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

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

Paul Griggs (NPI 1578584264)

Field	Value
Entity Type	Individual
Organization	Paul Griggs
Address	332 Ne Northgate Way
City	Seattle
State	WA
ZIP	98125
Taxonomy	Ophthalmology Physician
NPI Enumerated	July 21, 2006

Payer Source	Total Paid
Medicare	$2.2M
Medicaid	$0

Key Findings

PAUL GRIGGS is an ophthalmology physician based in SEATTLE, WA with an NPI enumerated on 2006-07-21 (~20 years ago) and lifetime Medicare revenue reported at $2.2M. The tenure (NPI ~20 years ago) indicates an established billing history in Medicare, and the recorded revenue scale positions Medicare as the material payer for this clinician's practice.

The provider's revenue profile is highly concentrated in intravitreal therapeutics and related drug administration codes: J2777 ($849.1K revenue, 37.9% of Medicare revenue), J0178 ($485.8K revenue, 21.7% of Medicare revenue), and J3490 ($198K revenue, 8.8% of Medicare revenue). This code mix — high-dollar biologic drug codes plus eye injection procedure 67028 — is consistent with a retina-focused practice model that delivers frequent injection therapy as a primary service line.

Top-3 concentration is pronounced: the precomputed top three Medicare codes account for 68.4% of this provider's total Medicare revenue. Such concentration means a large share of the practice's Medicare income is driven by a few injectable drug codes, which can make overall revenue sensitive to changes in drug use patterns or reimbursement for those specific HCPCS entries.

Payer mix is effectively single-payer Medicare: lifetime Medicare revenue is $2.2M and there is no Medicaid billing on file. The absence of any Medicaid claims indicates limited diversification of public-payer exposure and suggests the provider either does not participate in Medicaid or does not serve a Medicaid population at scale.

Competitive standing by code is mixed: J2777 ranks #310 of 2039 nationally (85th percentile; typical, unremarkable volume for this code), indicating above-average national activity for that faricimab entry but still described as typical in the dataset. By contrast J0178 ranks #1631 of 3204 (49th percentile; typical, unremarkable volume) and J3490 ranks #616 of 2838 (78th percentile; typical, unremarkable volume), so the provider is a stronger-than-average participant on some biologic codes and middling on others rather than a consistent national outlier across all drug lines.

Procedure and imaging volumes show patterns of a high-throughput outpatient retinal practice: 67028 appears with 1.5K claims ($178.3K revenue, 8.0%), 92134 has 1.5K claims ($48.7K revenue, 2.2%), and 92014 reports 1.6K claims ($148.6K revenue, 6.6%) where 92014 is flagged as an extreme outlier (ranks #535 of 35415 providers nationally, 98th percentile). The very high claim volumes and extreme/ notable percentiles on evaluation and imaging codes point to substantial clinic visit and diagnostic throughput beyond typical levels for many peers.

Specific imaging and diagnostic codes are also outlier-level relative to peers: 92250 (980 claims, $28.4K revenue, 1.3%) is labeled an extreme outlier (99th percentile) and 92012 (841 claims, $64.8K revenue, 2.9%) is notably above typical volume (96th percentile). These high percentiles for fundus photography and established patient exams reinforce that the practice performs frequent monitoring and documentation, likely to support ongoing intravitreal treatment regimens.

Operational implications: the heavy reliance on a few drug codes (top 3 = 68.4% of Medicare revenue) combined with no Medicaid billing on file suggests revenue vulnerability to shifts in therapeutic utilization, payer coverage, or reimbursement policies affecting those specific J-codes. Given the provider's long NPI tenure (2006-07-21, ~20 years ago) and the high volumes on both injections and imaging, analysts should treat this as an established, retina-centered outpatient practice with concentrated Medicare exposure rather than a diversified multi-payer practice.

Medicare: Complete Services Breakdown

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

17 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J2777	Injection, faricimab‑svoa, 0.1 mg	29,280	$30	$849.1K
J0178	Injection, aflibercept, 1 mg	700	$690	$485.8K
J3490	Unclassified drugs	120	$1,640	$198K
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.	1,490	$120	$178.3K
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…	1,580	$90	$148.6K
J7999	Compounded drug, not otherwise classified	1,010	$70	$75K
92242	The provider injects two different special dyes into one or both eyes that cause the blood vessels to stand out in photographic images timed so that multiple frames are taken in rapid succession. He…	290	$240	$68.7K
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…	840	$80	$64.8K
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.	1,480	$30	$48.7K
J7312	Injection, dexamethasone, intravitreal implant, 0.1 mg	270	$160	$43.4K

Showing 1–10 of 17

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 17 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Washington Distribution

Paul Griggs — 4 of 17 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Washington

Full comparison — all codes billed, vs. state median

17 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J2777	15	50	12,780	$30	$599.7K
J0178	38	90	470	$680	$597.2K
67028	23	110	550	$90	$72.9K
J3490	17	70	70	$50	$51.2K
J7312	7	20	270	$160	$46K
66821	119	260	50	$230	$20.4K
92242	2	20	50	$210	$19.7K
92014	2	790	110	$80	$16.8K
J7999	2	70	150	$70	$15.9K
92012	11	220	70	$70	$12.9K

Showing 1–10 of 17

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Sight Partners	WA	Ambulatory Surgical Clinic/Center	$4.9M	$342.1K
David Spinak	WA	Ophthalmology Physician	$4.1M	$0
Steve Kim	WA	Ophthalmology Physician	$3.4M	$20
David Saperstein	WA	Ophthalmology Physician	$3.3M	$100
Adrian Omalley	WA	Ophthalmology Physician	$3M	$0
Andrew Barloon	WA	Ophthalmology Physician	$2.7M	$20
Charles Birnbach	WA	Ophthalmology Physician	$2.4M	$0
Todd Schneiderman	WA	Ophthalmology Physician	$2.3M	$0
Brenda Myers Powell	WA	Retina Specialist (Ophthalmology) Physician	$2.2M	$0
Todd Klesert	WA	Ophthalmology Physician	$2.1M	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Professional Medical Corp	WA	Durable Medical Equipment & Medical Supplies	$0	$18.6M
Jeremy Storm	WA	Internal Medicine Physician	$323K	$0
Thu Nguyen	WA	Nurse Practitioner	$164.3K	$0
Emily Hilderman	WA	Adult Health Nurse Practitioner	$79.9K	$0
Wensi Sun	WA	Ophthalmology Physician	$61.1K	$0
Rion Berg	WA	Podiatrist	$51.5K	$0
Wonsuk Kim	WA	Diagnostic Radiology Physician	$34K	$230

Paul Griggs — 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