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    v1.0.28
    OpenPayerNPI Medicare & MedicaidDavid Sappenfield
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    David Sappenfield — Billing Profile & Reimbursement Data

    NPI 1639161862 · Durham, NC · Retina Specialist (Ophthalmology) Physician

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    David Sappenfield is a retina specialist (ophthalmology) physician provider located in Durham, North Carolina. This profile covers 11 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.

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    Provider details (source: NPPES NPI Registry)

    FieldValue
    Entity TypeIndividual
    OrganizationDavid Sappenfield
    Address4102 N Roxboro St
    CityDurham
    StateNC
    ZIP27704
    TaxonomyRetina Specialist (Ophthalmology) Physician
    NPI EnumeratedAugust 15, 2005

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

    Payer SourceTotal Paid
    Medicare$512.7K
    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.

    11 rows

    CPT/HCPCS CodeDescriptionClaimsAvg PaidRevenue
    J0178Injection, aflibercept, 1 mg610$690$424.9K
    67028The 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.420$80$32.4K
    92014An 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…370$80$29.9K
    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.320$30$9.1K
    92012For 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…150$60$8.8K
    99204The provider sees a new 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 provider…30$100$2.7K
    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…30$80$2K
    99212The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,…40$30$1.4K
    99213The 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…10$60$680
    92133The provider performs computerized diagnostic imaging of the optic nerve in the posterior segment (back part) of the eye, interprets the data, and provides a report. The service may be on one or both…20$30$580

    Showing 1–10 of 11

    Medicare: Competitive Analysis & Benchmarks

    How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 11 CPT/HCPCS codes.

    View: State1 / 2

    Full comparison — all codes billed, vs. state median

    11 rows

    CPT/HCPCS CodeRankProvider CountMedian ClaimsAvg PaidAverage Revenue
    J017863100950$690$881K
    6702879120780$90$80K
    92014148880110$80$17.7K
    9921415,64518,060110$80$15.1K
    920129730080$60$8.9K
    9213413579070$30$7.5K
    9921315,94116,32070$50$7.1K
    992044,8168,43030$110$4.8K
    9213359476060$20$2.5K
    992121,1152,89030$30$2.1K

    Showing 1–10 of 11

    Nearby Providers

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

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    Emergeortho PANCOrthopaedic Surgery Physician$0$20.9M
    Private Diagnostic Clinic, PLLCNCPediatrics Physician$0$17.5M
    Sunrise Clinical Associates, PLLCNCCommunity/Behavioral Health Agency$0$16.5M
    County Of Durham Finance DeptNCLand Ambulance$2.4M$11.3M
    Rapha Healthcare Services,llcNCMulti-Specialty Clinic/Center$0$13.6M
    Php Of Nc, IncNCDevelopmentally Disabled Services Day Training Agency$0$12.7M
    Bayada Home Health, Care, Inc.NCHome Health Agency$0$11.6M
    Duke University Health System, Inc.NCGeneral Acute Care Hospital$0$11.6M
    Duke University Health System, Inc.NCParenteral & Enteral Nutrition Supplies (DME)$0$8.3M
    Duke University Health System, Inc.NCInternal Medicine Physician$0$7.6M

    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.

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    Medicare Revenue by CPT/HCPCS Code
    Claims Volume vs. North Carolina Distribution
    David Sappenfield — 0 of 11 codes billed far more than typical (above p95)
    p5–p95 (all providers)p25–p75MedianThis providerOutlier
    Rank Distribution — North Carolina