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.

Michael Johnson (NPI 1548203185)

Field	Value
Entity Type	Individual
Organization	Michael Johnson
Address	3531 Mary Ader Ave Ste D
City	Charleston
State	SC
ZIP	29414
Taxonomy	Ophthalmology Physician
NPI Enumerated	June 13, 2006

Payer Source	Total Paid
Medicare	$3M
Medicaid	$0

Key Findings

This provider reports Total Medicare revenue of $3M and has no Medicaid billing on file, making the practice effectively single-payer (Medicare) in the claims dataset. The precomputed top-3 Medicare codes account for 81.8% of Medicare revenue, indicating a highly concentrated Medicare revenue base.

The top revenue-driving codes—J0178, Q5128, and 67028—are all intravitreal drug administration and injection procedures, which signals a retina-focused ophthalmology practice built around high-volume, office-based injectable therapies and associated procedure support. The code mix suggests day-to-day operations are dominated by anti-VEGF and other intravitreal pharmacologic treatments rather than surgical retina or general ophthalmology as the primary revenue driver.

Revenue concentration is pronounced: J0178 alone represents 61.1% of Medicare revenue and Q5128 adds 15.6%, with the three leading codes together accounting for the precomputed 81.8% share of Medicare revenue. This reliance on a small set of high-cost injectable therapy codes creates a narrow revenue profile that is sensitive to changes in drug mix, reimbursement, or utilization of those specific therapies.

Competitive standing for the top injectables is mixed: J0178 (2.6K claims, $694 avg paid/claim, $1.8M revenue) ranks #282 of 3204 providers nationally (91th percentile; typical, unremarkable volume for this code), Q5128 (2.2K claims, $214 avg paid/claim, $461.2K revenue) ranks #62 of 373 providers nationally (84th percentile; typical, unremarkable volume for this code), and 67028 (1.7K claims, $89 avg paid/claim, $149.1K revenue) ranks #614 of 4255 providers nationally (86th percentile; typical, unremarkable volume for this code). These positions indicate a solid, above-average presence on nationally tracked injectable services but not a dominant national outlier.

Imaging and monitoring services show distinctive volume: 92134 has 2.7K claims and $76.5K revenue (2.6% of Medicare revenue) and is labeled an "extreme outlier, far above typical national volume" (ranks #531 of 26868 providers nationally, 98th percentile). High retinal imaging volume is consistent with an active injection practice requiring frequent diagnostics and monitoring, and it represents an important operational complement to the drug administration revenue stream.

Office evaluation and management and ancillary ophthalmology codes are also prominent relative to peers: 99214 (793 claims, $61.1K revenue) ranks #19977 of 479517 providers nationally (96th percentile; notably above typical national volume) and 92250 (457 claims, $11.9K revenue) ranks #1415 of 25087 providers nationally (94th percentile; notably above typical national volume). These elevated percentiles indicate consistent follow-up and chronic disease management capacity supporting the high injection and imaging volumes.

J3490 (unclassified drugs) accounts for $69.1K revenue from 39 claims with a $1773 avg paid/claim and is reported at a 31th percentile national rank, which makes it a modest contributor to revenue but notable for the very high average payment per claim. The presence of unclassified drug billing at a high per-claim payment suggests occasional use of nonstandard or high-cost injectable items that are being billed outside specific HCPCS drug codes and may warrant coding review for payer contracts or utilization management.

The provider has a long tenure in the Medicare dataset, with the NPI enumerated 2006-06-13 (~20 years ago), consistent with an established referral base and mature practice workflows that would support sustained high volumes of intravitreal injections, frequent imaging, and ongoing E/M follow-up for chronic retinal conditions.

Medicare: Complete Services Breakdown

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

22 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J0178	Injection, aflibercept, 1 mg	2,600	$690	$1.8M
Q5128	Injection, ranibizumab-eqrn (cimerli), biosimilar, 0.1 mg	2,160	$210	$461.2K
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.	1,680	$90	$149.1K
J2778	Injection, ranibizumab, 0.1 mg	500	$180	$88.5K
J2781	Injection, pegcetacoplan, intravitreal, 1 mg	650	$120	$77.4K
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.	2,730	$30	$76.5K
J3490	Unclassified drugs	40	$1,770	$69.1K
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…	790	$80	$61.1K
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…	590	$70	$38.2K
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…	430	$80	$35.3K

Showing 1–10 of 22

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 22 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. South Carolina Distribution

Michael Johnson — 1 of 22 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

22 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0178	11	50	970	$690	$1.1M
J2778	22	30	1,440	$180	$337.4K
Q5128	3	10	1,150	$220	$273.3K
J2781	10	20	720	$120	$128K
67028	17	50	1,140	$90	$110.3K
J3490	39	50	70	$510	$57.7K
67042	11	30	20	$1,150	$32.3K
J9035	42	40	200	$50	$26.1K
92014	132	540	160	$80	$24.3K
99426	8	20	200	$40	$23.3K

Showing 1–10 of 22

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Eastern Maine Medical Center	ME	General Acute Care Hospital	$0	$159.3M
Eric Jablon	SC	Ophthalmology Physician	$8.9M	$0
Houlton Regional Hospital	ME	Rural Health Clinic/Center	$0	$7M
Stephen Phillips	SC	Ophthalmology Physician	$5M	$0
John Kerrison	SC	Ophthalmology Physician	$5M	$0
Charleston Neurosciences Institute	SC	Ophthalmology Physician	$0	$4.2M
Houlton Regional Hospital	ME	Critical Access Hospital	$0	$4.1M
Daniel Alfaro	SC	Ophthalmology Physician	$3.6M	$0
Houlton Regional Hospital	ME	Rural Health Clinic/Center	$0	$3.1M
Mrh Corp.	ME	Family Medicine Physician	$0	$1.9M

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
South Carolina Dept Of Mental Health Accounting Office	SC	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$65.9M
Bon Secours St. Francis Xavier Hospital Inc.	SC	General Acute Care Hospital	$0	$35.9M
Coastal Pediatric Associates, P.A.	SC	Pediatrics Physician	$0	$25M
Charleston Ent Associates, LLC	SC	Otolaryngology Physician	$0	$7.1M
Physicians Eye Surgery Center LLC	SC	Ambulatory Surgical Clinic/Center	$3.9M	$70.1K
Bon Secours St Francis Xavier Hospital, Inc.	SC	Emergency Medicine Physician	$0	$2.3M
Charleston Endoscopy Center	SC	Ambulatory Surgical Clinic/Center	$1.6M	$434.5K
Lowrey King	SC	Ophthalmology Physician	$1.3M	$0
Mona Camacci	SC	Ophthalmology Physician	$1.1M	$0
Palmetto Endoscopy Center LLC	SC	Ambulatory Surgical Clinic/Center	$684.7K	$105.5K

Michael Johnson — 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