Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • NPI Medicare & Medicaid
    • Healthcare Providers
    • Health Insurance Payers
    • States
    • Service Lines
    • Taxonomy Codes
    Lookup tools
    • Billing Code Lookup
    • CPT Modifier Lookup
    • Provider Taxonomy Code Lookup
    • Healthcare Provider & Facility Lookup
    • Health Insurance Payer Lookup
    • Payer Contact Directory

    Policy & Benchmark Tools

    • Prior Authorization Lookup
    • Coverage Criteria Lookup
    • Timely Filing Lookup
    • Billing Code Reimbursement Rates
    • Payer Comparison Dashboard
    • Facility Comparison Dashboard
    • All tools

    Company

    • About OpenPayer
    • Data Sources
    • Trek Health
    OpenPayerby Trek Health
    LinkedInYouTube

    © 2026 Trek Health. All rights reserved.

    OpenPayer is built and maintained by Trek Health.

    v1.0.28
    OpenPayerNPI Medicare & MedicaidCarol Shields
    Ask Trek AI about this page

    Carol Shields — Billing Profile & Reimbursement Data

    NPI 1578652988 · Philadelphia, PA · Ophthalmology Physician

    Customize your policy alerts

    Sign up for Carol Shields — Billing Profile & Reimbursement Data policy alerts

    Get alerted when relevant policies change without checking for updates manually.

    Monitor payer policy activity

    Receive email alerts as soon as relevant payer policies are published or updated.

    Carol Shields is a ophthalmology physician provider located in Philadelphia, Pennsylvania. This profile covers 38 Medicare and 0 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.

    Table of contents

    Progress1 / 8

    Explore openpayer tools

    • Billing CodesCPT, HCPCS, DRG & more
    • Reimbursement RatesCommercial vs. Medicare rate reports
    • ProvidersHospitals & facilities
    • PayersPlans & market footprint
    • Taxonomy CodesNUCC specialty codes
    • ModifiersCPT modifiers & usage
    • Prior AuthorizationPA policies by payer & drug
    • Timely FilingFiling deadlines by payer
    • Coverage CriteriaMedical necessity by payer
    • Payer ContactsClaims, PA & appeals contacts
    View all tools

    Provider details (source: NPPES NPI Registry)

    FieldValue
    Entity TypeIndividual
    OrganizationCarol Shields
    Address840 Walnut Street
    CityPhiladelphia
    StatePA
    ZIP19107
    TaxonomyOphthalmology Physician
    NPI EnumeratedOctober 12, 2006

    Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)

    Payer SourceTotal Paid
    Medicare$486.9K
    Medicaid$0

    Medicare: Total Revenue Breakdown by CPT/HCPCS Code

    Medicare revenue breakdown by CPT/HCPCS procedure code.

    View: Bar Chart1 / 2

    Medicare: Complete Services Breakdown

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

    38 rows

    CPT/HCPCS CodeDescriptionClaimsAvg PaidRevenue
    67218In this procedure, the provider temporarily implants a radio therapeutic source within the eye to treat a cancerous lesion within the retina. After four to five days, he removes the source.60$1,130$68.7K
    76510The provider uses B–scan and quantitative A–scan ultrasound imaging to examine the intraocular and orbital structures.900$50$47.8K
    99215The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the…320$140$44.3K
    92134The 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.1,180$30$36.5K
    92250Code 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,…1,200$30$35.9K
    99205The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the provider…140$180$25.2K
    99214The 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…240$80$20K
    67210The provider destroys a lesion of the retina using a laser beam that heats up the tissue.50$400$19.9K
    68320The provider performs a surgical repair of the conjunctiva using the patient’s own conjunctival tissue as a graft or by rearranging the existing tissue. This procedure is done to treat a condition…80$220$18.4K
    65286In this procedure, the provider uses a special glue to repair lacerations, or tears in the cornea, the front portion of the eye that focuses light on the lens, and or the sclera, the white of the eye.80$210$16.6K

    Showing 1–10 of 38

    Medicare: Competitive Analysis & Benchmarks

    How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 38 CPT/HCPCS codes.

    View: State1 / 2

    Full comparison — all codes billed, vs. state median

    38 rows

    CPT/HCPCS CodeRankProvider CountMedian ClaimsAvg PaidAverage Revenue
    67028179180600$90$87.5K
    6721811060$1,130$68.7K
    76510110690$50$36.7K
    6580021030$100$26.1K
    6740021010$890$16.1K
    6721073030$370$16K
    992145,60423,230100$80$14.5K
    9224211060$220$13.3K
    2101521030$530$13.1K
    6528611060$220$12K

    Showing 1–10 of 38

    Related Providers

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

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    Sara LallyPAOphthalmology Physician$281.8K$0
    Prashant YadavMAOphthalmology Physician$24.5K$0

    Nearby Providers

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

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    Quality ProgressionsPACase Management Agency$0$50.8M
    Bright Beginnings Therapeutic Services, LLCPACommunity/Behavioral Health Agency$0$46.8M
    Thomas Jefferson University Hospitals IncPAGeneral Acute Care Hospital$0$40.3M
    Jefferson University PhysiciansPAGeneral Practice Physician$0$30.8M
    The Pennsylvania Hospital Of The University Of Pennsylvania Health SysPAGeneral Acute Care Hospital$0$25.7M
    Philadelphia Mental Health ClinicPAClinic/Center$0$18.3M
    Philadelphia FightPAFederally Qualified Health Center (FQHC)$0$18.1M
    Public Health Mangement CorporationPAFederally Qualified Health Center (FQHC)$0$9.3M
    Addiction Medicine And Health Advocates, IncorporatedPAMethadone Clinic$56.9K$9.2M
    Assessment & Treatment AlternativesPACommunity/Behavioral Health Agency$0$9.1M

    Frequently Asked Questions

    References

    1. 1.Medicare Physician & Other Practitioner by Provider and Service. CMS.gov.Provider-level Medicare Part B utilization and payment data.
    2. 2.NPPES NPI Registry. CMS.gov.National Provider Identifier registry used for provider enumeration and taxonomy metadata.

    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

    Medicare Revenue by CPT/HCPCS Code
    Claims Volume vs. Pennsylvania Distribution
    Carol Shields — 10 of 25 codes billed far more than typical (above p95)
    p5–p95 (all providers)p25–p75MedianThis providerOutlier
    Rank Distribution — Pennsylvania