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 Ohio for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to Ohio 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. Ohio (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.

Martin Wilkes (NPI 1518164995)

Field	Value
Entity Type	Individual
Organization	Martin Wilkes
Address	89 Sylvania Dr Fl 2
City	Beavercreek
State	OH
ZIP	45440
Taxonomy	Retina Specialist (Ophthalmology) Physician
NPI Enumerated	June 29, 2007

Payer Source	Total Paid
Medicare	$2.1M
Medicaid	$0

Key Findings

This provider is effectively single‑payer: total Medicare revenue is $2.1M and there is no Medicaid billing on file, so Medicaid does not contribute to the observable payer mix and Medicare dominates this provider’s public-payor revenue stream. Analysts should treat Medicaid as absent when modeling public-payor exposure or access patterns for this NPI.

Revenue is highly concentrated in a small set of drug and injection codes: the top 3 Medicare codes (J0178, J2777, 67028) account for 86.2% of the provider’s total Medicare revenue, with J0178 alone representing $1.3M (64.2% of Medicare revenue), J2777 $316.7K (15.5%), and 67028 $134.3K (6.6%). This concentration indicates the practice’s financial performance is dominated by intravitreal biologic therapy and related injection services.

The code mix and dollar volumes point to a retina-focused outpatient injection clinic model: J0178 (aflibercept) shows 1.9K claims at $690 avg paid/claim and J2777 (faricimab) has 10.9K claims at $29 avg paid/claim, while 67028 (standalone intravitreal injection) has 1.5K claims. High volumes of drug administration together with frequent, lower‑reimbursement imaging and E/M codes suggest the practice manages chronic retinal disease with repeated injections and monitoring visits.

Competitive standing for the principal injection codes is modest rather than dominant: J0178 ranks #575 of 3204 nationally (82th percentile; typical, unremarkable volume) and J2777 ranks #953 of 2039 (53th percentile; typical, unremarkable volume). Those ranks indicate the provider is a regular participant in anti‑VEGF and newer biologic administration nationally but is not among the highest‑volume specialty centers for these drugs.

Several diagnostic and routine visit codes are notable outliers in national activity: 92134 (retinal imaging) has 2.2K claims for $62.7K and ranks #834 of 26868 (97th percentile; notably above typical national volume), and 99213 (established office E/M) has 743 claims for $43.1K and ranks #12565 of 457151 (97th percentile; notably above typical national volume). These high percentiles for imaging and low‑level E/M imply a heavy monitoring and follow‑up workflow consistent with frequent injection cohorts.

There are limited surgical retina volumes relative to injection and imaging work: 67042 (23 claims, $20K) ranks #434 of 1087 (57th percentile) and 67036 (22 claims, $13.1K) ranks #307 of 832 (60th percentile), indicating vitreoretinal surgery is performed but represents a much smaller share of revenue and clinical activity than injections. Analysts should interpret the practice as primarily medical retina rather than a surgery‑heavy center.

One statistical outlier worth noting is J3590 (unclassified biologics): 725 claims generating $88.5K rank #36 of 631 (94th percentile; notably above typical national volume). The relatively high percentile on an unclassified biologic code could reflect use of miscellaneous or compound products in this clinic and is worth follow‑up if comparing drug mix or billing granularity against peers.

The provider has long tenure on file, with an NPI enumerated on 2007-06-29 (~19 years ago), which supports stability in the billing history and suggests these patterns reflect an established clinical practice rather than a newly opened clinic or transient billing artifact.

Medicare: Complete Services Breakdown

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

16 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J0178	Injection, aflibercept, 1 mg	1,910	$690	$1.3M
J2777	Injection, faricimab‑svoa, 0.1 mg	10,920	$30	$316.7K
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.	1,540	$90	$134.3K
J3590	Unclassified biologics	730	$120	$88.5K
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.	2,240	$30	$62.7K
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…	740	$60	$43.1K
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…	270	$90	$23.2K
67042	In this procedure, the provider removes vitreous humor, the gelatinous material that gives shape to the eye, using a mechanical cutting tool. He removes the internal limiting membrane of the retina…	20	$870	$20K
67036	The provider removes vitreous fluid from the eye to access the posterior segment of the eye and introduce surgical instruments through incisions in the pars plana.	20	$600	$13.1K
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…	90	$120	$10.5K

Showing 1–10 of 16

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 16 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Ohio Distribution

Martin Wilkes — 2 of 16 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Ohio

Full comparison — all codes billed, vs. state median

16 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0178	20	100	840	$680	$729K
J2777	31	70	9,480	$30	$353.3K
67028	23	150	470	$90	$64K
J3590	10	100	200	$100	$30K
67042	24	50	20	$960	$29.7K
67108	25	30	20	$1,020	$26.5K
67036	12	50	20	$870	$21K
92014	1,250	1,390	100	$70	$12.9K
99214	3,559	20,010	100	$70	$11.7K
67121	7	10	20	$550	$11.1K

Showing 1–10 of 16

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Pediatric Academic Association, Inc.	OH	Pediatrics Physician	$0	$37.2M
Dayton Children's Specialty Physicians, Inc.	OH	Pediatrics Physician	$0	$31.8M
Lester E Cox Medical Centers	MO	Family Medicine Physician	$0	$17M
Cei Physicians Psc LLC	OH	Ophthalmology Physician	$0	$8.5M
Cei Physicians Psc LLC	OH	Ophthalmologic Surgery Clinic/Center	$4.1M	$1M
James Osher	OH	Ophthalmology Physician	$3.7M	$0
Bruce Buerk	OH	Retina Specialist (Ophthalmology) Physician	$3.4M	$0
Juan Lebron	OH	Retina Specialist (Ophthalmology) Physician	$2.7M	$0
Kendall Wannamaker	NC	Ophthalmology Physician	$2.7M	$0
Hang Pham	OH	Ophthalmology Physician	$2.6M	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Reliable Home Health Care LLC	OH	Home Health Agency	$0	$8.4M
Dayton Eye Surgery Center L L C	OH	Ambulatory Surgical Clinic/Center	$1.6M	$656.4K
Scott Schoenberger	OH	Retina Specialist (Ophthalmology) Physician	$2.1M	$0
Digestivecare, LLC	OH	Ambulatory Surgical Clinic/Center	$877K	$1.1M
Endoscopy Center Of Dayton Ltd	OH	Ambulatory Surgical Clinic/Center	$447.5K	$222.8K
Eye Laser And Surgery Center LLC	OH	Ambulatory Surgical Clinic/Center	$664.8K	$0
Bal Srivastava	OH	Cardiovascular Disease Physician	$384.6K	$0
Syed Hasan	OH	Specialist	$306.4K	$0
James Knowles	OH	Ophthalmology Physician	$281.7K	$0
Mark Krebs	OH	Clinical Cardiac Electrophysiology Physician	$276K	$0

Martin Wilkes — 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