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

Why is the Medicaid comparison limited to South Carolina 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. South Carolina (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.

John Payne (NPI 1528143021)

Field	Value
Entity Type	Individual
Organization	John Payne
Address	124 Sunset Court
City	West Columbia
State	SC
ZIP	29169
Taxonomy	Ophthalmology Physician
NPI Enumerated	October 25, 2006

Payer Source	Total Paid
Medicare	$4M
Medicaid	$0

Key Findings

This provider reports $4M in lifetime Medicare revenue and has no Medicaid billing on file, so the practice is effectively single‑payer in the claims data provided. The absence of any Medicaid claims suggests limited exposure to state program reimbursement dynamics and indicates Medicare beneficiaries drive the entirety of recorded public-payer volume for this NPI.

Revenue is highly concentrated in a small set of retinal drug codes: the precomputed top 3 Medicare codes account for 87.3% of this provider’s total Medicare revenue, led by J0178 at $2.9M (71.9% of Medicare revenue). This concentration means most of the provider’s public-payer revenue is dependent on a few high-value intravitreal therapies rather than a broad mix of office‑based E/M or surgical procedures.

The code mix and descriptions point to a retina-focused ophthalmology practice centered on intravitreal anti‑VEGF therapy and associated diagnostic imaging. The top-selling codes — J0178 (aflibercept), J2777 (faricimab-svoa), and J2778 (ranibizumab) — are injectable retinal pharmaceuticals, and high counts of injection and imaging CPTs indicate ongoing, chronic-treatment workflows typical of neovascular AMD and diabetic macular edema management.

Procedure and diagnostic claim volumes underline a high-throughput injection and imaging operation: 92134 appears with 2.9K claims and $80.1K revenue and is labeled an "extreme outlier" (ranks #464 of 26868 providers nationally, 98th percentile), while 67028 appears with 2.1K claims and $200.1K revenue and is "notably above typical national volume" (ranks #334 of 4255 providers nationally, 92th percentile). These volumes are consistent with frequent retinal injections supported by substantial OCT/retinal imaging capacity and separate intravitreal injection billing.

Competitive standing varies by code: the provider ranks highly on aflibercept use (J0178 ranks #55 of 3204 nationally, 98th percentile and described as "notably above typical national volume"), indicating a major national presence for that product; by contrast, J2777 (ranks #893 of 2039, 56th percentile) and J2778 (ranks #285 of 1208, 76th percentile) are in more typical national volume bands. This pattern suggests leadership in aflibercept utilization specifically, while participation in other retinal drug markets is moderate.

Reimbursement mix shows both high-dollar and low-dollar items driving revenue: J0178 carries an average paid/claim of $690, J2778 averages $182 paid/claim, and J2777 averages $29 paid/claim. The combination of a high average paid per J0178 claim and large claim volume explains why a single drug code dominates revenue, making the practice sensitive to drug‑specific utilization and pricing shifts.

Operationally, the provider’s long tenure (NPI enumerated 2006-10-25, ~20 years ago) is consistent with an established retinal practice capable of maintaining a chronic-treatment patient panel. That longevity, combined with the concentrated revenue mix and documented high procedure volumes, suggests a stable, procedure-driven business model focused on ongoing intravitreal therapy.

From a strategic and risk perspective, heavy dependence on one therapeutic code (J0178 at $2.9M) and the lack of Medicaid billing constrains diversification of payer risk and could amplify the financial impact of changes in drug utilization patterns, reimbursement, or guideline shifts. For payers and contracting teams, this profile signals a high-volume Medicare retina provider whose reimbursement sensitivity will be concentrated around intravitreal drug pricing and access rather than broad-based outpatient E/M or surgical case mix.

Medicare: Complete Services Breakdown

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

14 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J0178	Injection, aflibercept, 1 mg	4,200	$690	$2.9M
J2777	Injection, faricimab‑svoa, 0.1 mg	11,700	$30	$339.3K
J2778	Injection, ranibizumab, 0.1 mg	1,550	$180	$281.6K
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.	2,130	$90	$200.1K
Q5128	Injection, ranibizumab-eqrn (cimerli), biosimilar, 0.1 mg	520	$220	$112.8K
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.	2,860	$30	$80.1K
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…	690	$60	$42.8K
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…	530	$80	$42.1K
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…	150	$110	$16.9K
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…	10	$860	$12.1K

Showing 1–10 of 14

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 14 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. South Carolina Distribution

John Payne — 2 of 14 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — South Carolina

Full comparison — all codes billed, vs. state median

14 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0178	3	50	970	$690	$1.1M
J2777	22	40	15,960	$30	$594.7K
J2778	13	30	1,440	$180	$337.4K
Q5128	12	10	1,150	$220	$273.3K
67028	11	50	1,140	$90	$110.3K
67042	19	30	20	$1,150	$32.3K
J9035	36	40	200	$50	$26.1K
92014	112	540	160	$80	$24.3K
92012	17	240	110	$60	$14.2K
92235	21	30	50	$100	$11K

Showing 1–10 of 14

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Palmetto Retina Center LLC	SC	Ophthalmology Physician	$0	$10.6M
John Wells	SC	Ophthalmology Physician	$3.9M	$0
Joshua Robinson	MI	Ophthalmology Physician	$3.7M	$0
William Clark	SC	Ophthalmology Physician	$3.3M	$0
Barron Fishburne	SC	Retina Specialist (Ophthalmology) Physician	$3.3M	$0
Jeffrey Gross	SC	Retina Specialist (Ophthalmology) Physician	$3M	$0
David Johnson	SC	Retina Specialist (Ophthalmology) Physician	$3M	$0
Oksana Demediuk	GA	Retina Specialist (Ophthalmology) Physician	$2.9M	$0
Daniel Will	SC	Retina Specialist (Ophthalmology) Physician	$2.8M	$0
Eugene Long	GA	Hematology & Oncology Physician	$1.9M	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Palmetto Infusion Services LLC	SC	Infusion Therapy Clinic/Center	$0	$93.6M
Lexington Health Inc	SC	General Acute Care Hospital	$0	$27.4M
Lexington County Health Services District Inc	SC	General Acute Care Hospital	$0	$19.2M
United Cerebral Palsy Of South Carolina, Inc	SC	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$15.7M
Lexington Health Inc	SC	Emergency Medicine Physician	$0	$4.2M
Karen Park Family Dentistry, P.A.	SC	Dentist	$0	$4.2M
Lexington County Health Serv	SC	General Acute Care Hospital	$0	$4M
Steven Madden	SC	Hematology & Oncology Physician	$4M	$0
Lexington Treatment Specialists LLC	SC	Methadone Clinic	$76.7K	$3.6M
Lexington Health Inc	SC	Obstetrics & Gynecology Physician	$0	$3.5M

John Payne — Billing Profile & Reimbursement Data

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John Payne — 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