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NPI 1528096971 · Jackson, MS · Retina Specialist (Ophthalmology) Physician
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James Brown is a retina specialist (ophthalmology) physician provider located in Jackson, Mississippi. This profile covers 21 Medicare and 3 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 | James Brown |
| Address | 1200 N State St |
| City | Jackson |
| State | MS |
| ZIP | 39202 |
| Taxonomy | Retina Specialist (Ophthalmology) Physician |
| NPI Enumerated | June 28, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $5.4M |
| Medicaid | $8.9K |
This provider’s Medicare activity is overwhelmingly dominated by intravitreal anti-VEGF therapy: J0178 (6.4K claims, $685 avg paid/claim, $4.4M revenue) alone represents 82.2% of the provider’s Medicare revenue and the provider ranks #9 of 3204 nationally for this code (100th percentile; extreme outlier). The code mix — high-volume injectable therapy plus retinal imaging and office E/Ms — is consistent with a retina specialty practice focused on repeated, high-frequency drug administration and follow-up.
Revenue concentration is acute on both payers: the top 3 Medicare codes account for 90.6% of this provider’s total Medicare revenue, driven primarily by J0178, 67028, and J2778. On Medicaid the top 3 codes account for 100.0% of its total Medicaid revenue, with 92134 and 67028 together representing essentially all Medicaid receipts, indicating very little revenue diversification outside a few procedure lines.
Medicare dwarfs Medicaid for this clinician: lifetime Medicare revenue is $5.4M versus total Medicaid revenue of $8.9K, signaling an effectively single-payer revenue profile heavily weighted to Medicare. Given this scale gap, operational and competitive analysis should prioritize Medicare utilization patterns and reimbursement dynamics over Medicaid activity.
The provider’s national competitive standing is prominent for key procedures: J0178 is an extreme outlier (rank #9 of 3204, 100th percentile) and 67028 is also labeled an extreme outlier (rank #50 of 4255, 99th percentile), indicating unusually high national volume for intravitreal injection services. In addition, 92134 (retinal imaging) shows extreme outlier status on Medicare (rank #37 of 26868, 100th percentile), which suggests a high-throughput clinic model that combines frequent injections with routine imaging.
In contrast, the provider’s Medicaid footprint is modest within state peers: 92134 ranks #17 of 41 in-state (60th percentile) and 67028 ranks #13 of 15 in-state (14th percentile), indicating that while imaging and injections are core services for the provider, their Medicaid volumes do not mirror the national Medicare dominance and are middling or low compared with in-state counterparts. The Medicaid file also records J9035 with $0 revenue, a data point worth flagging for follow-up rather than assuming material Medicaid drug revenue.
Office evaluation-and-management and new-patient visit codes are present but represent a small share of revenue; 99213 (2.3% of Medicare revenue) and 99203 (0.5% of Medicare revenue) are both flagged as extreme outlier ranks nationally (100th percentile), implying high patient throughput for follow-up and new-patient visits that accompanies the injection-focused practice. This pattern supports a clinic workflow built around frequent, procedure-driven encounters rather than a broad mix of nonprocedural ophthalmology.
The provider has long tenure on file, with NPI enumeration dated 2006-06-28 (~20 years ago), which supports interpretation of the observed volume as an established practice rather than a short-term anomaly. Longevity combined with extreme national rankings for key codes suggests sustained high-volume operations rather than a recent spike.
Operational risk and strategic implications follow from the concentration: reliance on a single high-cost drug/procedure set (J0178 representing 82.2% of Medicare revenue and the top-3 Medicare codes accounting for 90.6%) creates sensitivity to drug pricing, payer policy changes, and utilization review focused on intravitreal injections. Analysts should prioritize monitoring of J0178 utilization, reimbursement trends, and adherence to payer-specific coverage rules given how heavily the practice’s revenue depends on that code.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
21 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 6,440 | $690 | $4.4M |
| 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. | 3,540 | $90 | $300.7K |
| J2778 | Injection, ranibizumab, 0.1 mg | 840 | $180 | $150.4K |
| 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. | 5,250 | $20 | $126K |
| 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… | 2,120 | $60 | $123K |
| J7999 | Compounded drug, not otherwise classified | 700 | $70 | $47.1K |
| J2777 | Injection, faricimab‑svoa, 0.1 mg | 1,620 | $30 | $47K |
| Q5124 | Injection, ranibizumab-nuna, biosimilar, (byooviz), 0.1 mg | 220 | $170 | $36.5K |
| 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… | 370 | $80 | $27.6K |
| 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. | 40 | $600 | $21K |
Showing 1–10 of 21
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 21 CPT/HCPCS codes.
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Full comparison — all codes billed, vs. state median
21 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J2778 | 6 | 10 | 1,300 | $180 | $1.3M |
| J0178 | 2 | 20 | 670 | $680 | $990.1K |
| J2777 | 12 | 10 | 8,460 | $30 | $325.2K |
| 67028 | 2 | 30 | 600 | $80 | $107K |
| J7999 | 3 | 10 | 150 | $150 | $64.6K |
| Q5124 | 3 | 10 | 320 | $170 | $62.5K |
| 67041 | 8 | 10 | 20 | $1,090 | $35.9K |
| 67036 | 4 | 10 | 20 | $890 | $25.7K |
| 92014 | 217 | 350 | 170 | $70 | $23K |
| 99214 | 2,825 | 4,110 | 170 | $70 | $21.9K |
Showing 1–10 of 21
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.
3 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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. | 150 | $30 | $5K |
| 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. | 40 | $100 | $3.9K |
| J9035 | Injection, bevacizumab, 10 mg | 60 | $0 | $0 |
How this provider's Medicaid billing volume and revenue compare to other Mississippi providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Mississippi median
3 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| J9035 | Injection, bevacizumab, 10 mg | 9 | 10 | 280 | $50 | $153.9K |
| 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 | 20 | 300 | $30 | $88.7K |
| 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. | 17 | 40 | 70 | $10 | $19.3K |
Other providers in the same ZIP code as James Brown, ranked by combined Medicare and Medicaid revenue.
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