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NPI 1568579407 · Evansville, IN · Ophthalmology Physician
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Drew Sommerville is a ophthalmology physician provider located in Evansville, Indiana. This profile covers 25 Medicare and 2 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 | Drew Sommerville |
| Address | 6149 E Columbia St |
| City | Evansville |
| State | IN |
| ZIP | 47715 |
| Taxonomy | Ophthalmology Physician |
| NPI Enumerated | August 24, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $6.6M |
| Medicaid | $10.6K |
This is a procedure‑driven ophthalmology practice heavily focused on intravitreal biologic injections and retinal diagnostics. Medicare billing is dominated by J0178 (7.8K claims, $686 avg paid/claim, $5.4M revenue, 81.9% of this provider's total Medicare revenue) and supported by high volumes of intravitreal injection code 67028 (4.3K claims, $85 avg paid/claim, $365K revenue, 5.6%). The presence of substantial 92134 imaging (4.1K claims, $30 avg paid/claim, $124K revenue) and other retina procedure codes indicates an operational model built around frequent injection visits coupled with retinal imaging follow‑up.
Revenue concentration is extreme on Medicare: the top three Medicare codes account for 90.7% of this provider's total Medicare revenue, signaling material dependence on a small set of high‑yield services. For Medicaid the top three codes account for 100.0% of this provider's total Medicaid revenue, showing virtually all Medicaid income comes from the same limited service mix (primarily 67028 at 90.9% and 92134 at 9.1% of Medicaid revenue).
Medicare dominates this provider’s payer mix by scale: total Medicare revenue is $6.6M compared with total Medicaid revenue of $10.6K, so the practice is effectively Medicare‑centric. This asymmetry implies that financial performance, utilization trends, and payer policy changes affecting Medicare‑reimbursed retinal injections and related imaging will drive overall revenue risk.
The provider is a national outlier on several injection and imaging codes. J0178 ranks #3 of 3204 providers nationally (100th percentile; extreme outlier), 67028 ranks #17 of 4255 providers nationally (100th percentile; extreme outlier), and 92134 ranks #116 of 26868 providers nationally (100th percentile; extreme outlier), indicating volumes far above typical national peers for those services.
Other injected biologics and intravitreal codes show more typical national volumes: J2777 (7.3K claims, $29 avg paid/claim, $212.3K revenue, 3.2% of Medicare revenue) ranks #1237 of 2039 (39th percentile) and J2778 (914 claims, $177 avg paid/claim, $161.8K revenue, 2.5% of Medicare revenue) ranks #465 of 1208 (62th percentile). These placements suggest the practice’s extreme concentration is specific to select drugs and services rather than across all intravitreal products.
Competitive standing in Medicaid is modest compared with Medicare dominance. For Medicaid 67028 ranks #48 of 55 in‑state (13th percentile) and 92134 ranks #63 of 84 in‑state (25th percentile), indicating the provider is not a leading Medicaid participant in these procedures within the state even though the same services drive nearly all of its Medicaid revenue.
Tenure and consistency: the provider’s NPI was enumerated on 2006-08-24 (~20 years ago), indicating a long period of presence in the market. The longevity combined with the concentrated, procedure‑heavy billing pattern supports a stable, established retinal injection clinic model rather than a newer or mixed ambulatory general ophthalmology practice.
From a payer or network strategy perspective, this profile signals that contracting or utilization management focused on high‑cost intravitreal biologics and visit frequency (J0178 and 67028) will disproportionately affect this provider’s reimbursement and referral economics. Given that J0178 alone accounts for $5.4M and 81.9% of Medicare revenue, policy levers or formularies that alter access or reimbursement for that drug would materially change the provider’s revenue base.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
25 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 7,840 | $690 | $5.4M |
| 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. | 4,290 | $90 | $365K |
| J2777 | Injection, faricimab‑svoa, 0.1 mg | 7,320 | $30 | $212.3K |
| J2778 | Injection, ranibizumab, 0.1 mg | 910 | $180 | $161.8K |
| 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. | 4,130 | $30 | $124K |
| 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… | 850 | $80 | $71.3K |
| J3590 | Unclassified biologics | 880 | $70 | $58.7K |
| J7312 | Injection, dexamethasone, intravitreal implant, 0.1 mg | 360 | $160 | $57.5K |
| 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 | $650 | $25.4K |
| 67041 | In this procedure, the provider removes scar tissue from the retinal membrane that obscures vision. He removes vitreous humor, the gelatinous material that gives shape to the eye, using a mechanical… | 30 | $860 | $22.2K |
Showing 1–10 of 25
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 25 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
25 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J0178 | 1 | 60 | 830 | $690 | $868.8K |
| J2777 | 18 | 40 | 6,750 | $30 | $395.6K |
| J2778 | 3 | 10 | 560 | $180 | $150K |
| 67028 | 1 | 80 | 550 | $80 | $78.6K |
| J7312 | 2 | 10 | 280 | $160 | $47.7K |
| 67042 | 12 | 20 | 20 | $1,310 | $47K |
| 67036 | 4 | 10 | 30 | $1,040 | $37.4K |
| 67108 | 5 | 20 | 20 | $1,150 | $32.2K |
| J3590 | 6 | 50 | 220 | $60 | $24.5K |
| 67041 | 3 | 10 | 20 | $1,000 | $22K |
Showing 1–10 of 25
Medicaid revenue breakdown by year and by CPT/HCPCS procedure code, including monthly billing trends and the top codes driving revenue.
View: By Year1 / 3
Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.
2 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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. | 70 | $150 | $9.6K |
| 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. | 80 | $10 | $960 |
How this provider's Medicaid billing volume and revenue compare to other Indiana providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Indiana median
2 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 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. | 48 | 60 | 1,260 | $50 | $108.4K |
| 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. | 63 | 80 | 680 | $20 | $34.5K |
Other providers in the same ZIP code as Drew Sommerville, ranked by combined Medicare and Medicaid revenue.
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