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    OpenPayerNPI Medicare & MedicaidMichael Emerson
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    Michael Emerson — Billing Profile & Reimbursement Data

    NPI 1649222902 · Minneapolis, MN · Retina Specialist (Ophthalmology) Physician

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    Michael Emerson is a retina specialist (ophthalmology) physician provider located in Minneapolis, Minnesota. This profile covers 12 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
    OrganizationMichael Emerson
    Address710 E 24th St Ste 304
    CityMinneapolis
    StateMN
    ZIP55404
    TaxonomyRetina Specialist (Ophthalmology) Physician
    NPI EnumeratedMay 16, 2006

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

    Payer SourceTotal Paid
    Medicare$1.8M
    Medicaid$0

    Key Findings

    This clinician is operating as a retina-focused ophthalmologist whose billing is dominated by intravitreal anti-VEGF therapy and retina-specific procedures: the top revenue codes are J0178 (aflibercept), Q5128 (ranibizumab biosimilar), and 67028 (isolated intravitreal injection), and these three codes together account for 80.9% of the provider's Medicare revenue. Claim volumes for those codes are high (J0178: 1.3K claims; Q5128: 1.4K claims; 67028: 1.9K claims) and the average paid/claim values ($693, $216, and $96 respectively) reflect a service mix weighted toward drug reimbursement plus frequent office-based injections. This pattern is consistent with a practice focused on medical retina care rather than primarily general ophthalmology.

    Revenue concentration is pronounced: total Medicare revenue is $1.8M while the provider has no Medicaid billing on file, and the top three Medicare codes (J0178, Q5128, 67028) make up 80.9% of that Medicare revenue. That level of dependence on a small set of high-value injection codes creates focused revenue exposure to changes in anti-VEGF utilization or reimbursement policies. The absence of any Medicaid revenue means reimbursement risk is concentrated entirely within the Medicare channel.

    Payer mix is effectively single-payer Medicare: the provider reports $1.8M in lifetime Medicare revenue and none for Medicaid. For financial planning and competitive benchmarking, analysts should treat this clinician as Medicare-dependent with no observable Medicaid footprint to offset volume or pricing changes in Medicare. This also limits direct in-state Medicaid competitive comparisons because there are no Medicaid claims on file for this NPI.

    Competitive standing on the largest revenue driver is typical rather than dominant: J0178 accounts for $932.8K (53.1% of Medicare revenue) and the provider ranks #941 of 3204 providers nationally (71th percentile; typical, unremarkable volume for this code). Q5128 contributes $303.5K (17.3%) and ranks #99 of 373 (74th percentile; typical, unremarkable volume), while 67028 contributes $185.9K (10.6%) and ranks #440 of 4255 (90th percentile; typical, unremarkable volume). In short, the practice is a meaningful participant in anti-VEGF delivery but is not a national-volume outlier on its single largest drug code.

    There are notable statistical outliers in ancillary and diagnostic services that suggest above-average imaging and alternative drug use relative to peers: 92134 (retinal imaging) has 2.9K claims, $85.1K revenue and ranks #438 of 26868 providers (98th percentile; extreme outlier), and J9035 (bevacizumab) shows 1.5K claims, $80K revenue and ranks #43 of 1852 providers (98th percentile; notably above typical national volume). Additionally, 92012 (established intermediate eye exam) ranks #433 of 17177 (97th percentile; notably above typical). These high percentiles indicate the provider delivers far more retinal imaging and uses bevacizumab at notably higher rates than most peers, which could reflect practice-level protocols, patient mix, or referral patterns.

    Procedure mix also includes surgical retina work at measurable volume: 67108 (retinal detachment repair) and 67042 (vitrectomy with membrane peel) each have 25 claims and generate $23K and $21.7K respectively, indicating the practice performs a modest number of operative retinal procedures in addition to high-volume injections and imaging. This combination of office-based injections, high-volume diagnostics, and some surgical cases is characteristic of a full-service retina practice that manages both chronic medical retina diseases and occasional surgical referrals.

