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    OpenPayerNPI Medicare & MedicaidLeo Santamarina
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    Leo Santamarina — Billing Profile & Reimbursement Data

    NPI 1659339646 · Sellersville, PA · Ophthalmology Physician

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    Leo Santamarina is a ophthalmology physician provider located in Sellersville, Pennsylvania. This profile covers 16 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
    OrganizationLeo Santamarina
    Address711 Lawn Ave Ste 3
    CitySellersville
    StatePA
    ZIP18960
    TaxonomyOphthalmology Physician
    NPI EnumeratedMay 2, 2006

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

    Payer SourceTotal Paid
    Medicare$2.4M
    Medicaid$0

    Key Findings

    This provider is effectively single-payer in the dataset: Total Medicare revenue is $2.4M while there is no Medicaid billing on file. The practice’s revenue and utilization analysis should therefore be interpreted as Medicare-dominant rather than balanced across public payers.

    Revenue is highly concentrated in three injectable drug codes: J2777 ($1.1M, 46.5%), J0178 ($817.7K, 33.9%), and J2778 ($141.2K, 5.9%), which together account for 86.3% of the provider's total Medicare revenue per the precomputed top-3 share. This concentration indicates that a small set of intravitreal drug administrations drives the overwhelming majority of Medicare dollars for this NPI.

    The mix of top codes (J2777, J0178, J2778) and procedural codes such as 67028 suggests an operation centered on retina-focused, office-based intravitreal injections and related retinal procedures. These code descriptions point to routine anti-VEGF and newer biologic injections as the core clinical service line rather than broad general ophthalmology procedures.

    J2777 shows very high claim volume (38.7K claims) with a low average paid/claim ($29) and $1.1M in revenue; it ranks #175 of 2039 providers nationally (91th percentile) and is characterized in the source as "typical, unremarkable volume for this code." The combination of very large claim counts and low per-claim payment suggests billing tied to small unit increments or frequent administrations, making J2777 the single largest Medicare revenue driver for this provider by both claims and dollars.

    J0178 and J2778 are also major revenue contributors but are described as more modest nationally: J0178 appears as $817.7K revenue from 1.2K claims and ranks #1094 of 3204 (66th percentile; "typical, unremarkable volume for this code"), while J2778 is $141.2K from 780 claims and ranks #527 of 1208 (56th percentile; "typical, unremarkable volume for this code"). These rankings position the provider as a solid regional participant in aflibercept and ranibizumab administration but not an outsized national leader across those agents.

    The provider records notably above-typical utilization in certain diagnostic and evaluation codes that support an injection practice: 92134 has 1.8K claims, $60.1K revenue (2.5% of Medicare revenue) and ranks #1199 of 26868 providers (96th percentile; "notably above typical national volume"). Likewise, 99214 (688 claims, $65.4K revenue, 2.7% of Medicare revenue) ranks #27112 of 479517 providers (94th percentile; "notably above typical national volume"). These elevated percentiles for retinal imaging and established-patient E&M suggest frequent follow-up and monitoring consistent with ongoing intravitreal therapy.

    Clinical breadth beyond injections appears limited in revenue share: general ophthalmology new-patient codes (92004, 99204) and other procedure codes appear at much lower dollar volumes (e.g., 92004 $2.3K, 99204 $3.2K) and lower national ranks. This pattern reinforces that the practice's economic model is focused on recurring treatment administration and monitoring rather than a large volume of comprehensive new-patient evaluations.

    The NPI has long tenure in the dataset (enumerated 2006-05-02, ~20 years ago), indicating an established practice presence in SELLERSVILLE, PA. Tenure combined with the concentrated injection revenue stream suggests a stable, procedure-driven operation likely focused on retina care within the Medicare population.

    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.

    16 rows

    CPT/HCPCS CodeDescriptionClaimsAvg PaidRevenue
    J2777Injection, faricimab‑svoa, 0.1 mg38,700$30$1.1M
    J0178Injection, aflibercept, 1 mg1,200$680$817.7K
    J2778Injection, ranibizumab, 0.1 mg780$180$141.2K
    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.1,420$90$127.7K
    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…690$100$65.4K
    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.1,820$30$60.1K
    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…560$90$50.6K
    92235The provider uses a special dye, fluorescein that causes the blood vessels in the one or both eyes to stand out in photographic images taken with the use of multiframe timing, or serial images, taken…80$110$9K
    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,…180$30$5.5K
    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$110$3.2K

    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

    Full comparison — all codes billed, vs. state median

    16 rows

    CPT/HCPCS CodeRankProvider CountMedian ClaimsAvg PaidAverage Revenue
    J017857140830$690$865.1K
    J277841701,030$190$417.1K
    J277751007,950$30$360.2K
    6702844180600$90$87.5K
    920141991,570130$80$21K
    9921482023,230100$80$14.5K
    92235157040$100$10K
    92134511,32060$30$8.4K
    9921318,29822,37070$60$7.7K
    992045,34510,29030$110$5K

    Showing 1–10 of 16

    Related Providers

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

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    Randall PeairsPAOphthalmology Physician$5.6M$13.5K
    Carl ParkPAOphthalmology Physician$5.5M$0
    Daniel WillSCRetina Specialist (Ophthalmology) Physician$2.8M$0
    Erik KrugerPAOphthalmology Physician$2.4M$11.8K
    Ravi PatelNJRetina Specialist (Ophthalmology) Physician$1.7M$84.4K
    Anthony AndrewsPAOphthalmology Physician$1.3M$100
    Mark GroholPAOptometrist$221.5K$697.4K
    Bradford SgrignoliPARetina Specialist (Ophthalmology) Physician$669.8K$15.9K
    Neal AdamsMDOphthalmology Physician$497.9K$5.3K
    Thomas BolandPAOphthalmology Physician$457.5K$0

    Nearby Providers

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

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    Bayada Home Health Care, Inc.PAHome Health Agency$0$19.6M
    Penn Foundation IncPACommunity/Behavioral Health Agency$0$8.3M
    Penn Foundation, Inc.PACommunity/Behavioral Health Agency$0$6.1M
    Daniel ShragerPADermatology Physician$3.4M$0
    James SpearsPAHematology & Oncology Physician$2.1M$0
    Sarah GoodyearPAHematology & Oncology Physician$1.6M$0
    Mitchell AldenPAHematology & Oncology Physician$1.5M$0
    Anthony MagdalinskiPAHematology & Oncology Physician$1.3M$0
    Martin HightowerPARadiation Oncology Physician$961.4K$0
    The Endoscopy Center LLCPAClinic/Center$886.5K$3.8K

    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
    Leo Santamarina — 3 of 16 codes billed far more than typical (above p95)
    p5–p95 (all providers)p25–p75MedianThis providerOutlier
    Rank Distribution — Pennsylvania