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.

Thomas Jones (NPI 1578587002)

Field	Value
Entity Type	Individual
Organization	Thomas Jones
Address	3930 Hoyt Ave
City	Everett
State	WA
ZIP	98201
Taxonomy	Ophthalmology Physician
NPI Enumerated	July 27, 2006

Payer Source	Total Paid
Medicare	$217K
Medicaid	$0

Medicare: Complete Services Breakdown

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

16 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
66984	The provider inserts an artificial lens after removing an extracapsular cataract by aspiration or use of ultrasonic waves. This procedure is done without the use of an endoscopic laser probe to…	130	$410	$54K
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…	660	$80	$53.8K
66982	The provider inserts an intraocular lens prosthesis after extracapsular cataract extraction using complex techniques and devices. He may perform this by means of an iris expansion device, providing…	30	$580	$14.6K
00142	The provider performs anesthesia services for a patient undergoing an eye lens procedure.	180	$80	$14.6K
67904	The provider repairs a drooping eyelid by tightening the levator muscle that controls eyelid movement to improve cosmetic appearance or remove the obstruction to a patient’s vision. He accesses the…	20	$680	$14.3K
66821	The provider removes the haziness from the capsule of the eye using a laser for a patient with a secondary membranous cataract.	60	$240	$14.1K
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…	210	$60	$12.7K
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…	110	$80	$8.7K
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…	90	$70	$6K
92250	Code 92250 describes the taking of fundus photographs, that is, photographs of the posterior segment of the inner aspect of the eye, to document alterations in the optic nerve head, retinal vessels,…	230	$30	$5.9K

Showing 1–10 of 16

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 16 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Washington Distribution

Thomas Jones — 0 of 16 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

16 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
66984	136	460	50	$560	$97.5K
67904	22	30	30	$600	$30.6K
66982	65	120	30	$720	$27.3K
66821	103	260	50	$230	$20.4K
92014	55	790	110	$80	$16.8K
99214	5,090	10,860	100	$80	$13.6K
92012	61	220	70	$70	$12.9K
00142	43	350	30	$80	$8.6K
99213	3,737	9,690	60	$60	$6.5K
92136	93	230	140	$20	$5.5K

Showing 1–10 of 16

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Community Health Center Of Snohomish County	WA	Dentist	$0	$112.1M
Providence Health & Services-wa	WA	General Acute Care Hospital	$0	$62.4M
Sunrise Services, Inc.	WA	Community/Behavioral Health Agency	$0	$21.4M
Optum Care Washington PLLC	WA	Multi-Specialty Clinic/Center	$0	$19.5M
North Sound Emergency Medicine PC	WA	Emergency Medicine Physician	$0	$8.7M
Catholic Community Services Western Washington	WA	Substance Use Disorder Rehabilitation Clinic/Center	$0	$7.9M
Providence Health & Services- Washington	WA	General Practice Physician	$0	$7.6M
Assured Independence, LLC	WA	Emergency Response System Companies	$0	$7M
Pioneer Human Services	WA	Substance Abuse Rehabilitation Facility	$0	$6.2M
Evergreen Recovery Centers	WA	Substance Use Disorder Rehabilitation Clinic/Center	$0	$5.9M

Thomas Jones — Billing Profile & Reimbursement Data

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Thomas Jones — Billing Profile & Reimbursement Data

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Medicare: Total Revenue Breakdown by CPT/HCPCS Code

Medicare: Complete Services Breakdown

Medicare: Competitive Analysis & Benchmarks

Nearby Providers

Frequently Asked Questions

References