    The provider is long‑tenured at the NPI level—enumerated 2006-05-16 (~20 years ago)—which supports the observed sustained Medicare revenue of $1.8M and high cumulative claim volumes across retina-specific codes. Longevity plus the concentrated anti-VEGF and imaging footprint suggests established referral relationships and an entrenched clinical role in the Minneapolis, MN market, important context when assessing local competitive dynamics and capacity for absorbing volume shifts.

    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.

    12 rows

    CPT/HCPCS CodeDescriptionClaimsAvg PaidRevenue
    J0178Injection, aflibercept, 1 mg1,350$690$932.8K
    Q5128Injection, ranibizumab-eqrn (cimerli), biosimilar, 0.1 mg1,410$220$303.5K
    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.1,940$100$185.9K
    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.2,940$30$85.1K
    J9035Injection, bevacizumab, 10 mg1,460$60$80K
    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…1,050$70$69.4K
    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…460$80$37.1K
    67108The provider repairs a detached retina using heat produced by a laser beam or by freezing the tissues. He may attach a scleral buckle to simplify the passage of fluid through and behind the retina or…30$920$23K
    67042In this procedure, the provider removes vitreous humor, the gelatinous material that gives shape to the eye, using a mechanical cutting tool. He removes the internal limiting membrane of the retina…30$870$21.7K
    92004The provider performs a comprehensive level ophthalmological evaluation of a new patient and initiates a diagnostic and treatment program for one or more visits.120$110$13.4K

    Showing 1–10 of 12

    Medicare: Competitive Analysis & Benchmarks

    How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 12 CPT/HCPCS codes.

    View: State1 / 2

    Full comparison — all codes billed, vs. state median

    12 rows

    CPT/HCPCS CodeRankProvider CountMedian ClaimsAvg PaidAverage Revenue
    J01781240580$690$743.4K
    Q51289201,410$220$393.8K
    67028880420$90$64.8K
    6704251020$1,300$48K
    6710821010$1,230$34.4K
    J9035240220$50$16.9K
    9201446830100$80$11.9K
    92012420060$60$8.8K
    92134958040$30$4.8K
    992049063,34020$110$3.6K

    Showing 1–10 of 12

    Related Providers

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

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    Hennepin Healthcare System, IncMNGeneral Acute Care Hospital$420.8K$708.9M
    Hennepin CountyMNCase Manager/Care Coordinator$0$34.9M
    Vitreoretinal Surgery PLLCMNOphthalmology Physician$0$27.8M
    Hennepin Healthcare System, IncMNHome Health Agency$0$23.2M
    Hennepin Healthcare System, IncMNClinic/Center$0$12.3M
    David WilliamsMNRetina Specialist (Ophthalmology) Physician$5.5M$0
    David ParkeMNOphthalmology Physician$4.8M$0
    Sundeep DevMNOphthalmology Physician$4.5M$0
    John DaviesMNOphthalmology Physician$3.9M$0
    Polly QuiramMNOphthalmology Physician$3.7M$0

    Nearby Providers

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

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    Nu-way House IncMNSubstance Abuse Rehabilitation Facility$0$200.8M
    Childrens Health CareMNChildren's Hospital$0$100M
    Midwest Home Health Care, Inc.MNHome Health Agency$0$73.5M
    Midwest Quality Home Care, Inc.MNHome Health Agency$0$66.7M
    Regents Of The University Of MinnesotaMNFederally Qualified Health Center (FQHC)$0$55.2M
    Minnesota Professional Health Services,incMNHome Health Agency$0$51.9M
    Park Ave Center IncMNSubstance Use Disorder Rehabilitation Clinic/Center$0$50.8M
    Minnesota Quality Care, Inc.MNHome Health Agency$0$48.4M
    Direct Home Health Care, Inc.MNHome Health Agency$0$30.7M
    Aaa A-z Friendly Languages IncMNInterpreter$0$29.4M

    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. Minnesota Distribution
    Michael Emerson — 4 of 12 codes billed far more than typical (above p95)
    p5–p95 (all providers)p25–p75MedianThis providerOutlier
    Rank Distribution — Minnesota