beneficiaries.

Revenue concentration is very high: the precomputed top 3 Medicare codes account for 86.1% of this provider's total Medicare revenue, driven primarily by J0178 ($622.4K, 68.4%), 67028 ($102.2K, 11.2%), and J2778 ($58.2K, 6.4%). This concentration signals that a small set of injection and procedure codes underpins the vast majority of billed Medicare dollars.

The code mix and volume indicate a retina-focused, office‑based injection and imaging practice: high utilization of J0178 (906 claims, $687 avg paid/claim), J2778 (325 claims, $179 avg paid/claim), J9035 (813 claims, $54 avg paid/claim), and the injection procedure 67028 (1.1K claims, $89 avg paid/claim) align with routine intravitreal anti‑VEGF therapy for neovascular retinal disease. Elevated use of retinal imaging (92134: 1.4K claims, $28 avg paid/claim) further supports an integrated diagnostic/treatment workflow where OCT imaging and same‑day or regularly scheduled injections are core services.

Competitive standing is mixed across service lines: for the lead drug J0178 the provider ranks #1379 of 3204 (57th percentile), and for 67028 the provider ranks #1194 of 4255 (72th percentile), both characterized as typical or unremarkable national volume for those codes, indicating a modest, market‑average presence in aflibercept injections and isolated intravitreal procedures. By contrast, retinal imaging (92134) is a relative strength — the provider ranks #1640 of 26868 (94th percentile) and is described as notably above typical national volume for this code, suggesting above‑average throughput on diagnostic imaging compared with peers.

Statistical labels from national comparisons reinforce the profile: most high‑revenue drug and office visit codes are reported as "typical, unremarkable volume," while 92134 is explicitly flagged as "notably above typical national volume," highlighting imaging as an outlier on the high side. The provider’s use of bevacizumab (J9035) appears in the dataset with substantial claim count (813 claims) but is described as "typical, unremarkable volume for this code," which suggests a conventional mix of branded and compounded anti‑VEGF use rather than an unusual substitution pattern.

Tenure and experience are long-standing: the NPI was enumerated on 2007-06-21 (~19 years ago), indicating sustained presence in the market that may support an established referral base and clinic operations tuned to retina care. This longevity aligns with the practice pattern seen in the claims mix — ongoing, repetitive procedural throughput rather than a recently established practice.

Operational and revenue risk note: dependence on a single high‑value drug is material — J0178 alone represents $622.4K (68.4%) of Medicare revenue — and the top three codes together account for 86.1% of Medicare dollars. Such concentration creates sensitivity to shifts in drug pricing, payer coverage policies, or changes in clinical utilization of aflibercept versus alternatives, so payers and analysts should consider monitoring utilization trends for these codes.

Clinical workflow implication for contracting and network decisions: the combination of a high share of drug reimbursement (J0178, J2778, J9035) and above‑typical imaging volume (92134) suggests this provider operates a high‑throughput retina/injection clinic with in‑house diagnostics. For payers evaluating network value or case management, the practice likely delivers bundled, repeatable services that hinge on anti‑VEGF administration and frequent OCT surveillance.

Medicare: Complete Services Breakdown

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	910	$690	$622.4K
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.	1,150	$90	$102.2K
J2778	Injection, ranibizumab, 0.1 mg	330	$180	$58.2K
J9035	Injection, bevacizumab, 10 mg	810	$50	$43.9K
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.	1,400	$30	$39.3K
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…	380	$60	$22.9K
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…	80	$110	$8.3K
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…	60	$90	$4.7K
99203	The provider sees a new 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 provider…	30	$70	$2.4K
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…	20	$160	$2.3K

Showing 1–10 of 13

Medicare: Competitive Analysis & Benchmarks

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

Claims Volume vs. Wisconsin Distribution

Benjamin Ernst — 2 of 13 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Wisconsin

Full comparison — all codes billed, vs. state median

13 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0178	17	60	440	$690	$488.1K
J2778	6	10	520	$180	$131.2K
67028	9	110	310	$80	$43.7K
J9035	5	70	110	$50	$14.5K
92014	525	720	120	$70	$12.9K
92012	6	160	50	$60	$5.1K
92134	16	600	60	$30	$4.7K
92004	383	520	30	$80	$3.9K
99204	295	3,390	30	$100	$3.7K
67145	12	20	20	$170	$3.1K

Showing 1–10 of 13

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Northeast Wisconsin Retina Associates Sc	WI	Retina Specialist (Ophthalmology) Physician	$0	$2.4M
Khalid Kahook	WI	Retina Specialist (Ophthalmology) Physician	$1.8M	$390
Michael Possin	WI	Retina Specialist (Ophthalmology) Physician	$1.7M	$360
Rajeev Buddi	WI	Retina Specialist (Ophthalmology) Physician	$1.3M	$0
Anthony Parendo	WI	Retina Specialist (Ophthalmology) Physician	$1.2M	$0
Charles Hejny	WI	Retina Specialist (Ophthalmology) Physician	$834.4K	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Options Lab, Inc.	WI	Clinical Medical Laboratory	$440.8K	$12.5M
Tri-county Community Dental Clinic, Inc.	WI	Dental Clinic/Center	$0	$4.9M
Catalpa Health	WI	Community/Behavioral Health Agency	$0	$4M
Appleton Dental Care LLC	WI	Dental Clinic/Center	$0	$1.6M
Pinnacle Cataract And Laser Institute LLC	WI	Ambulatory Surgical Clinic/Center	$994.5K	$481.6K
Options Treatment Programs, Inc	WI	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$1.2M
Micheal Vrabec	WI	Ophthalmology Physician	$380.3K	$0
Douglas Salm	WI	Ophthalmology Physician	$314.9K	$0
Ryan Funk	WI	Otolaryngology Physician	$217.6K	$34K
John Mcmahan	WI	Otolaryngology Physician	$99.7K	$0

Benjamin Ernst — Billing Profile & Reimbursement Data

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Key Findings

Medicare: Total Revenue Breakdown by CPT/HCPCS Code

Medicare: Complete Services Breakdown

Medicare: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References